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Arundell LLC, Saunders R, Buckman JEJ, Lewis G, Stott J, Singh S, Jena R, Naqvi SA, Leibowitz J, Pilling S. Differences in psychological treatment outcomes by ethnicity and gender: an analysis of individual patient data. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1519-1531. [PMID: 38321296 PMCID: PMC11343885 DOI: 10.1007/s00127-024-02610-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/01/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE There are discrepancies in mental health treatment outcomes between ethnic groups, which may differ between genders. NHS Talking Therapies for anxiety and depression provide evidence-based psychological therapies for common mental disorders. This study examines the intersection between ethnicity and gender as factors associated with psychological treatment outcomes. Aims were to explore by gender: (1) differences in psychological treatment outcomes for minoritized ethnic people compared to White-British people, (2) whether differences are observed when controlling for clinical and socio-demographic factors associated with outcomes, and (3) whether organization-level factors moderate differences in outcomes between ethnic groups. METHODS Patient data from eight NHS Talking Therapies for anxiety and depression services (n = 98,063) was used to explore associations between ethnicity and outcomes, using logistic regression. Stratified subsamples were used to separately explore factors associated with outcomes for males and females. RESULTS In adjusted analyses, Asian (OR = 0.82 [95% CI 0.78; 0.87], p < .001, 'Other' (OR = 0.79 [95%CI 0.72-0.87], p < .001) and White-other (0.93 [95%CI 0.89-0.97], p < .001) ethnic groups were less likely to reliably recover than White-British people. Asian (OR = 1.48 [95% CI 1.35-1.62], p < .001), Mixed (OR = 1.18 [95% CI 1.05-1.34], p = .008), 'Other' (OR = 1.60 [95% CI 1.38-1.84], p < .001) and White-other (OR = 1.18 [95% CI 1.09-1.28], p < .001) groups were more likely to experience a reliable deterioration in symptoms. Poorer outcomes for these groups were consistent across genders. There was some evidence of interactions between ethnic groups and organization-level factors impacting outcomes, but findings were limited. CONCLUSIONS Across genders, Asian, 'Other' and White-other groups experienced worse treatment outcomes across several measures in adjusted models. Reducing waiting times or offering more treatment sessions might lead to increased engagement and reduced drop-out for some patient groups.
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Affiliation(s)
- Laura-Louise C Arundell
- CORE Data Lab, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK.
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK.
| | - Rob Saunders
- CORE Data Lab, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK
| | - Joshua E J Buckman
- CORE Data Lab, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK
- iCope, Camden and Islington Psychological Therapies Services, Camden and Islington NHS Foundation Trust, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, W1T 7NF, UK
| | - Joshua Stott
- CORE Data Lab, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK
- ADAPT Lab, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK
| | - Satwant Singh
- Waltham Forest Talking Therapies, North-East London NHS Foundation Trust, London, UK
| | - Renuka Jena
- Waltham Forest Talking Therapies, North-East London NHS Foundation Trust, London, UK
| | | | - Judy Leibowitz
- iCope, Camden and Islington Psychological Therapies Services, Camden and Islington NHS Foundation Trust, London, UK
| | - Stephen Pilling
- CORE Data Lab, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
- iCope, Camden and Islington Psychological Therapies Services, Camden and Islington NHS Foundation Trust, London, UK
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Claridy MD, Hernandez-Green N, Rathbun SL, Cordero JF. Community level factors and racial inequities in delivery hospitalizations involving severe maternal morbidity in the United States, 2016-2019. Sci Rep 2024; 14:19297. [PMID: 39164399 PMCID: PMC11336213 DOI: 10.1038/s41598-024-70130-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 08/13/2024] [Indexed: 08/22/2024] Open
Abstract
The objective of this study was to evaluate the racial and ethnic disparities in delivery hospitalizations involving severe maternal morbidity (SMM) by location of residence and community income. We used the 2016 to 2019 Healthcare Cost and Utilization Project National Inpatient Sample. International Classification of Diseases, Tenth Revision, Clinical Modification codes were used to identify delivery hospitalizations with SMM. Using logistic regression models, we examined the association between race and ethnicity and delivery hospitalizations involving SMM. In adjusted analyses, the models were stratified by location of residence and community income and adjusted for patient and hospital characteristics. In rural areas, non-Hispanic Black women (AOR 1.50; 95% CI 1.25-1.79) and women of other races (AOR 1.32; 95% CI 1.03-1.69) had an increased odds of experiencing a delivery hospitalization involving SMM when compared to non-Hispanic White women. In micropolitan areas, non-Hispanic Black women (AOR 1.88; 95% CI 1.79-1.97), non-Hispanic Asian/Pacific Islander women (AOR 1.54; 95% CI 1.16-2.05), and women of other races (AOR 1.31; 95% CI 1.03-1.67) had an increased odds of experiencing a delivery hospitalization involving SMM when compared to non-Hispanic White women. Non-Hispanic Black women also had increased odds of experiencing a delivery hospitalization involving SMM in communities with the lowest income (quartile 1) (AOR 1.59; 95% CI 1.49-1.66), middle income (quartiles 2 and 3) (AOR 1.81; 95% CI 1.72-1.91), and highest income (AOR 2.09; 95% CI 1.90-2.29) when compared to non-Hispanic White women. We found that location of residence and community income are associated with racial and ethnic differences in SMM in the United States. These factors, outside of individual factors assessed in previous studies, provide a better understanding of some of the structural and systemic factors that may contribute to SMM.
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Affiliation(s)
- Mechelle D Claridy
- Department of Epidemiology and Biostatistics, University of Georgia, 101 Buck Road, 30602, Athens, Georgia.
| | - Natalie Hernandez-Green
- Center for Maternal Health Equity, Morehouse School of Medicine, 720 Westview Drive, Atlanta, Georgia
| | - Stephen L Rathbun
- Department of Epidemiology and Biostatistics, University of Georgia, 101 Buck Road, 30602, Athens, Georgia
| | - José F Cordero
- Department of Epidemiology and Biostatistics, University of Georgia, 101 Buck Road, 30602, Athens, Georgia
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Midgette Y, Halvorson E, Chandler A, Aguilar A, Strahley AE, Gomez Y, Lassiter R, Akinola M, Hanson S, Montez K. Caregiver and Provider Perceptions of Health Disparities in the NICU: A Qualitative Study. Acad Pediatr 2024:S1876-2859(24)00284-5. [PMID: 39069230 DOI: 10.1016/j.acap.2024.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 07/08/2024] [Accepted: 07/21/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVES To describe the experience of caregivers and their perceptions of disparate care in the NICU, and (2) explore inter-professional NICU provider perspectives on potential biases and perceptions of disparate care. METHODS This qualitative study was conducted in one southeastern level IV NICU. Semi-structured interviews assