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Mou T, Shinnick J, DeAndrade S, Roselli N, Andebrhan S, Akanbi T, Ackenbom M, Carter-Brooks C, Beestrum M, Cichowski S, Brown O. Disparities Research for Pelvic Floor Disorders: A Systematic Review and Critique of Literature. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024:02273501-990000000-00180. [PMID: 38465998 DOI: 10.1097/spv.0000000000001469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
IMPORTANCE Understanding the status of pelvic floor disorder (PFD) disparities research will allow the opportunity to advance future pelvic floor equity efforts. OBJECTIVES The aims of the study were to (1) characterize the landscape of PFD disparities literature using the 3 phases of disparities research framework, (2) describe the characteristics of PFD disparities studies, and (3) identify critical knowledge gaps. STUDY DESIGN We performed a systematic review of peer-reviewed publications addressing disparities in PFDs among U.S. populations from PubMed, Embase, Scopus, or the Cochrane Database indexed between 1997 and 2022. Using the triphasic framework for advancing health disparities research by Kilbourne et al (Am J Public Health. 2006;96(12):2113-21), we categorized the included studies into the detecting phase (identifies and measures disparities in historically marginalized populations), understanding phase (establishes disparity determinants), or reducing phase (conducts interventions to alleviate inequities). All screening, coding, and quality reviews were independently performed by at least 2 authors. We used descriptive analysis and the χ2 test for comparisons. RESULTS The initial search identified 10,178 studies, of which 123 were included. Of the included studies, 98 (79.7%), 22 (17.9%), and 3 (2.4%) studies were detecting, understanding, and reducing phase research, respectively. The most common disparity category investigated was race and ethnicity (104 studies), and one third of these studies attributed drivers of racial and ethnic differences to structural influences. Publications of detecting phase studies outpaced the growth of understanding and reducing phase research. CONCLUSIONS Most PFD disparities research focused on identifying historically marginalized populations with inadequate progression to understanding and reducing phases. We recommend progressing PFD disparities research beyond the detecting phase to advance health equity in PFD care.
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Affiliation(s)
- Tsung Mou
- From the Division of Urogynecology and Reconstructive Pelvic Surgery, Tufts Medical Center, Boston, MA
| | - Julia Shinnick
- Division of Urogynecology and Reconstructive Pelvic Surgery, Women and Infants Hospital, Providence, RI
| | - Samantha DeAndrade
- Division of Female Pelvic Medicine and Reconstructive Surgery, Harbor UCLA, Torrance, CA
| | - Nicole Roselli
- Division of Female Pelvic Medicine and Reconstructive Surgery, Bellevue Hospital/NYU Langone Medical Center, New York, NY
| | - Sarah Andebrhan
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL
| | - Tracey Akanbi
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA
| | - Mary Ackenbom
- Magee-Women's Research Institute, University of Pittsburgh, Pittsburgh, PA
| | | | - Molly Beestrum
- Research and Information Services, Northwestern University, Chicago, IL
| | - Sara Cichowski
- Division of Urogynecology and Reconstructive Pelvic Surgery, Oregon Health and Science University, Portland, OR
| | - Oluwateniola Brown
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, IL
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Jennings AM, Cox DJ. Starting the Conversation Around the Ethical Use of Artificial Intelligence in Applied Behavior Analysis. Behav Anal Pract 2024; 17:107-122. [PMID: 38405299 PMCID: PMC10891004 DOI: 10.1007/s40617-023-00868-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 02/27/2024] Open
Abstract
Artificial intelligence (AI) is increasingly a part of our everyday lives. Though much AI work in healthcare has been outside of applied behavior analysis (ABA), researchers within ABA have begun to demonstrate many different ways that AI might improve the delivery of ABA services. Though AI offers many exciting advances, absent from the behavior analytic literature thus far is conversation around ethical considerations when developing, building, and deploying AI technologies. Further, though AI is already in the process of coming to ABA, it is unknown the extent to which behavior analytic practitioners are familiar (and comfortable) with the use of AI in ABA. The purpose of this article is twofold. First, to describe how existing ethical publications (e.g., BACB Code of Ethics) do and do not speak to the unique ethical concerns with deploying AI in everyday, ABA service delivery settings. Second, to raise questions for consideration that might inform future ethical guidelines when developing and using AI in ABA service delivery. In total, we hope this article sparks proactive dialog around the ethical use of AI in ABA before the field is required to have a reactionary conversation.
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Affiliation(s)
- Adrienne M. Jennings
- Department of Behavioral Science, Daemen University, 4380 Main Street, Amherst, NY 14226 USA
| | - David J. Cox
- Institute for Applied Behavioral Science, Endicott College, Beverly, MA USA
- RethinkFirst, 49 W 27th St, 8th floor, New York, NY 10001 USA
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Ransome Y, Valido AD, Espelage DL, Clements GL, Harrell C, Eckel C, Price N, Nassau R, Nyhan K, Taggart TL. A systematic review of how social connectedness influences associations between racism and discrimination on health outcomes. Epidemiol Rev 2023; 45:44-62. [PMID: 37477041 DOI: 10.1093/epirev/mxad009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 06/12/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023] Open
Abstract
Racial discrimination is a well-known risk factor of racial disparities in health. Although progress has been made in identifying multiple levels through which racism and racial discrimination influences health, less is known about social factors that may buffer racism's associations with health. We conducted a systematic review of the literature with a specific focus on social connectedness, racism, and health, retrieving studies conducted in the United States and published between January 1, 2012, and July 30, 2022, in peer-reviewed journals. Of the 787 articles screened, 32 were selected for full-text synthesis. Most studies (72%) were at the individual level, cross-sectional, and among community/neighborhood, school, or university samples. Studies had good methodological rigor and low risk of bias. Measures of racism and racial discrimination varied. Discrimination scales included unfair treatment because of race, schedule of racist events, experiences of lifetime discrimination, and everyday discrimination. Measures of social connectedness (or disconnectedness) varied. Social-connectedness constructs included social isolation, loneliness, and social support. Mental health was the most frequently examined outcome (75%). Effect modification was used in 56% of studies and mediation in 34% of studies. In 81% of studies, at least 1 aspect of social connectedness significantly buffered or mediated the associations between racism and health. Negative health associations were often weaker among people with higher social connectedness. Social connectedness is an important buffering mechanism to mitigate the associations between racial discrimination and health. In future studies, harmonizing metrics of social connectedness and racial discrimination can strengthen causal claims to inform interventions.
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Affiliation(s)
- Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06510, United States
| | - Alberto D Valido
- School of Education, Applied Developmental Sciences and Special Education, Human Development and Family Science, School Psychology, University of North Carolina Chapel Hill, Chapel Hill, NC 27514, United States
| | - Dorothy L Espelage
- School of Education, Applied Developmental Sciences and Special Education, Human Development and Family Science, School Psychology, University of North Carolina Chapel Hill, Chapel Hill, NC 27514, United States
| | - Graceson L Clements
- School of Education, Applied Developmental Sciences and Special Education, Human Development and Family Science, School Psychology, University of North Carolina Chapel Hill, Chapel Hill, NC 27514, United States
| | - Crystal Harrell
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06510, United States
| | - Caroline Eckel
- Department of Sociology, University of California, Davis, Davis, CA 95616, United States
| | - Natalie Price
- Milken Institute School of Public Health, Department of Prevention and Community Health, The George Washington University, Washington, DC 20037, United States
| | - Rachel Nassau
- The George Washington School of Medicine and Health Sciences, Washington, DC 20052, United States
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, Yale School of Public Health, New Haven, CT 06510, United States
| | - Tamara L Taggart
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06510, United States
- Milken Institute School of Public Health, Department of Prevention and Community Health, The George Washington University, Washington, DC 20037, United States
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Merino-Soto C, Núñez Benítez MÁ, Domínguez-Guedea MT, Toledano-Toledano F, Moral de la Rubia J, Astudillo-García CI, Rivera-Rivera L, Leyva-López A, Angulo-Ramos M, Flores Laguna OA, Hernández-Salinas G, Rodríguez Castro JH, González Peña OI, Garduño Espinosa J. Medical outcomes study social support survey (MOS-SSS) in patients with chronic disease: A psychometric assessment. Front Psychiatry 2023; 13:1028342. [PMID: 36713918 PMCID: PMC9874003 DOI: 10.3389/fpsyt.2022.1028342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
Purpose Currently, information on the psychometric properties of the Medical outcomes study-social support survey (MOS-SSS) for patients with chronic disease in primary health care, suggests problems in the dimensionality, specifically predominant unidimensionality in a multidimensional measure. The aim of this study was to determine the internal structure (dimensionality, measurement invariance and reliability) and association with other variables. Methods A total of 470 patients with chronic disease from a Family Medicine Unit at the Instituto Mexicano del Seguro Social, IMSS, with a mean age of 51.51 years were included. Participants responded to the Questionnaire of Sociodemographic Variables (Q-SV), SF-36 Health-Related Quality of Life Scale-version 1.1, and MOS-SSS. Results Non-parametric (Mokken scaling analysis) and parametric (confirmatory factor analysis) analyses indicated unidimensionality, and three-factor model was not representative. A new 8-item version (MOS-S) was developed, where measurement invariance, equivalence with the long version, reliability, and relationship with the SF-36 were satisfactory. Conclusion The MOS-SSS scale is unidimensional, and the shortened version yields valid and reliable scores for measuring social support in patients with chronic disease at the primary health care.
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Affiliation(s)
- Cesar Merino-Soto
- Instituto de Investigación de Psicología, Universidad de San Martín de Porres, Surquillo, Peru
| | | | | | - Filiberto Toledano-Toledano
- Hospital Infantil de México Federico Gómez, Unidad de Investigación en Medicina Basada en Evidencias, Mexico City, Mexico
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Unidad de Investigación Sociomédica, Mexico City, Mexico
- Instituto Nacional de Ciencias e Innovación para la Formación de Comunidad Científica, INDEHUS, Dirección de Investigación y Diseminación del Conocimiento, Mexico City, Mexico
| | | | | | - Leonor Rivera-Rivera
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Morelos, Mexico
| | - Ahidée Leyva-López
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Morelos, Mexico
| | - Marisol Angulo-Ramos
- Instituto Nacional de Ciencias e Innovación para la Formación de Comunidad Científica, INDEHUS, Dirección de Investigación y Diseminación del Conocimiento, Mexico City, Mexico
| | - Omar Arodi Flores Laguna
- Facultad de Ciencias Empresariales y Jurídicas, Universidad de Montemorelos, Montemorelos, Mexico
| | - Gregorio Hernández-Salinas
- Tecnológico Nacional de México/Instituto Tecnológico Superior de Zongolica-Extensión Tezonapa, Heroica Veracruz, Mexico
| | - Jorge Homero Rodríguez Castro
- División de Estudios de Posgrado e Investigación, Tecnológico Nacional de Mexico/Instituto Tecnologico de Ciudad Victoria, Ciudad Victoria, Tamaulipas, Mexico
| | - Omar Israel González Peña
- Hospital Infantil de México Federico Gómez, Unidad de Investigación en Medicina Basada en Evidencias, Mexico City, Mexico
| | - Juan Garduño Espinosa
- Dirección de Investigación, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Mexico City, Mexico
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Muhammad T, Srivastava S, Sekher TV. Assessing socioeconomic inequalities in cognitive impairment among older adults: a study based on a cross-sectional survey in India. BMC Geriatr 2022; 22:389. [PMID: 35505289 PMCID: PMC9066837 DOI: 10.1186/s12877-022-03076-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/21/2022] [Indexed: 01/17/2023] Open
Abstract
Background The rapidly aging population is a major concern for countries, especially where cognitive health in older age is poor. The study examined the socioeconomic and health-related factors associated with cognitive impairment among older adults and the contribution of those factors to the concentration of low cognitive functioning among older adults from economically poor households. Methods Data this study were derived from the “Building Knowledge Base on Population Ageing in India” (BKPAI) survey, which was carried out in seven major states of India. The effective sample size for the analysis was 9176 older adults aged 60 years and above. Results from descriptive and bivariate analysis were reported in the initial stage. Multivariable logistic regression analysis was conducted to explore the associations. Additionally, the concentration index and concentration curve were used to measure socioeconomic inequality in cognitive impairment among older adults. Wagstaff decomposition was employed to explore the key contributors in the concentration index. Results Nearly 60% of older adults suffered from cognitive impairment in the study. The likelihood of cognitive impairment were higher among older adults with a low level of self-perceived income sufficiency [coefficient: 0.29; confidence interval (CI): 0.07- 0.52] compared to older adults with higher levels of perceived income status. Older adults with more than 10 years of schooling were less likely to be cognitively impaired [coefficient: -1.27; CI: − 1.50- -1.04] in comparison to those with no education. Cognitive impairment was concentrated among older adults from households with the lowest wealth quintile (concentration index (CCI): − 0.10: p < 0.05). Educational status explained 44.6% of socioeconomic inequality, followed by 31.8% by wealth status and 11.5% by psychological health. Apart from these factors, difficulty in instrumental activities of daily living (3.7%), caste (3.7%), and perceived income sufficiency to fulfil basic needs (3.0%) explained socioeconomic inequality in cognitive impairment among older adults. Conclusions Findings suggest that older adults with lower perceived income, lower levels of education, poor physical and mental health, and poor physical and social resources were more likely to be cognitively impaired. Education, wealth and psychological health are major contributors in socioeconomic inequality in late-life cognitive impairment, which may be target areas in future policy formulation to reduce the inequality in cognitive impairment in older Indian adults.
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Affiliation(s)
- T Muhammad
- Department of Family and Generations, International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Shobhit Srivastava
- Department of Survey Research & Data Analytics, International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India.
| | - T V Sekher
- Department of Family and Generations, International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
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Janevic MR, Mathur VA, Booker SQ, Morais C, Meints SM, Yeager KA, Meghani SH. Making Pain Research More Inclusive: Why and How. THE JOURNAL OF PAIN 2022; 23:707-728. [PMID: 34678471 PMCID: PMC9018873 DOI: 10.1016/j.jpain.2021.10.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/28/2021] [Accepted: 10/05/2021] [Indexed: 02/09/2023]
Abstract
Current knowledge about mechanisms and interventions for pain has largely been derived from samples that are healthier, wealthier, younger, and more likely to be White than the general population. Failure to conduct inclusive pain research not only restricts generalizability and application of findings, but also hampers the discovery of mechanisms and the development of measures and interventions that are valid across population subgroups. Most of all, inclusive practices are critical to ensure that underrepresented groups derive equitable benefit from pain research. Here, we provide guidance for the pain research community on how to adopt inclusive research practices. We define "inclusion" to encompass a range of identities and characteristics, including racialized group/ethnicity, disability status, gender identity, sexual orientation, and age. We first describe principles relevant to promoting inclusion in pain research, including attention to: 1) stakeholder engagement; 2) structural factors underlying inequities; 3) the limitations of "disparity" research; 4) intersectionality; and 5) universal design. Next, we provide checklists with practical strategies for making studies more inclusive at each stage of the research process. We conclude by calling for system-level changes to ensure that the future of pain research is socially just, scientifically productive, and responsive to the needs of all people. PERSPECTIVE: This paper offers guidance on promoting inclusion of underrepresented groups in pain research. We describe principles relevant to conducting more inclusive research; eg, attention to stakeholder engagement, structural factors, and universal design. We provide checklists with practical strategies for inclusion at each stage of the research process.
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Affiliation(s)
| | - Vani A. Mathur
- Department of Psychological & Brain Sciences, Texas A&M University
| | - Staja Q. Booker
- College of Nursing, Department of Biobehavioral Nursing Science University of Florida
| | - Calia Morais
- Department of Community Dentistry and Behavioral Science, University of Florida
| | - Samantha M. Meints
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School
| | | | - Salimah H. Meghani
- Department of Biobehavioral Health Sciences; New Courtland Center for Transitions and Health; Leonard Davis Institute of Health Economics, University of Pennsylvania
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Mezuk B, Tarraf W, Johnson-Lawrence V, Ilardo J, Lichtenberg PA, Jackson JS. Analytic Training for Junior Investigators in Minority Aging Research: The Michigan Model. THE GERONTOLOGIST 2021; 60:1392-1402. [PMID: 32352144 DOI: 10.1093/geront/gnaa001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Indexed: 11/12/2022] Open
Abstract
Since 1997, the Resource Centers for Minority Aging Research Program at the National Institute on Aging has been the model for training social and behavioral scientists in minority aging and health disparities research. The latest cycle of these Centers implemented a new structure for the analytic training of junior investigators and for advancing methodologic work relevant to improving the rigor of minority aging research. In this article, we describe the conceptual framework, logistical approaches, challenges, and lessons learned from our experience training junior investigators in methodology through the Michigan Center for Urban African American Aging Research over the past 20 years, with the goal of informing future analytic training efforts for the next generation of scholars focused on minority aging issues.
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Affiliation(s)
- Briana Mezuk
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Wassim Tarraf
- Institute of Gerontology, Wayne State University, Detroit, Michigan
| | - Vicki Johnson-Lawrence
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, Michigan
| | - Joan Ilardo
- Office of Research, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | | | - James S Jackson
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
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Hekler E, Tiro JA, Hunter CM, Nebeker C. Precision Health: The Role of the Social and Behavioral Sciences in Advancing the Vision. Ann Behav Med 2020; 54:805-826. [PMID: 32338719 PMCID: PMC7646154 DOI: 10.1093/abm/kaaa018] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In 2015, Collins and Varmus articulated a vision for precision medicine emphasizing molecular characterization of illness to identify actionable biomarkers to support individualized treatment. Researchers have argued for a broader conceptualization, precision health. Precision health is an ambitious conceptualization of health, which includes dynamic linkages between research and practice as well as medicine, population health, and public health. The goal is a unified approach to match a full range of promotion, prevention, diagnostic, and treatment interventions to fundamental and actionable determinants of health; to not just address symptoms, but to directly target genetic, biological, environmental, and social and behavioral determinants of health. PURPOSE The purpose of this paper is to elucidate the role of social and behavioral sciences within precision health. MAIN BODY Recent technologies, research frameworks, and methods are enabling new approaches to measure, intervene, and conduct social and behavioral science research. These approaches support three opportunities in precision health that the social and behavioral sciences could colead including: (a) developing interventions that continuously "tune" to each person's evolving needs; (b) enhancing and accelerating links between research and practice; and (c) studying mechanisms of change in real-world contexts. There are three challenges for precision health: (a) methods of knowledge organization and curation; (b) ethical conduct of research; and (c) equitable implementation of precision health. CONCLUSIONS Precision health requires active coleadership from social and behavioral scientists. Prior work and evidence firmly demonstrate why the social and behavioral sciences should colead with regard to three opportunity and three challenge areas.
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Affiliation(s)
- Eric Hekler
- Department of Family Medicine and Public Health, School of Medicine, UC San Diego, La Jolla, CA, USA
- Center for Wireless and Population Health Systems, Qualcomm Institute, UC San Diego, La Jolla, CA, USA
- Design Lab, UC San Diego, La Jolla, CA, USA
| | - Jasmin A Tiro
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Christine M Hunter
- Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD, USA
| | - Camille Nebeker
- Department of Family Medicine and Public Health, School of Medicine, UC San Diego, La Jolla, CA, USA
- Center for Wireless and Population Health Systems, Qualcomm Institute, UC San Diego, La Jolla, CA, USA
- Design Lab, UC San Diego, La Jolla, CA, USA
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Lopez-Vergara HI, Rosales R, Scheuermann TS, Nollen NL, Leventhal AM, Ahluwalia JS. Social determinants of alcohol and cigarette use by race/ethnicity: Can we ignore measurement issues? Psychol Assess 2020; 32:1075-1086. [PMID: 32924524 DOI: 10.1037/pas0000948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Psychometric critiques of cross-cultural research emphasize testing whether instruments measure the same construct across cultural groups. We tested for measurement invariance (by race/ethnicity) of instruments used to evaluate the relationship between alcohol and tobacco use with perceived discrimination and socioeconomic status (SES). Tests of psychometric equivalence across race/ethnicity focused on: the latent organization of constructs (configural invariance); if observed indicators have equal factor loadings or "true score" variance (metric invariance); and whether manifest indicators change uniformly contingent on change in the latent variable (scalar invariance). A cross-sectional survey of 2,376 cigarette smokers (794 Black, 786 Latinx, 796 White; mean age = 43 [SD = 12]; 58% female) was recruited via an online research panel. Discrimination was indicated by self-report; SES was indicated by self-reported education, employment, income, and the "SES Ladder;" alcohol use was indicated by frequency and typical quantity of drinking, and frequency of heavy drinking; tobacco use was indicated by frequency of smoking, cigarettes per smoking day, and time to first cigarette. All instruments demonstrated configural invariance; either full metric invariance (alcohol and discrimination) or partial metric invariance (tobacco and SES); and all constructs demonstrated partial scalar invariance. Results support psychometric critiques; for example, all of the SES indicators violated assumptions of classical measurement theory for valid between group comparisons. All of our instruments displayed some degree of systematic bias in measurement across race/ethnicity. Studies testing ethnic/racial differences may need to move beyond classical measurement theory, and may benefit from using statistical approaches that can test for (and model) bias in measurement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Robert Rosales
- Center for Alcohol and Addiction Studies, Brown University
| | | | - Nikki L Nollen
- Department of Population Health, University of Kansas Medical School
| | - Adam M Leventhal
- Department of Preventive Medicine, University of Southern California
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Conley CC, Small BJ, Christie J, Hoogland AI, Augusto BM, Garcia JD, Pal T, Vadaparampil ST. Patterns and covariates of benefit finding in young Black breast cancer survivors: A longitudinal, observational study. Psychooncology 2020; 29:1115-1122. [PMID: 32323400 DOI: 10.1002/pon.5398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/03/2020] [Accepted: 04/14/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the patterns and covariates of benefit finding over time among young Black breast cancer (BC) survivors. METHODS Black women (N = 305) with invasive BC diagnosed ≤50 years were recruited an average of 1.9 years post-BC diagnosis. Participants completed self-report questionnaires of benefit finding, social support, and illness intrusions at three time points (M time since BC diagnosis: T2 = 3.1 years, T3 = 4.0 years). Relationships between posttraumatic growth constructs (social support, illness intrusions) and benefit finding over time were examined using mixed models. Models controlled for cultural variables (religiosity, time orientation, and collectivism), receipt of chemotherapy, general health status, and partner status. RESULTS Participants reported high levels of benefit finding (M = 2.99, SE = 0.04 on a 0-4 scale). When accounting for covariates, benefit finding did not change over time since BC diagnosis (P = .21). Benefit finding scores at BC diagnosis were associated with more illness intrusions, greater religiosity, and having received chemotherapy (all Ps < .04). Social support was associated with change in benefit finding scores over time, such that a 1-point increase in social support was associated with a 0.05 increase in benefit finding per year (P = .02). CONCLUSIONS This study addresses key gaps in knowledge regarding benefit finding among Black cancer survivors. Consistent with findings from majority White samples, social support and illness intrusions appear to play a key role in benefit finding in Black BC survivors. Cultural constructs-including religiosity-must also be considered in future studies of benefit finding among minority populations.
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Affiliation(s)
- Claire C Conley
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Brent J Small
- School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Juliette Christie
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Bianca M Augusto
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Jennifer D Garcia
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Tuya Pal
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
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Agurs-Collins T, Persky S, Paskett ED, Barkin SL, Meissner HI, Nansel TR, Arteaga SS, Zhang X, Das R, Farhat T. Designing and Assessing Multilevel Interventions to Improve Minority Health and Reduce Health Disparities. Am J Public Health 2020; 109:S86-S93. [PMID: 30699029 DOI: 10.2105/ajph.2018.304730] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Multilevel interventions can be uniquely effective at addressing minority health and health disparities, but they pose substantial methodological, data analytic, and assessment challenges that must be considered when designing and applying interventions and assessment. To facilitate the adoption of multilevel interventions to reduce health disparities, we outline areas of need in filling existing operational challenges to the design and assessment of multilevel interventions. We discuss areas of development that address overarching constructs inherent in multilevel interventions, with a particular focus on their application to minority health and health disparities. Our approach will prove useful to researchers, as it allows them to integrate information related to health disparities research into the framework of broader constructs with which they are familiar. We urge researchers to prioritize building transdisciplinary teams and the skills needed to overcome the challenges in designing and assessing multilevel interventions, as even small contributions can accelerate progress toward improving minority health and reducing health disparities. To make substantial progress, however, a concerted and strategic effort, including work to advance analytic techniques and measures, is needed.
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Affiliation(s)
- Tanya Agurs-Collins
- Tanya Agurs-Collins is with the National Cancer Institute, National Institutes of Health (NIH), Rockville, MD. Susan Persky is with the Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD. Electra D. Paskett is with the Department of Internal Medicine, The Ohio State University, Columbus. Shari L. Barkin is with the Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN. Helen I. Meissner is with the Office of Disease Prevention, NIH, Bethesda. Tonja R. Nansel is with the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda. Sonia S. Arteaga is with the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda. Xinzhi Zhang is with Clinical and Health Services Research, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Rina Das is with the Division of Extramural Scientific Programs, NIMHD, Bethesda. Tilda Farhat is with the Office of Science Policy, Strategic Planning, Analysis, Reporting, and Data, NIMHD, Bethesda. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Susan Persky
- Tanya Agurs-Collins is with the National Cancer Institute, National Institutes of Health (NIH), Rockville, MD. Susan Persky is with the Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD. Electra D. Paskett is with the Department of Internal Medicine, The Ohio State University, Columbus. Shari L. Barkin is with the Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN. Helen I. Meissner is with the Office of Disease Prevention, NIH, Bethesda. Tonja R. Nansel is with the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda. Sonia S. Arteaga is with the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda. Xinzhi Zhang is with Clinical and Health Services Research, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Rina Das is with the Division of Extramural Scientific Programs, NIMHD, Bethesda. Tilda Farhat is with the Office of Science Policy, Strategic Planning, Analysis, Reporting, and Data, NIMHD, Bethesda. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Electra D Paskett
- Tanya Agurs-Collins is with the National Cancer Institute, National Institutes of Health (NIH), Rockville, MD. Susan Persky is with the Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD. Electra D. Paskett is with the Department of Internal Medicine, The Ohio State University, Columbus. Shari L. Barkin is with the Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN. Helen I. Meissner is with the Office of Disease Prevention, NIH, Bethesda. Tonja R. Nansel is with the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda. Sonia S. Arteaga is with the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda. Xinzhi Zhang is with Clinical and Health Services Research, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Rina Das is with the Division of Extramural Scientific Programs, NIMHD, Bethesda. Tilda Farhat is with the Office of Science Policy, Strategic Planning, Analysis, Reporting, and Data, NIMHD, Bethesda. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Shari L Barkin
- Tanya Agurs-Collins is with the National Cancer Institute, National Institutes of Health (NIH), Rockville, MD. Susan Persky is with the Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD. Electra D. Paskett is with the Department of Internal Medicine, The Ohio State University, Columbus. Shari L. Barkin is with the Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN. Helen I. Meissner is with the Office of Disease Prevention, NIH, Bethesda. Tonja R. Nansel is with the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda. Sonia S. Arteaga is with the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda. Xinzhi Zhang is with Clinical and Health Services Research, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Rina Das is with the Division of Extramural Scientific Programs, NIMHD, Bethesda. Tilda Farhat is with the Office of Science Policy, Strategic Planning, Analysis, Reporting, and Data, NIMHD, Bethesda. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Helen I Meissner
- Tanya Agurs-Collins is with the National Cancer Institute, National Institutes of Health (NIH), Rockville, MD. Susan Persky is with the Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD. Electra D. Paskett is with the Department of Internal Medicine, The Ohio State University, Columbus. Shari L. Barkin is with the Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN. Helen I. Meissner is with the Office of Disease Prevention, NIH, Bethesda. Tonja R. Nansel is with the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda. Sonia S. Arteaga is with the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda. Xinzhi Zhang is with Clinical and Health Services Research, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Rina Das is with the Division of Extramural Scientific Programs, NIMHD, Bethesda. Tilda Farhat is with the Office of Science Policy, Strategic Planning, Analysis, Reporting, and Data, NIMHD, Bethesda. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Tonja R Nansel
- Tanya Agurs-Collins is with the National Cancer Institute, National Institutes of Health (NIH), Rockville, MD. Susan Persky is with the Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD. Electra D. Paskett is with the Department of Internal Medicine, The Ohio State University, Columbus. Shari L. Barkin is with the Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN. Helen I. Meissner is with the Office of Disease Prevention, NIH, Bethesda. Tonja R. Nansel is with the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda. Sonia S. Arteaga is with the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda. Xinzhi Zhang is with Clinical and Health Services Research, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Rina Das is with the Division of Extramural Scientific Programs, NIMHD, Bethesda. Tilda Farhat is with the Office of Science Policy, Strategic Planning, Analysis, Reporting, and Data, NIMHD, Bethesda. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Sonia S Arteaga
- Tanya Agurs-Collins is with the National Cancer Institute, National Institutes of Health (NIH), Rockville, MD. Susan Persky is with the Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD. Electra D. Paskett is with the Department of Internal Medicine, The Ohio State University, Columbus. Shari L. Barkin is with the Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN. Helen I. Meissner is with the Office of Disease Prevention, NIH, Bethesda. Tonja R. Nansel is with the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda. Sonia S. Arteaga is with the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda. Xinzhi Zhang is with Clinical and Health Services Research, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Rina Das is with the Division of Extramural Scientific Programs, NIMHD, Bethesda. Tilda Farhat is with the Office of Science Policy, Strategic Planning, Analysis, Reporting, and Data, NIMHD, Bethesda. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Xinzhi Zhang
- Tanya Agurs-Collins is with the National Cancer Institute, National Institutes of Health (NIH), Rockville, MD. Susan Persky is with the Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD. Electra D. Paskett is with the Department of Internal Medicine, The Ohio State University, Columbus. Shari L. Barkin is with the Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN. Helen I. Meissner is with the Office of Disease Prevention, NIH, Bethesda. Tonja R. Nansel is with the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda. Sonia S. Arteaga is with the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda. Xinzhi Zhang is with Clinical and Health Services Research, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Rina Das is with the Division of Extramural Scientific Programs, NIMHD, Bethesda. Tilda Farhat is with the Office of Science Policy, Strategic Planning, Analysis, Reporting, and Data, NIMHD, Bethesda. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Rina Das
- Tanya Agurs-Collins is with the National Cancer Institute, National Institutes of Health (NIH), Rockville, MD. Susan Persky is with the Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD. Electra D. Paskett is with the Department of Internal Medicine, The Ohio State University, Columbus. Shari L. Barkin is with the Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN. Helen I. Meissner is with the Office of Disease Prevention, NIH, Bethesda. Tonja R. Nansel is with the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda. Sonia S. Arteaga is with the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda. Xinzhi Zhang is with Clinical and Health Services Research, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Rina Das is with the Division of Extramural Scientific Programs, NIMHD, Bethesda. Tilda Farhat is with the Office of Science Policy, Strategic Planning, Analysis, Reporting, and Data, NIMHD, Bethesda. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Tilda Farhat
- Tanya Agurs-Collins is with the National Cancer Institute, National Institutes of Health (NIH), Rockville, MD. Susan Persky is with the Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD. Electra D. Paskett is with the Department of Internal Medicine, The Ohio State University, Columbus. Shari L. Barkin is with the Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN. Helen I. Meissner is with the Office of Disease Prevention, NIH, Bethesda. Tonja R. Nansel is with the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda. Sonia S. Arteaga is with the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda. Xinzhi Zhang is with Clinical and Health Services Research, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Rina Das is with the Division of Extramural Scientific Programs, NIMHD, Bethesda. Tilda Farhat is with the Office of Science Policy, Strategic Planning, Analysis, Reporting, and Data, NIMHD, Bethesda. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
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12
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Mikulík R, Caso V, Bornstein NM, Svobodová V, Pezzella FR, Grecu A, Simsic S, Gdovinova Z, Członkowska A, Mishchenko TS, Flomin Y, Milanov IG, Andonova S, Tiu C, Arsovska A, Budinčević H, Groppa SA, Bereczki D, Kõrv J, Kharitonova T, Vosko MR. Enhancing and accelerating stroke treatment in Eastern European region: Methods and achievement of the ESO EAST program. Eur Stroke J 2020; 5:204-212. [PMID: 32637654 DOI: 10.1177/2396987319897156] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 12/03/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction Despite the availability of prevention and therapies of stroke, their implementation in clinical practice, even of low-cost ones, remains poor. In 2015, the European Stroke Organisation (ESO) initiated the ESO Enhancing and Accelerating Stroke Treatment (EAST) program, which aims to improve stroke care quality, primarily in Eastern Europe. Here, we describe its methods and milestones. Patients and methods The ESO EAST program is using an implementation strategy based on a 'detecting-understanding-reducing disparities' conceptual framework: stroke care quality is first measured (after developing a platform for data collection), gaps are identified in the current service delivery, and ultimately feedback is provided to participating hospitals, followed by the application of interventions to reduce disparities. The ESO EAST program is carried out by establishing a stroke quality registry, stroke management infrastructure, and creating education and training opportunities for healthcare professionals. Results Program management and leadership infrastructure has been established in 19 countries (Country Representatives in 22 countries, National Steering Committee in 19 countries). A software platform for data collection and analysis: Registry of Stroke Care Quality was developed, and launched in 2016, and has been used to collect data from over 90,000 patients from >750 hospitals and 56 countries between September 2016 and May 2019. Training in thrombolysis, nursing and research skills has been initiated. Discussion ESO EAST is the first pan-Eastern European (and beyond) multifaceted quality improvement intervention putting evidence-informed policies into practice. Continuous monitoring of stroke care quality allows hospital-to-hospital and country-to-country benchmarking and identification of the gaps and needs in health care.
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Affiliation(s)
- Robert Mikulík
- International Clinical Research Center and Department of Neurology, St. Anne's University Hospital and Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Valeria Caso
- Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Natan M Bornstein
- Shaare Zedek Medical center, Jerusalem, Tel Aviv University, Tel Aviv, Israel
| | - Veronika Svobodová
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | | | - Andreea Grecu
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Steven Simsic
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Zuzana Gdovinova
- Faculty of Medicine, Department of Neurology, P.J. Šafárik University, University Hospital L. Pasteur, Košice, Slovakia
| | - Anna Członkowska
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Tamara S Mishchenko
- Department of Clinical Neurology, Psychiatry and Narcology, V.N. Karazin Kharkiv National University, Kharkiv, Ukraine
| | - Yuriy Flomin
- Comprehensive Stroke Unit, MC 'Universal Clinic 'Oberig', Kyiv, Ukraine
| | - Ivan G Milanov
- Neurology Clinic, Medical University of Sofia, Sofia, Bulgaria
| | - Silva Andonova
- Medical University - Varna, University Hospital "St. Marina" Second Clinic of Neurology with ICU and Stroke Unit, Varna, Bulgaria
| | - Cristina Tiu
- Department of Clinical Neurosciences, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Anita Arsovska
- University Clinic of Neurology, Medical Faculty, University "Ss. Cyril and Methodius", Skopje, North Macedonia
| | - Hrvoje Budinčević
- Department of Neurology, Stroke and Intensive Care Unit, Sveti Duh University Hospital, Zagreb, Croatia
| | - Stanislav A Groppa
- Department of Neurology and Neurosurgery, National Center of Epileptology, Institute of Emergency Medicine, Chisinau, Moldova.,Laboratory of Neurobiology and Medical Genetics, State University of Medicine and Pharmacy "Nicolae Testemiţanu," Chisinau, Moldova
| | - Daniel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Tatiana Kharitonova
- Department of Acute Cerebrovascular Pathology and Emergency Neurology, Research Institute of Emergency Medicine n.a. I.I. Dzhanelidze, Saint-Petersburg, Russia
| | - Milan R Vosko
- Department of Neurology, Med Campus III, Kepler University Hospital, Linz, Austria
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Besar Sa'aid H, Mathew S, Richardson M, Bielecki JM, Sander B. Mapping the evidence on health equity considerations in economic evaluations of health interventions: a scoping review protocol. Syst Rev 2020; 9:6. [PMID: 31915067 PMCID: PMC6950907 DOI: 10.1186/s13643-019-1257-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/18/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Equity in health has become an important policy agenda around the world, prompting health economists to advance methods to enable the inclusion of equity in economic evaluations. Among the methods that have been proposed to explicitly include equity are the weighting analysis, equity impact analysis, and equity trade-off analysis. This is a new development and a comprehensive overview of trends and concepts of health equity in economic evaluations is lacking. Thus, our objective is to map the current state of the literature with respect to how health equity is considered in economic evaluations of health interventions reported in the academic and gray literature. METHODS We will conduct a scoping review to identify and map evidence on how health equity is considered in economic evaluations of health interventions. We will search relevant electronic, gray literature and key journals. We developed a search strategy using text words and Medical Subject Headings terms related to health equity and economic evaluations of health interventions. Articles retrieved will be uploaded to reference manager software for screening and data extraction. Two reviewers will independently screen the articles based on their titles and abstracts for inclusion, and then will independently screen a full text to ascertain final inclusion. A simple numerical count will be used to quantify the data and a content analysis will be conducted to present the narrative; that is, a thematic summary of the data collected. DISCUSSION The results of this scoping review will provide a comprehensive overview of the current evidence on how health equity is considered in economic evaluations of health interventions and its research gaps. It will also provide key information to decision-makers and policy-makers to understand ways to include health equity into the prioritization of health interventions when aiming for a more equitable distribution of health resources. SYSTEMATIC REVIEW REGISTRATION This protocol was registered with Open Science Framework (OSF) Registry on August 14, 2019 (https://osf.io/9my2z/registrations).
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Affiliation(s)
- Hafizah Besar Sa'aid
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada. .,Faculty of Business and Management, Universiti Teknologi MARA (UiTM), Sungai Petani, Kedah, Malaysia. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Sharon Mathew
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Marina Richardson
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Joanna M Bielecki
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
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Greenfield EA. Designing Retrospective Measures on Childhood for Older African American Adults. Int J Aging Hum Dev 2019; 92:158-169. [PMID: 31760756 DOI: 10.1177/0091415019887683] [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: 11/16/2022]
Abstract
A growing body of research addresses the long-term implications of early-life circumstances for adult health and aging by drawing on retrospective reports on childhood. There has been little scholarly discourse on considerations for the design of such questions for members of racial/ethnic minority groups specifically. This article aims to encourage greater attention to this area by presenting insights from the process of designing a childhood history questionnaire within an ongoing study of cognition, health, and aging among older African American adults in greater Newark, New Jersey. The article presents on three overarching themes, including the importance of (a) adopting a resilience orientation with attention to protective factors, (b) being sensitive to concerns about questions on adverse childhood experiences, and (c) orienting to ethnoracially embedded cohort influences. The article concludes by describing the particular importance of cultural humility-with attention to intersectional social positions-among researchers who are engaged in studies on childhood with older adults from underrepresented racial/ethnic groups.
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Affiliation(s)
- Emily A Greenfield
- 242612 Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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Basu J, Hanchate A, Bierman A. Racial/Ethnic Disparities in Readmissions in US Hospitals: The Role of Insurance Coverage. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2018; 55:46958018774180. [PMID: 29730971 PMCID: PMC5946640 DOI: 10.1177/0046958018774180] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We examine differences in rates of 30-day readmissions across patients by race/ethnicity and the extent to which these differences were moderated by insurance coverage. We use hospital discharge data of patients in the 18 years and above age group for 5 US states, California, Florida, Missouri, New York, and Tennessee for 2009, the latest year prior to the start of Centers for Medicare & Medicaid Services’ Hospital Compare program of public reporting of hospital performance on 30-day readmissions. We use logistic regression models by state to estimate the association between insurance status, race, and the likelihood of a readmission within 30 days of an index hospital admission for any cause. Overall in 5 states, non-Hispanic blacks had a slightly higher risk of 30-day readmissions relative to non-Hispanic whites, although this pattern varied by state and insurance coverage. We found higher readmission risk for non-Hispanic blacks, compared with non-Hispanic whites, among those covered by Medicare and private insurance, but lower risk among uninsured and similar risk among Medicaid. Hispanics had lower risk of readmissions relative to non-Hispanic whites, and this pattern was common across subgroups with private, Medicaid, and no insurance coverage. Uninsurance was associated with lower risk of readmissions among minorities but higher risk of readmissions among non-Hispanic whites relative to private insurance. The study found that risk of readmissions by racial ethnic groups varies by insurance status, with lower readmission rates among minorities who were uninsured compared with those with private insurance or Medicare, suggesting that lower readmission rates may not always be construed as a good outcome, because it could result from a lack of insurance coverage and poor access to care, particularly among the minorities.
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Affiliation(s)
- Jayasree Basu
- 1 Agency for Healthcare Research and Quality, Rockville, MD, USA
| | | | - Arlene Bierman
- 1 Agency for Healthcare Research and Quality, Rockville, MD, USA
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Margolis R, Bellin MH, Sacco P, Harrington D, Butz A. Evaluation of MOS social support in low-income caregivers of African American children with poorly controlled asthma. J Asthma 2018; 56:951-958. [PMID: 30273501 DOI: 10.1080/02770903.2018.1510504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective: The purpose of this study was to examine the factor structure of the Medical Outcomes Study Social Support Survey (MOS-SSS) in a sample of low-income, urban caregivers of African American children with poorly controlled asthma. Although the MOS-SSS is a commonly used measure of social support, its psychometric properties have not been studied in this population. Methods: Confirmatory factor analysis was conducted to determine the most appropriate factor structure for the MOS-SSS in caregivers of African American children with frequent Emergency Department visits for uncontrolled asthma. The following models were tested and compared using established fit statistics: an 18-item second-order four factor model, an 18-item four factor model, a bifactor model and an 18-item one factor model with nested models. Results: Participating caregivers were single (75.6%) and female (97%). An 18-item one factor version of the scale had the best fit statistics compared to the other models tested: χ2 (142) = 308.319, p > 0.001; Root mean square error of approximation (RMSEA) = 0.077; CFI (Comparative Fit Index) = 0.990; and Tucker-Lewis Index (TLI) = 0.988. Construct validity was supported by a statistically significant negative relationship between our final MOS-SSS model and caregiver depressive symptoms ( β = -0.374, p < 0.001). Conclusions: The 18-item one factor MOS-SSS may be appropriate for use in research and clinical practice with caregivers of African American children with poorly controlled asthma. It appears promising as a mechanism to advance understanding of relationships between social support and asthma outcomes in this vulnerable population.
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Affiliation(s)
- Rachel Margolis
- a School of Social Work, University of Maryland , Baltimore , MD , USA
| | - Melissa H Bellin
- a School of Social Work, University of Maryland , Baltimore , MD , USA
| | - Paul Sacco
- a School of Social Work, University of Maryland , Baltimore , MD , USA
| | - Donna Harrington
- a School of Social Work, University of Maryland , Baltimore , MD , USA
| | - Arlene Butz
- b Department of Pediatrics, The Johns Hopkins University School of Medicine , Freeland , MD , USA
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Nápoles AM, Stewart AL. Transcreation: an implementation science framework for community-engaged behavioral interventions to reduce health disparities. BMC Health Serv Res 2018; 18:710. [PMID: 30208873 PMCID: PMC6134771 DOI: 10.1186/s12913-018-3521-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/04/2018] [Indexed: 12/22/2022] Open
Abstract
Background Methods for translating evidence-based behavioral interventions into real-world settings seldom account for the special issues in reaching health disparity populations. Main text The objective of this article is to describe an innovative “transcreational” framework for designing and delivering interventions in communities to reduce health disparities. We define transcreation as the process of planning, delivering, and evaluating interventions so that they resonate with the community experiencing health disparities, while achieving intended health outcomes. The Transcreation Framework for Community-engaged Behavioral Interventions to Reduce Health Disparities comprises seven steps: 1) identify community infrastructure and engage partners; 2) specify theory; 3) identify multiple inputs for new program; 4) design intervention prototype; 5) design study, methods, and measures for community setting; 6) build community capacity for delivery; and 7) deliver transcreated intervention and evaluate implementation processes. Communities are engaged from the start and interventions are delivered by community-based interventionists and tested in community settings. The framework applies rigorous scientific methods for evaluating program effectiveness and implementation processes. It incorporates training and ongoing technical assistance to assure treatment fidelity and build community capacity. Conclusions This framework expands the types of scientific evidence used and balances fidelity to evidence and fit to the community setting. It can guide researchers and communities in developing and testing behavioral interventions to reduce health disparities that are likely to be sustained because infrastructure development is embedded in the research.
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Affiliation(s)
- Anna María Nápoles
- National Institute on Minority Health and Health Disparities, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD, 20892, USA.
| | - Anita L Stewart
- University of California San Francisco, 3333 California Street, Suite 350E, San Francisco, CA, 94118, USA
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Multiple Chronic Conditions and Disparities in 30-Day Hospital Readmissions Among Nonelderly Adults. J Ambul Care Manage 2018; 41:262-273. [PMID: 29771742 DOI: 10.1097/jac.0000000000000246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examines the patterns of 30-day hospital readmissions by race/ethnicity and multiple chronic conditions (MCC) burden among nonelderly adult patients. We used hospital discharge data of patients in the 18- to 64-year age group in 5 US states, California, Florida, Missouri, New York, and Tennessee, for 2009 from the Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) of the Agency for Healthcare Research and Quality, linked to contextual and provider data from the Health Resources and Services Administration. A multilevel logistic regression model was used for data pooled over 5 states, adjusting for patient, hospital, and community characteristics. Controlling for other covariates, the study found that a higher MCC burden was associated with a higher all-cause 30-day readmission risk. We found considerable heterogeneity in levels of readmission risk among racial/ethnic subgroups stratified by chronic conditions. Among patients with a lowest MCC burden, African Americans had the highest risk of readmission, but with a higher MCC burden, the risk of readmission increased most for Hispanics.
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Chen Y, Lin HY, Tseng TS, Wen H, DeVivo MJ. Racial Differences in Data Quality and Completeness: Spinal Cord Injury Model Systems' Experiences. Top Spinal Cord Inj Rehabil 2018; 24:110-120. [PMID: 29706755 DOI: 10.1310/sci2402-110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Among people with spinal cord injury (SCI), minorities experience a disproportionately higher burden of diseases. Knowledge of data quality by race/ethnicity will help better design racial health disparity research and understand potential errors/biases. Objective: To investigate racial/ethnic differences in response completeness in a longitudinal SCI database. Methods: This study included 7,507 participants (5,483 non-Hispanic whites, 1,414 non-Hispanic blacks, and 610 Hispanics) enrolled in the National SCI Database who returned for follow-up between 2001 and 2006 and were aged ≥18 years at follow-up. Missing data were defined as any missing, unknown, or refusal response to interview items. Results: The overall missing rate was 29.7%, 9.5%, 9.7%, 10.7%, 12.0%, and 9.8% for the Craig Handicap Assessment and Reporting Technique-Short Form (CHART) economic self-sufficiency subscale, CAGE questionnaire, drug use, Diener's Satisfaction with Life Scale, Patient Health Questionnaire, and pain severity, respectively. The missing rate for the CHART measure was significantly higher among non-Hispanic blacks and Hispanics than among non-Hispanic whites, after controlling for demographics, injury factors, mode of data collection, and study sites. The missing data in the other outcome measures examined were also significantly higher among non-Hispanic blacks than among non-Hispanic whites but were not significantly different between Hispanics and non-Hispanic whites. Conclusion: Our study highlights the importance of research methodology designed to improve non-response or response incompleteness, particularly in non-Hispanic blacks, as we move to reduce racial/ethnic disparities and strive to explain how and why disparities occur in the SCI population.
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Affiliation(s)
- Yuying Chen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama
| | - Hui-Yi Lin
- Biostatistics, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Tung-Sung Tseng
- Behavioral & Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Huacong Wen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Physical Therapy, School of Health Professionals, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael J DeVivo
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama
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20
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Paz SH, Jones L, Calderón JL, Hays RD. Readability and Comprehension of the Geriatric Depression Scale and PROMIS ® Physical Function Items in Older African Americans and Latinos. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 10:117-131. [PMID: 27599978 DOI: 10.1007/s40271-016-0191-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression and physical function are particularly important health domains for the elderly. The Geriatric Depression Scale (GDS) and the Patient-Reported Outcomes Measurement Information System (PROMIS®) physical function item bank are two surveys commonly used to measure these domains. It is unclear if these two instruments adequately measure these aspects of health in minority elderly. OBJECTIVE The aim of this study was to estimate the readability of the GDS and PROMIS® physical function items and to assess their comprehensibility using a sample of African American and Latino elderly. METHODS Readability was estimated using the Flesch-Kincaid and Flesch Reading Ease (FRE) formulae for English versions, and a Spanish adaptation of the FRE formula for the Spanish versions. Comprehension of the GDS and PROMIS® items by minority elderly was evaluated with 30 cognitive interviews. RESULTS Readability estimates of a number of items in English and Spanish of the GDS and PROMIS® physical functioning items exceed the U.S. recommended 5th-grade threshold for vulnerable populations, or were rated as 'fairly difficult', 'difficult', or 'very difficult' to read. Cognitive interviews revealed that many participants felt that more than the two (yes/no) GDS response options were needed to answer the questions. Wording of several PROMIS® items was considered confusing, and interpreting responses was problematic because they were based on using physical aids. CONCLUSIONS Problems with item wording and response options of the GDS and PROMIS® physical function items may reduce reliability and validity of measurement when used with minority elderly.
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Affiliation(s)
- Sylvia H Paz
- UCLA Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA, 911 Broxton Avenue, Los Angeles, CA, 90024-1736, USA.
| | - Loretta Jones
- Healthy African American Families, 4305 Degnan Blvd, Suite 105, Los Angeles, CA, 90008, USA
- Charles R. Drew University of Medicine and Science, 1731 E 120th St, Los Angeles, CA, 90059, USA
| | - José L Calderón
- UCLA Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA, 911 Broxton Avenue, Los Angeles, CA, 90024-1736, USA
| | - Ron D Hays
- UCLA Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA, 911 Broxton Avenue, Los Angeles, CA, 90024-1736, USA
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
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21
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Katz PP, Barton J, Trupin L, Schmajuk G, Yazdany J, Ruiz PJ, Yelin E. Poverty, Depression, or Lost in Translation? Ethnic and Language Variation in Patient-Reported Outcomes in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2017; 68:621-8. [PMID: 26414775 DOI: 10.1002/acr.22748] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 09/02/2015] [Accepted: 09/22/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Despite advances in therapies, disparities in outcomes have been documented for rheumatoid arthritis (RA) patients for both ethnicity and English language proficiency. The goals of these analyses were to compare differences in RA patient-reported outcomes, by both self-identification of ethnicity and English language proficiency, and to identify factors that might explain differences among groups. METHODS Data were collected through structured telephone interviews of a longitudinal cohort with physician-diagnosed RA (n = 438); only women were included (n = 335). Three groups were defined based on self-reported ethnicity and English proficiency: white/English (n = 219), Hispanic/English (n = 39), and Hispanic/Spanish (n = 77). Outcomes examined were patient-reported physical functioning, pain, and presence of moderate or severe fatigue. Multivariate regression analyses compared outcomes among groups, adjusting for sociodemographic characteristics, health and disease factors, and depression. RESULTS Hispanic/Spanish women had worse function, pain, and fatigue than either English-proficient group. Depression was associated with all outcomes (P < 0.0001), and accounted for greater differentials in scores than ethnicity/language proficiency. In interaction analyses, differences between women who were and were not depressed were greater for Hispanic/English than for Hispanic/Spanish. Nondepressed Hispanic/Spanish scores were significantly worse than nondepressed Hispanic/English, i.e., the impact of depression was less for Hispanic/Spanish women because both depressed and nondepressed women in this group reported worse outcomes. After adjustment for sociodemographic factors and depression, language remained significantly associated with outcomes. CONCLUSION Disparities in patient-reported outcomes may be driven less by ethnicity than by sociodemographic or psychological factors. Measurement instruments that are not culturally appropriate and equivalent may also hamper meaningful analyses of disparities.
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Affiliation(s)
| | | | | | | | | | - Pedro J Ruiz
- California Pacific Medical Center, San Francisco, California
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22
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Salway SM, Payne N, Rimmer M, Buckner S, Jordan H, Adams J, Walters K, Sowden SL, Forrest L, Sharp L, Hidajat M, White M, Ben-Shlomo Y. Identifying inequitable healthcare in older people: systematic review of current research practice. Int J Equity Health 2017; 16:123. [PMID: 28697768 PMCID: PMC5505033 DOI: 10.1186/s12939-017-0605-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/13/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is growing consensus on the importance of identifying age-related inequities in the receipt of public health and healthcare interventions, but concerns regarding conceptual and methodological rigour in this area of research. Establishing age inequity in receipt requires evidence of a difference that is not an artefact of poor measurement of need or receipt; is not warranted on the grounds of patient preference or clinical safety; and is judged to be unfair. METHOD A systematic, thematic literature review was undertaken with the objective of characterising recent research approaches. Studies were eligible if the population was in a country within the Organisation for Economic Co-operation and Development and analyses included an explicit focus on age-related patterns of healthcare receipt including those 60 years or older. A structured extraction template was applied. Extracted material was synthesised in thematic memos. A set of categorical codes were then defined and applied to produce summary counts across key dimensions. This process was iterative to allow reconciliation of discrepancies and ensure reliability. RESULTS Forty nine studies met the eligibility criteria. A wide variety of concepts, terms and methodologies were used across these studies. Thirty five studies employed multivariable techniques to produce adjusted receipt-need ratios, though few clearly articulated their rationale, indicating the need for great conceptual clarity. Eighteen studies made reference to patient preference as a relevant consideration, but just one incorporated any kind of adjustment for this factor. Twenty five studies discussed effectiveness among older adults, with fourteen raising the possibility of differential effectiveness, and one differential cost-effectiveness, by age. Just three studies made explicit reference to the ethical nature of healthcare resource allocation by age. While many authors presented suitably cautious conclusions, some appeared to over-stretch their findings concluding that observed differences were 'inequitable'. Limitations include possible biases in the retrieved material due to inconsistent database indexing and a focus on OECD country populations and studies with English titles. CONCLUSIONS Caution is needed among clinicians and other evidence-users in accepting claims of healthcare 'ageism' in some published papers. Principles for improved research practice are proposed.
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Affiliation(s)
- Sarah M. Salway
- School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Nick Payne
- School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Melanie Rimmer
- School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Stefanie Buckner
- Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
| | - Hannah Jordan
- School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, CB2 0QQ UK
| | - Kate Walters
- Centre for Ageing & Population Studies, Department of Primary Care & Population Health, University College London, Rowland Hill Street, London, NW3 2PF UK
| | - Sarah L. Sowden
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon, Tyne NE2 4AX UK
| | - Lynne Forrest
- Administrative Data Research Centre, University of Edinburgh, Edinburgh Bioquarter, 9 Little France Road, Edinburgh, EH16 4UX UK
| | - Linda Sharp
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon, Tyne NE2 4AX UK
| | - Mira Hidajat
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, CB2 0QQ UK
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon, Tyne NE2 4AX UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
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23
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Gordon EJ. Culturally Competent Strategies for Increasing Knowledge of Live Kidney Donation in the Hispanic Community. CURRENT TRANSPLANTATION REPORTS 2017. [DOI: 10.1007/s40472-017-0136-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Sjetne IS, Iversen HH. Do experiences with pregnancy, birth and postnatal care in Norway vary by the women's geographic origin? a comparison of cross-sectional survey results. BMC Pregnancy Childbirth 2017; 17:37. [PMID: 28100175 PMCID: PMC5241967 DOI: 10.1186/s12884-016-1214-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 12/29/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A national survey was conducted to measure and benchmark women's experiences with pregnancy, birth and postnatal care in Norway. The purpose of this secondary analysis is to explore potential variation in these experiences with regard to the survey respondents' geographic origin. METHODS Data were collected in a national observational cross-sectional study, by a self-administered questionnaire and from registries. The questionnaire collects patient reported experience measures (PREMS) of mainly nontechnical aspects of the health-care services. While taking the clustered characteristics of the respondents into consideration, we compared the mean scores on 16 indexes between women of four different geographic origins using linear regression models. RESULTS The origin of the 4904 respondents were classified as Norway (n = 4028, 82%), Western Europe, North-America, Oceania (n = 233, 5%), Eastern Europe (n = 290, 6%), and Asia, Turkey, Africa, and South-America) (n = 353, 7%). The observed differences were moderate, and no consistency was present in the results in respect of direction or magnitude of the differences between the groups. CONCLUSIONS With some important cautions, we conclude that this study did not detect systematic differences between groups of different geographic origin, in their experiences with pregnancy and maternity care in Norway.
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Affiliation(s)
- Ingeborg S. Sjetne
- The Knowledge Centre for the Health Services, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway
| | - Hilde H. Iversen
- The Knowledge Centre for the Health Services, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway
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25
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Peled R, Porath A, Wilf-Miron R. Improving the quality of primary care by allocating performance-based targets, in a diverse insured population. BMC Health Serv Res 2016; 16:668. [PMID: 27871283 PMCID: PMC5117594 DOI: 10.1186/s12913-016-1920-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 11/11/2016] [Indexed: 11/30/2022] Open
Abstract
Background Primary Care Health organizations, operating under universal coverage and a regulated package of benefits, compete mainly over quality of care. Monitoring, primary care clinical performance, has been repeatedly proven effective in improving the quality of care. In 2004, Maccabi Healthcare Services (MHS), the second largest Israeli HMO, launched its Performance Measurement System (PMS) based on clinical quality indicators. A unique module was built in the PMS to adjust for case mix while tailoring targets to the local units. This article presents the concept and formulas developed to adjust targets to the units’ current performance, and analyze change in clinical indicators over a six year period, between sub-population groups. Methods Six process and intermediate outcome indicators, representing screening for breast and colorectal cancer and care for patients with diabetes and cardiovascular disease, were selected and analyzed for change over time (2003–2009) in overall performance, as well as the difference between the lowest and the highest socio-economic ranks (SERs) and Arab and non-Arab members. Results MHS demonstrated a significant improvement in the selected indicators over the years. Performance of members from low SERs and Arabs improved to a greater extent, as compared to members from high ranks and non-Arabs, respectively. Conclusion The performance measurement system, with its module for tailoring of units' targets, served as a managerial vehicle for bridging existing gaps by allocating more resources to lower performing units. This concept was proven effective in improving performance while reducing disparities between diverse population groups.
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Affiliation(s)
- Ronit Peled
- Department Health Systems Management, Faculty Health Sciences, Ben Gurion University of the Negev, Beer Sheva, 65321, Israel. .,Peres Academy Center, Rehovot, Israel.
| | - Avi Porath
- Department of Epidemiology, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.,The Gertner Institute for Epidemiology and Health Policy Research, Tel Aviv, Israel
| | - Rachel Wilf-Miron
- The Gertner Institute for Epidemiology and Health Policy Research, Tel Aviv, Israel.,The School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
Two measures of health, an index of functional and disability status and global selfrated health, and their transitions over a seven-year period were compared across two ethnic groups of elders in Taiwan: Mainlanders and Taiwanese. This ethnic division is considered a salient dimension of social stratification, shaping the two groups of elders'pathways through life. The results showed that Taiwanese elders experience a disproportionate burden on the two measures of health in part because of their lower socioeconomic status (SES). Also, Taiwanese elders are more likely to develop adverse health transitions than their Mainlander counterparts, and variations in perceptions of chronic illnesses may exist across ethnicity. The results suggest that both ethnicity and SES play important roles in linking social status to health status among this cohort of elders. Ethnicity and SES affect health collectively, and different components of SES may not confer the same health benefits across ethnic groups.
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Affiliation(s)
- Ho-Jui Tung
- National Defense Medical Center, Taipei, Taiwan
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27
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Fongwa MN, Cunningham W, Weech-Maldonado R, Gutierrez PR, Hays RD. Comparison of Data Quality for Reports and Ratings of Ambulatory Care by African American and White Medicare Managed Care Enrollees. J Aging Health 2016; 18:707-21. [PMID: 16980636 DOI: 10.1177/0898264306293264] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Compare missing data and reliability of health care evaluations between African Americans and Whites in Medicare managed care health plans. Method: Consumer Assessment of Healthcare Providers and Systems (CAHPS) 3.0 health plan survey data collected from 109,980 Medicare managed care enrollees (101,189 Whites, 8,791 African Americans) in 321 plans. Participants self-administered the survey and four single-item global ratings of care. Results: Missing data rates were significantly higher for African Americans than Whites on all CAHPS items ( p < .0001). Internal consistency reliability estimates for the CAHPS scales did not differ significantly between African Americans and Whites, but plan-level reliability estimates for the scales and global rating items were significantly lower for African Americans than Whites. Discussion: Higher missing data rates and lower plan-level reliability estimates for African American Medicare managed care enrollees suggest caution in making race/ethnicity comparisons. Future efforts are needed to enhance the quality of data collected from older African Americans.
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28
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Cook WK, Tseng W, Bautista R, John I. Ethnicity, socioeconomic status, and overweight in Asian American adolescents. Prev Med Rep 2016; 4:233-7. [PMID: 27413687 PMCID: PMC4929066 DOI: 10.1016/j.pmedr.2016.06.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/28/2016] [Accepted: 06/06/2016] [Indexed: 11/18/2022] Open
Abstract
Asian American children and adolescents are an under-investigated subpopulation in obesity research. This study aimed to identify specific profiles of Asian subgroups at high risk of adolescent overweight with special attention to Asian ethnicity, socioeconomic status (SES), and their interaction. Multiple logistic regression models were fitted using a sample of 1533 Asian American adolescents ages 12–17 from the 2007–2012 California Health Interview Survey (CHIS). In addition to Asian ethnicity and socioeconomic status (assessed by family income and parental education level), age, gender, nativity, and two lifestyle variables, fast food consumption and physical activity, were also controlled for in these models. Key predictors of overweight in Asian American adolescents included certain Asian ethnicities (Southeast Asian, Filipino, and mixed ethnicities), low family income (< 300% of the Federal Poverty Level), and being male. Multiplicative interaction terms between low family income and two ethnicities, Southeast Asian and Vietnamese that had the lowest SES among Asian ethnic groups, were significantly associated with greatly elevated odds of being overweight (ORs = 12.90 and 6.67, respectively). These findings suggest that high risk of overweight in Asian American adolescents associated with low family incomes may be further elevated for those in low-income ethnic groups. Future research might investigate ethnic-group SES as a meaningful indicator of community-level socioeconomic disparities that influence the health of Asian Americans. Southeast Asian and Filipino ethnicities were associated with adolescent overweight. Low family income was positively associated with Asian adolescent overweight. Ethnicity and low family income interacted to increase risk of adolescent overweight.
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Affiliation(s)
- Won Kim Cook
- Asian & Pacific Islander American Health Forum, United States
- Corresponding author.
| | | | | | - Iyanrick John
- Asian & Pacific Islander American Health Forum, United States
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29
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Read S, Grundy E, Foverskov E. Socio-economic position and subjective health and well-being among older people in Europe: a systematic narrative review. Aging Ment Health 2016; 20:529-42. [PMID: 25806655 PMCID: PMC4784497 DOI: 10.1080/13607863.2015.1023766] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Previous studies of older European populations have established that disability and morbidity vary with indicators of socio-economic position (SEP). We undertook a systematic narrative review of the literature to ascertain to what extent there is evidence of similar inequalities in the subjective health and well-being of older people in Europe. METHOD Relevant original research articles were searched for using Medline, Global Health, Embase, Social Policy and Practice, Cinahl, Web of Science and International Bibliography of the Social Sciences (IBSS). We included studies of SEP and indicators of subjective health and well-being (self-rated health; life satisfaction; quality of life) conducted since 1991 using population-based samples of older people in Europe and published 1995-2013. RESULTS A total of 71 studies were identified. Poorer SEP was associated with poorer subjective health and well-being. Associations varied somewhat depending on the SEP measure and subjective health and well-being outcome used. Associations were weaker when social support and health-related behaviours were adjusted for suggesting that these factors mediate the relationship between SEP and subjective health and well-being. Associations tended to be weaker in the oldest age groups. The patterns of associations by gender were not consistent and tended to diminish after adjusting for indicators of health and life circumstances. CONCLUSION The results of this systematic narrative review of the literature demonstrate the importance of social influences on later life subjective health and well-being and indicate areas which need further investigation, such as more studies from Eastern Europe, more longitudinal studies and more research on the role of mediating factors.
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Affiliation(s)
- Sanna Read
- Department of Social Policy, London School of Economics and Political Science, London, United Kingdom,Corresponding author.
| | - Emily Grundy
- Department of Social Policy, London School of Economics and Political Science, London, United Kingdom
| | - Else Foverskov
- Department of Social Policy, London School of Economics and Political Science, London, United Kingdom
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30
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Lewis D, Yerby L, Tucker M, Foster PP, Hamilton KC, Fifolt MM, Hites L, Shreves MK, Page SB, Bissell KL, Lucky FL, Higginbotham JC. Bringing Community and Academic Scholars Together to Facilitate and Conduct Authentic Community Based Participatory Research: Project UNITED. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010035. [PMID: 26703675 PMCID: PMC4730426 DOI: 10.3390/ijerph13010035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 09/14/2015] [Accepted: 09/14/2015] [Indexed: 11/16/2022]
Abstract
Cultural competency, trust, and research literacy can affect the planning and implementation of sustainable community-based participatory research (CBPR). The purpose of this manuscript is to highlight: (1) the development of a CBPR pilot grant request for application; and (2) a comprehensive program supporting CBPR obesity-related grant proposals facilitated by activities designed to promote scholarly collaborations between academic researchers and the community. After a competitive application process, academic researchers and non-academic community leaders were selected to participate in activities where the final culminating project was the submission of a collaborative obesity-related CBPR grant application. Teams were comprised of a mix of academic researchers and non-academic community leaders, and each team submitted an application addressing obesity-disparities among rural predominantly African American communities in the US Deep South. Among four collaborative teams, three (75%) successfully submitted a grant application to fund an intervention addressing rural and minority obesity disparities. Among the three submitted grant applications, one was successfully funded by an internal CBPR grant, and another was funded by an institutional seed funding grant. Preliminary findings suggest that the collaborative activities were successful in developing productive scholarly relationships between researchers and community leaders. Future research will seek to understand the full-context of our findings.
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Affiliation(s)
- Dwight Lewis
- Institute for Rural Health Research, The University of Alabama, Tuscaloosa, AL 35487, USA.
| | - Lea Yerby
- Institute for Rural Health Research, The University of Alabama, Tuscaloosa, AL 35487, USA.
- Department of Community and Rural Medicine, The University of Alabama, Tuscaloosa, AL 35487, USA.
| | - Melanie Tucker
- Department of Family Medicine, The University of Alabama, Tuscaloosa, AL 35487, USA.
| | - Pamela Payne Foster
- Institute for Rural Health Research, The University of Alabama, Tuscaloosa, AL 35487, USA.
- Department of Community and Rural Medicine, The University of Alabama, Tuscaloosa, AL 35487, USA.
| | - Kara C Hamilton
- Institute for Rural Health Research, The University of Alabama, Tuscaloosa, AL 35487, USA.
| | - Matthew M Fifolt
- Evaluation and Assessment Unit, The University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Lisle Hites
- Evaluation and Assessment Unit, The University of Alabama at Birmingham, Birmingham, AL 35294, USA.
- Department of Health Care Organization and Policy, The University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Mary Katherine Shreves
- Institute for Communication and Information Research, The University of Alabama, Tuscaloosa, AL 35487, USA.
| | - Susan B Page
- Institute for Rural Health Research, The University of Alabama, Tuscaloosa, AL 35487, USA.
| | - Kimberly L Bissell
- Institute for Communication and Information Research, The University of Alabama, Tuscaloosa, AL 35487, USA.
| | | | - John C Higginbotham
- Institute for Rural Health Research, The University of Alabama, Tuscaloosa, AL 35487, USA.
- Department of Community and Rural Medicine, The University of Alabama, Tuscaloosa, AL 35487, USA.
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Roth DL, Dilworth-Anderson P, Huang J, Gross AL, Gitlin LN. Positive Aspects of Family Caregiving for Dementia: Differential Item Functioning by Race. J Gerontol B Psychol Sci Soc Sci 2015; 70:813-9. [PMID: 26033356 PMCID: PMC4841161 DOI: 10.1093/geronb/gbv034] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 04/14/2015] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Due to increasing interest in the positive experiences associated with family caregiving, potential demographic group differences were examined on the Positive Aspects of Caregiving (PAC) scale at both the item and scale levels. METHOD Family caregivers (N = 642) completed the PAC as part of their participation in the Resources for Enhancing Alzheimer's Caregiver Health (REACH II) clinical trial. Multiple indicators, multiple causes models were used to examine potential differential item functioning (DIF) across demographic subgroups. RESULTS Overall PAC scale scores indicated that both Hispanics and African Americans experienced more PAC than Whites. Two items with statistically significant (p < .004) and practically meaningful (odds ratio > 2.0) DIF were found for African American caregivers. After controlling for the underlying unidimensional construct, African Americans reported that caregiving gave them "a more positive attitude toward life" and enabled them to "appreciate life more" than either Whites or Hispanics. No instances of meaningful DIF were found between Hispanics and Whites, women and men, or spouses and nonspouses. DISCUSSION PAC scores differ significantly by race. In addition, 2 items with meaningful race DIF identify content areas that are particularly relevant to the cultural experiences of African American caregivers.
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Affiliation(s)
- David L Roth
- Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, MD.
| | | | - Jin Huang
- Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Alden L Gross
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Laura N Gitlin
- Department of Community-Public Health, School of Nursing, Johns Hopkins University, Baltimore, MD
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Rogers SE, Thrasher AD, Miao Y, Boscardin WJ, Smith AK. Discrimination in Healthcare Settings is Associated with Disability in Older Adults: Health and Retirement Study, 2008-2012. J Gen Intern Med 2015; 30:1413-20. [PMID: 25773918 PMCID: PMC4579241 DOI: 10.1007/s11606-015-3233-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 10/03/2014] [Accepted: 01/23/2015] [Indexed: 11/01/2022]
Abstract
BACKGROUND As our society ages, improving medical care for an older population will be crucial. Discrimination in healthcare may contribute to substandard experiences with the healthcare system, increasing the burden of poor health in older adults. Few studies have focused on the presence of healthcare discrimination and its effects on older adults. OBJECTIVE We aimed to examine the relationship between healthcare discrimination and new or worsened disability. DESIGN This was a longitudinal analysis of data from the nationally representative Health and Retirement Study administered in 2008 with follow-up through 2012. PARTICIPANTS Six thousand and seventeen adults over the age of 50 years (mean age 67 years, 56.3 % female, 83.1 % white) were included in this study. MAIN MEASURES Healthcare discrimination assessed by a 2008 report of receiving poorer service or treatment than other people by doctors or hospitals (never, less than a year=infrequent; more than once a year=frequent). Outcome was self-report of new or worsened disability by 2012 (difficulty or dependence in any of six activities of daily living). We used a Cox proportional hazards model adjusting for age, race/ethnicity, gender, net worth, education, depression, high blood pressure, diabetes, cancer, lung disease, heart disease, stroke, and healthcare utilization in the past 2 years. KEY RESULTS In all, 12.6 % experienced discrimination infrequently and 5.9 % frequently. Almost one-third of participants (29 %) reporting frequent healthcare discrimination developed new or worsened disability over 4 years, compared to 16.8 % of those who infrequently and 14.7 % of those who never experienced healthcare discrimination (p < 0.001). In multivariate analyses, compared to no discrimination, frequent healthcare discrimination was associated with new or worsened disability over 4 years (aHR = 1.63, 95 % CI 1.16-2.27). CONCLUSIONS One out of five adults over the age of 50 years experiences discrimination in healthcare settings. One in 17 experience frequent healthcare discrimination, and this is associated with new or worsened disability by 4 years. Future research should focus on the mechanisms by which healthcare discrimination influences disability in older adults to promote better health outcomes for an aging population.
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Affiliation(s)
- Stephanie E Rogers
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, CA, USA.
| | - Angela D Thrasher
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Yinghui Miao
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, CA, USA
| | - W John Boscardin
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Alexander K Smith
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, CA, USA
- Veterans Affairs Medical Center, San Francisco, CA, USA
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Dmitrieva NO, Fyffe D, Mukherjee S, Fieo R, Zahodne LB, Hamilton J, Potter GG, Manly JJ, Romero HR, Mungas D, Gibbons LE. Demographic characteristics do not decrease the utility of depressive symptoms assessments: examining the practical impact of item bias in four heterogeneous samples of older adults. Int J Geriatr Psychiatry 2015; 30:88-96. [PMID: 24737612 PMCID: PMC4198512 DOI: 10.1002/gps.4121] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 03/10/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Previous studies have identified differential item function (DIF) in depressive symptoms measures, but the impact of DIF has been rarely reported. Given the critical importance of depressive symptoms assessment among older adults, we examined whether DIF due to demographic characteristics resulted in salient score changes in commonly used measures. METHODS Four longitudinal studies of cognitive aging provided a sample size of 3754 older adults and included individuals both with and without a clinical diagnosis of major depression. Each study administered at least one of the following measures: the Center for Epidemiologic Studies Depression scale (20-item ordinal response or 10-item dichotomous response versions), the Geriatric Depression Scale, and the Montgomery-Åsberg Depression Rating Scale. Hybrid logistic regression-item response theory methods were used to examine the presence and impact of DIF due to age, sex, race/ethnicity, and years of education on the depressive symptoms items. RESULTS Although statistically significant DIF due to demographic factors was present on several items, its cumulative impact on depressive symptoms scores was practically negligible. CONCLUSIONS The findings support substantive meaningfulness of previously reported demographic differences in depressive symptoms among older adults, showing that these individual differences were unlikely to have resulted from item bias attributable to demographic characteristics we examined.
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Affiliation(s)
- Natalia O. Dmitrieva
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC 27710, U.S.A
| | - Denise Fyffe
- Kessler Foundation Research Center, Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers, the State University of New Jersey, West Orange, NJ 07052, U.S.A
| | | | - Robert Fieo
- Cognitive Neuroscience Division, Department of Neurology and Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10032, U.S.A
| | - Laura B. Zahodne
- Cognitive Neuroscience Division, Department of Neurology and Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10032, U.S.A
| | - Jamie Hamilton
- Cognitive Neuroscience Division, Department of Neurology and Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10032, U.S.A
| | - Guy G. Potter
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC 27710, U.S.A
- Joseph and Kathleen Bryan Alzheimer’s Disease Research Center, Duke University Medical Center, Durham, NC 27705, U.S.A
| | - Jennifer J. Manly
- Cognitive Neuroscience Division, Department of Neurology and Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY 10032, U.S.A
| | - Heather R. Romero
- Joseph and Kathleen Bryan Alzheimer’s Disease Research Center, Duke University Medical Center, Durham, NC 27705, U.S.A
- Department of Psychology, University of Notre Dame, Notre Dame, IN 46556, U.S.A
| | - Dan Mungas
- Department of Neurology, University of California, Davis, University of California, Davis Medical Center, Sacramento, CA 95817, U.S.A
| | - Laura E. Gibbons
- General Internal Medicine, University of Washington, Seattle, WA 98104, U.S.A
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Landrine H, Corral I. Advancing research on racial-ethnic health disparities: improving measurement equivalence in studies with diverse samples. Front Public Health 2014; 2:282. [PMID: 25566524 PMCID: PMC4273553 DOI: 10.3389/fpubh.2014.00282] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/04/2014] [Indexed: 11/24/2022] Open
Abstract
To conduct meaningful, epidemiologic research on racial-ethnic health disparities, racial-ethnic samples must be rendered equivalent on other social status and contextual variables via statistical controls of those extraneous factors. The racial-ethnic groups must also be equally familiar with and have similar responses to the methods and measures used to collect health data, must have equal opportunity to participate in the research, and must be equally representative of their respective populations. In the absence of such measurement equivalence, studies of racial-ethnic health disparities are confounded by a plethora of unmeasured, uncontrolled correlates of race-ethnicity. Those correlates render the samples, methods, and measures incomparable across racial-ethnic groups, and diminish the ability to attribute health differences discovered to race-ethnicity vs. to its correlates. This paper reviews the non-equivalent yet normative samples, methodologies and measures used in epidemiologic studies of racial-ethnic health disparities, and provides concrete suggestions for improving sample, method, and scalar measurement equivalence.
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Affiliation(s)
- Hope Landrine
- Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Irma Corral
- Department of Psychiatry and Behavioral Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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Development of health equity indicators in primary health care organizations using a modified Delphi. PLoS One 2014; 9:e114563. [PMID: 25478914 PMCID: PMC4257722 DOI: 10.1371/journal.pone.0114563] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/05/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The purpose of this study was to develop a core set of indicators that could be used for measuring and monitoring the performance of primary health care organizations' capacity and strategies for enhancing equity-oriented care. METHODS Indicators were constructed based on a review of the literature and a thematic analysis of interview data with patients and staff (n = 114) using procedures for qualitatively derived data. We used a modified Delphi process where the indicators were circulated to staff at the Health Centers who served as participants (n = 63) over two rounds. Indicators were considered part of a priority set of health equity indicators if they received an overall importance rating of>8.0, on a scale of 1-9, where a higher score meant more importance. RESULTS Seventeen indicators make up the priority set. Items were eliminated because they were rated as low importance (<8.0) in both rounds and were either redundant or more than one participant commented that taking action on the indicator was highly unlikely. In order to achieve health care equity, performance at the organizational level is as important as assessing the performance of staff. Two of the highest rated "treatment" or processes of care indicators reflects the need for culturally safe and trauma and violence-informed care. There are four indicators that can be used to measure outcomes which can be directly attributable to equity responsive primary health care. DISCUSSION These indicators and subsequent development of items can be used to measure equity in the domains of treatment and outcomes. These areas represent targets for higher performance in relation to equity for organizations (e.g., funding allocations to ongoing training in equity-oriented care provision) and providers (e.g., reflexive practice, skill in working with the health effects of trauma).
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Abstract
While recently there have been renewed interest in women's childbearing intentions, the authors sought to bring needed research attention to understanding men's childbearing intentions. Nationally representative data from the 2006-2010 National Survey of Family Growth (NSFG) was used to examine pregnancy intentions and happiness for all births reported by men in the 5 years preceding the interview. We used bivariate statistical tests of associations between intention status, happiness about the pregnancy, and fathers' demographic characteristics, including joint race/ethnicity and union status subgroups. Multivariate logistic regressions were used to calculate adjusted odds ratios of a birth being intended, estimated separately by father's union status at birth. Using comparable data and measures from the male and female NSFG surveys, we tested for gender differences intentions and happiness, and examined the sensitivity of our results to potential underreporting of births by men. Nearly four out of ten of births to men were reported as unintended, with significant variation by men's demographic traits. Non-marital childbearing was more likely to be intended among Hispanic and black men. Sixty-two percent of births received a 10 on the happiness scale. Happiness about the pregnancy varied significantly by intention status. Men were significantly happier than women about the pregnancies, with no significant difference in intention status. Potential underreporting of births by men had little impact on these patterns. This study brings needed focus to men's childbearing intentions and improves our understanding of the context of their role as fathers. Men need to be included in strategies to prevent unintended pregnancy.
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Burgard SA, Chen PV. Challenges of health measurement in studies of health disparities. Soc Sci Med 2014; 106:143-50. [PMID: 24561776 DOI: 10.1016/j.socscimed.2014.01.045] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 01/25/2014] [Accepted: 01/27/2014] [Indexed: 12/29/2022]
Abstract
Health disparities are increasingly studied in and across a growing array of societies. While novel contexts and comparisons are a promising development, this commentary highlights four challenges to finding appropriate and adequate health measures when making comparisons across groups within a society or across distinctive societies. These challenges affect the accuracy with which we characterize the degree of inequality, limiting possibilities for effectively targeting resources to improve health and reduce disparities. First, comparisons may be challenged by different distributions of disease and second, by variation in the availability and quality of vital events and census data often used to measure health. Third, the comparability of self-reported information about specific health conditions may vary across social groups or societies because of diagnosis bias or diagnosis avoidance. Fourth, self-reported overall health measures or measures of specific symptoms may not be comparable across groups if they use different reference groups or interpret questions or concepts differently. We explain specific issues that make up each type of challenge and show how they may lead to underestimates or inflation of estimated health disparities. We also discuss approaches that have been used to address them in prior research, note where further innovation is needed to solve lingering problems, and make recommendations for improving future research. Many of our examples are drawn from South Africa or the United States, societies characterized by substantial socioeconomic inequality across ethnic groups and wide disparities in many health outcomes, but the issues explored throughout apply to a wide variety of contexts and inquiries.
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Affiliation(s)
- Sarah A Burgard
- University of Michigan, Department of Sociology, 500 South State Street, Ann Arbor, MI 48109-1382, USA.
| | - Patricia V Chen
- University of Michigan, Department of Sociology, 500 South State Street, Ann Arbor, MI 48109-1382, USA.
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Marra L, Field C, Caetano R, von Sternberg K. Construct validity of the short inventory of problems among Spanish speaking Hispanics. Addict Behav 2014; 39:205-10. [PMID: 24148139 DOI: 10.1016/j.addbeh.2013.09.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 08/07/2013] [Accepted: 09/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Research on ethnic health disparities requires the use of psychometrically sound instruments that are appropriate when applied to ethnically diverse populations. The Short Inventory of Problems (SIP) assesses alcohol-related consequences and is often used as a measure to evaluate intervention effectiveness in alcohol research; however, whether the psychometric properties of this instrument are comparable across language and ethnicity remains unclear. METHOD Multi-group confirmatory factor analysis (MGCFA) was used to test for the invariance of the measurement structure of the SIP across White Non-Hispanic English speaking (N=642), Hispanic English speaking (N=275), and Hispanic Spanish speaking (N=220) groups. RESULTS The MGCFA model in which factor loadings, measurement intercepts, and item residuals were constrained to be equal between English speakers and Spanish speakers exhibited a reasonable fit to the data, χ(2)(221)=1089.612 p<.001, TLI=.926; CFI=.922, RMSEA=.059 (90% CI=.055-.062). The ΔCFI supported strict factorial invariance, ΔCFI=.01, across groups; no significant group differences were found between factor loadings, measurement intercepts, or item residuals between English speakers and Spanish speakers. CONCLUSIONS This study extends the existing confirmatory factor analysis results of the SIP by providing additional data to inform the utility of the SIP among Hispanics. Strict factorial invariance between Spanish and English speakers is necessary to: conclude that the underlying constructs have the same meaning across groups; test for group differences in the latent variables across groups; and presume that group differences are attributable only to true differences between groups. Thus, the SIP is strongly supported for evaluating the effectiveness of alcohol treatment among Hispanics.
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Hong S, Cagle J. Factors associated with perceptions of the cancer care system: a multilevel modeling approach. J Psychosoc Oncol 2013; 31:642-58. [PMID: 24175900 DOI: 10.1080/07347332.2013.835020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Perceptions about the health care system are a key driver of disparities and utilization. This study examined individual and contextual factors related to care and noncare dimensions and their relationship to perceptions of the cancer care system. A national sample of 877 cases was modeled using a multilevel modeling approach. Insurance complaints, number of treatments, and advocacy impact were negatively associated with satisfaction with the cancer care system at the individual level. Also, respondents in states where more Christians resided and lower hospital capacity were more likely to indicate satisfaction. Findings suggest implications for practitioners and health policy makers.
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Affiliation(s)
- Seokho Hong
- a School of Social Work , University of Maryland , Baltimore , MD , USA
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Does the Consumer Assessment of Healthcare Providers and Systems Cultural Competence Survey provide equivalent measurement across English and Spanish versions? Med Care 2012; 50:S37-41. [PMID: 22895229 DOI: 10.1097/mlr.0b013e3182665189] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The English and Spanish versions of the Consumer Assessments of Healthcare Providers and Systems (CAHPS) Cultural Competence Survey (CAHPS-CC) assess patients' experiences with culturally competent care. The possibility exists that even when Spanish and English speakers experience the same levels of culturally competent care, responses describing their care may differ. This is called measurement bias. To deliver reliable and valid information across language, responses must provide equivalent measurement across both versions. In this study, we examined whether measurement bias on the CAHPS-CC impedes valid measurement across the English and Spanish versions. METHODS We used multiple group (MG) confirmatory factor analyses (CFA) to examine measurement bias across English (n=851) and Spanish (n=113) speakers. Participants came from a 2008 sample of 2 Medicaid managed care plans in New York and California. RESULTS MG-CFA provided general support for the equivalence of the CAHPS-CC in measuring doctor communication-positive behaviors, doctor communication-negative behaviors, doctor communication-preventative care, equitable treatment, and trust. We did observe statistically significant differences in the thresholds associated with the item asking whether a doctor gave easier to understand instructions. However, analyses indicated that bias did not meaningfully influence conclusions about average experiences using the English and Spanish versions of the CAHPS-CC. CONCLUSIONS Our results support the use of the English and Spanish versions of the CAHPS-CC. Though we found some bias, analyses demonstrated that it did not substantively impact conclusions for the studied domains. Health providers can place confidence in the 2 different CAHPS-CC translations.
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Teresi JA, Stewart AL, Stahl SM. Fifteen years of progress in measurement and methods at the resource centers for minority aging research. J Aging Health 2012; 24:985-91. [PMID: 22904184 DOI: 10.1177/0898264312457750] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jeanne A Teresi
- Columbia University Stroud Center and Research Division, Hebrew Home, NY, USA.
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Stewart AL, Thrasher AD, Goldberg J, Shea JA. A framework for understanding modifications to measures for diverse populations. J Aging Health 2012; 24:992-1017. [PMID: 22495768 PMCID: PMC3768261 DOI: 10.1177/0898264312440321] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Research on health disparities and determinants of health disparities among ethnic minorities and vulnerable older populations necessitates use of self-report measures. Most established instruments were developed on mainstream populations and may need adaptation for research with diverse populations. Although information is increasingly available on various problems using these measures in diverse groups, there is little guidance on how to modify the measures. A framework of issues to consider when modifying measures for diverse populations is presented. METHODS The authors describe reasons for considering modifications, the types of information that can be used as a basis for making modifications, and the types of modifications researchers have made. Recommendations are made to test modified measures to assure their appropriateness, and suggestions are provided on reporting modifications in publications using the measures. DISCUSSION The issues open a dialogue about what appropriate guidelines would be for researchers adapting measures in studies of ethnically diverse populations.
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Affiliation(s)
- Anita L Stewart
- Institute for Health & Aging, University of California San Francisco, 3333 California St. Suite 340, San Francisco, CA 94118, Phone: 415 502-5207,
| | - Angela D Thrasher
- Department of Health Behavior and Health Education, University of North Carolina Gillings School of Global Public Health, 315 Rosenau Hall, CB #7440, Chapel Hill, NC 27599-7440, Phone: 919-843-9293,
| | - Jack Goldberg
- Vietnam Era Twin Registry, Seattle VA and the University of Washington School of Public Health, Box 359780, 1730 Minor Avenue, Suite 1760, Seattle, WA 98105-1597, Phone: 206 543-4667,
| | - Judy A. Shea
- University of Pennsylvania, School of Medicine, Division of General Internal Medicine, 1223 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, Phone: 215 573-5111,
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Lebovits A. Maintaining Professionalism in Today's Business Environment: Ethical Challenges for the Pain Medicine Specialist. PAIN MEDICINE 2012; 13:1152-61. [DOI: 10.1111/j.1526-4637.2012.01465.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Roth DL, Mwase I, Holt CL, Clark EM, Lukwago SN, Kreuter MW. Religious involvement measurement model in a national sample of African Americans. JOURNAL OF RELIGION AND HEALTH 2012; 51:567-78. [PMID: 21416161 PMCID: PMC3646409 DOI: 10.1007/s10943-011-9475-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This study examined the factor structure of a brief measure of religious involvement developed previously in research with African American women. Telephone interview methods were used with a national sample of both African American women and men (N = 2,370). Confirmatory factor analyses supported the distinction between religious beliefs and religious behaviors factors and indicated that the factor loadings were equivalent for women and men. Women reported higher levels of religious involvement than men. These results support the validity of this relatively brief instrument for assessing these two dimensions of religious involvement for both African American women and men.
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Affiliation(s)
- David L Roth
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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Bagchi AD, Af Ursin R, Leonard A. Assessing cultural perspectives on healthcare quality. J Immigr Minor Health 2012; 14:175-82. [PMID: 20945098 DOI: 10.1007/s10903-010-9403-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study explores cultural differences in perceptions of quality of care and examines whether existing surveys, such as the Consumer Assessment of Healthcare Providers and Systems (CAHPS(®)) questionnaires, adequately capture conceptions of healthcare quality among members of racial/ethnic minority groups. Eight focus groups with African Americans, Asian Indians, Latinos, and whites were organized into two 45-minute segments. In one segment, participants rated the quality of care depicted in a video; in the other they discussed the concept of "healthcare quality." We found that members of racial/ethnic minority groups are more likely than whites to identify cultural competency and providing a holistic approach to care as important to healthcare quality. Neither of these concepts is currently included in the core CAHPS(®) questionnaire. The CAHPS(®) and other quality surveys may not accurately capture concepts of healthcare quality that members of racial/ethnic minority groups deem most important.
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Affiliation(s)
- Ann D Bagchi
- Research Division, Mathematica Policy Research, Princeton, NJ 08540, USA.
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Ashing-Giwa K, Rosales M. A cross-cultural validation of patient-reported outcomes measures: a study of breast cancers survivors. Qual Life Res 2012; 22:295-308. [PMID: 22367682 DOI: 10.1007/s11136-012-0140-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE Psychometric inadequacy interferes with the assessment of patient-reported health outcomes. This study examined the psychometric properties of several standardized measures in health research. METHODS Participants completed health outcomes measures including the FACT-G, SF-36, MOS Social Support Survey, and CES-D. Psychometric properties examined include reliability, and construct and concurrent validity. RESULTS 320 BCS including 88 African-, 95 English-proficient Latina-, and 137 Limited English-proficient Latina-Americans participated. The findings demonstrate acceptable reliability (α > 0.70) and consistent factor structures for most measures with the variance ranging from 56 to 84%. The FACT-G physical well-being and SF-36 role limitations subscales had the best fitting structures. Concurrent validity showed the FACT-G subscales correlated with their appropriate counterparts. CONCLUSIONS Despite being commonly used instruments in HRQOL (e.g., FACT-G, SF-36) and QOL (e.g., CES-D, MOS) research, few studies reported the psychometric properties of these and when applied cross-culturally. However, evaluating the psychometric properties of measures in health outcomes research should be done routinely.
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Affiliation(s)
- K Ashing-Giwa
- Center of Community Alliance for Research and Education (CCARE), Department of Population Sciences, City of Hope National Medical Center, 1500 E Duarte Road, Duarte, CA 91010-3000, USA.
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A Pragmatic Randomized Controlled Trial of Computerized CBT (SPARX) for Symptoms of Depression among Adolescents Excluded from Mainstream Education. Behav Cogn Psychother 2011; 40:529-41. [DOI: 10.1017/s1352465811000695] [Citation(s) in RCA: 172] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: Adolescents excluded from mainstream education have high mental health needs. The use of computerized Cognitive Behavioural Therapy (cCBT) has not been investigated with this group. Aims: To test the efficacy of the SPARX cCBT programme for symptoms of depression among adolescents in programmes for students excluded or alienated from mainstream education. Method: Adolescents (32; 34% Maori, 38% Pacific Island, 56% male) aged 13–16 with Child Depression Rating Scale Revised (CDRS-R) scores indicating possible through to almost certain depressive disorder were randomized to SPARX to be completed over the following 5 weeks (n = 20) or to waitlist control (n = 12). Assessments were at baseline, 5 weeks and 10 weeks. Those in the wait condition were invited to complete SPARX after the 5 week assessment. Results: Most participants (n = 26, 81%) completed at least 4 levels of SPARX and 22 (69%) completed all 7 levels. Among the 30 (94%) participants who began treatment as randomized and provided 5-week data, significant differences were found between cCBT and wait groups on the CDRS-R (baseline to 5-week mean change –14.7 versus –1.1, p<.001), remission (78% vs. 36%, p = .047) and on the Reynolds Adolescent Depression Scale (–4.6 vs. +3.2 p = .05) but not on other self-rating psychological functioning scales. In intent-to-treat analyses CDRS-R changes and remission remained significant. Gains were maintained at 10-week follow-up. Conclusions: SPARX appears to be a promising treatment for students with symptoms of depression who are in alternative schooling programmes for those excluded from mainstream education.
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Wong ST, Browne AJ, Varcoe C, Lavoie J, Smye V, Godwin O, Littlejohn D, Tu D. Enhancing measurement of primary health care indicators using an equity lens: An ethnographic study. Int J Equity Health 2011; 10:38. [PMID: 21892956 PMCID: PMC3182883 DOI: 10.1186/1475-9276-10-38] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 09/05/2011] [Indexed: 11/24/2022] Open
Abstract
Introduction One important goal of strengthening and renewal in primary healthcare (PHC) is achieving health equity, particularly for vulnerable populations. There has been a flurry of international activity toward the establishment of indicators relevant to measuring and monitoring PHC. Yet, little attention has been paid to whether current indicators: 1) are sensitive enough to detect inequities in processes or outcomes of care, particularly in relation to the health needs of vulnerable groups or 2) adequately capture the complexity of delivering PHC services across diverse groups. The purpose of this paper is to contribute to the discourse regarding what ought to be considered a PHC indicator and to provide some concrete examples illustrating the need for modification and development of new indicators given the goal of PHC achieving health equity. Methods Within the context of a larger study of PHC delivery at two Health Centers serving people facing multiple disadvantages, a mixed methods ethnographic design was used. Three sets of data collected included: (a) participant observation data focused on the processes of PHC delivery, (b) interviews with Health Center staff, and (c) interviews with patients. Results Thematic analysis suggests there is a disjuncture between clinical work addressing the complex needs of patients facing multiple vulnerabilities such as extreme levels of poverty, multiple chronic conditions, and lack of housing and extant indicators and how they are measured. Items could better measure and monitor performance at the management level including, what is delivered (e.g., focus on social determinants of health) and how services are delivered to socially disadvantaged populations (e.g., effective use of space, expectation for all staff to have welcoming and mutually respectful interactions). New indicators must be developed to capture inputs (e.g., stability of funding sources) and outputs (e.g., whole person care) in ways that better align with care provided to marginalized populations. Conclusions The current emphasis on achieving greater equity through PHC, the continued calls for the renewal and strengthening of PHC, and the use of monitoring and performance indicators highlight the relevance of ensuring that there are more accurate methods to capture the complex work of PHC organizations.
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Affiliation(s)
- Sabrina T Wong
- University of British Columbia (UBC) School of Nursing, Critical Research in Health and Health care Inequities, 2211 Wesbrook Mall, Vancouver, British Columbia, V6T-2B5, Canada.
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Wallen GR, Middleton KR, Rivera-Goba MV, Mittleman BB. Validating English- and Spanish-language patient-reported outcome measures in underserved patients with rheumatic disease. Arthritis Res Ther 2011; 13:R1. [PMID: 21208400 PMCID: PMC3216273 DOI: 10.1186/ar3219] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 10/19/2010] [Accepted: 01/05/2011] [Indexed: 11/25/2022] Open
Abstract
Introduction Rheumatic diseases are among the most common and debilitating health problems in the United States. These diseases are chronic, can result in severe decrements of physical and psychosocial functioning and affect patients' overall quality of life. A consensus regarding the best patient outcomes to be measured in randomized, controlled trials and prospective natural history studies is essential to provide best estimates of efficacy and safety of interventions across diverse patient populations. Methods Face-to-face English- and Spanish-language cognitive interviews were conducted among urban Hispanic and African American patients with rheumatic disease to develop a questionnaire booklet. Six measures validating patient-reported outcomes were included: the Arthritis Self-Efficacy Scale, the Stanford Health Assessment Questionnaire Disability Index, the Wong-Baker Faces Pain Scale, the Short Acculturation Scale, the Center for Epidemiologic Studies Depression Scale and the Inventory of Complementary and Alternative Medicine Practices. A sample of patients (n = 15) attending the National Institute of Arthritis and Musculoskeletal and Skin Diseases Community Health Center participated in the initial interviews. Revised measures were further tested for reliability in a separate sample of patients (n = 109) upon enrollment at the health center. Results Cognitive interviews provided feedback for questionnaire modifications and methods to enhance content validity and data quality, including discarding redundant questions, providing visual aids and concrete examples when appropriate and increasing the use of racially and ethnically concordant interviewers. The cognitive interviews further elucidated that some contextual assumptions and language usage in the original questionnaires may not have taken each respondent's environmental and sociocultural context into consideration. Internal reliability for previously tested measures remained high (Cronbach's α = 0.87-0.94). Conclusions Cognitive interviewing techniques are useful in a diverse sample of racial and ethnic minority patients with rheumatic disease as a method to assess the content validity of the specific outcome measures selected. The data collection approaches and methods described here ultimately enhance data quality. Vigilance is required in the selection of outcome measures in studies or in practice, particularly with each new language translation and/or culturally unique or diverse sample.
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Affiliation(s)
- Gwenyth R Wallen
- Nursing and Patient Care Services, Clinical Center, National Institutes of Health, 10 Center Drive, Room 2B14, MSC-115, Bethesda, MD 20892-1151, USA.
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Day EC, Li Y, Diez-Roux A, Kandula N, Moran A, Rosas S, Shlipak MG, Peralta CA. Associations of acculturation and kidney dysfunction among Hispanics and Chinese from the Multi-Ethnic Study of Atherosclerosis (MESA). Nephrol Dial Transplant 2010; 26:1909-16. [PMID: 21051500 DOI: 10.1093/ndt/gfq676] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Acculturation affects health, but it has never been studied with kidney disease. METHODS We studied the association of language spoken at home, generation and birth place with kidney function among Hispanics and Chinese in the Multi-Ethnic Study of Atherosclerosis (n = 2999). Kidney function was determined by cystatin C (eGFRcys) and albumin/creatinine ratio (ACR). We evaluated mediators in models: Model 1 = age, sex, income, education; Model 2 = Model 1 + behaviors; and Model 3 = Model 1 + comorbidities. RESULTS Among Hispanics, speaking mixed Spanish/English was significantly associated with lower eGFRcys (- 2.83 mL/min/1.73 m(2), - 5.69-0.04) and higher ACR (RD 40%, 17-68%) compared with speaking Spanish only; this was mildly attenuated by behaviors (- 2.29, - 5.33-0.75; RD 42%, 18-72%) but not comorbidities (- 3.04, - 5.83 to - 0.23); RD 35%, 14-59%). US-born Hispanics had lower eGFRcys compared with foreign-born Hispanics [1.83 mL/min/1.73 m(2) lower (0.97-1.31) for Generation 1; 1.37 mL/min/1.73 m(2) lower (0.75-1.57) for Generation ≥ 2]. In contrast, Chinese who spoke any English had higher eGFRcys (2.53, 95% CI: - 1.70-6.78), but similar ACR (RD - 5%, 95% CI: - 26-23%) compared with those speaking Chinese only, but associations were not statistically significant. CONCLUSION Higher acculturation was associated with worse kidney function in Hispanics, mediated perhaps by behavioral factors but not comorbidities. Associations may be in the opposite direction among Chinese. Future studies are needed to elucidate these mechanisms.
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Affiliation(s)
- Erica Chan Day
- San Francisco VA Medical Center, San Francisco, CA, USA.
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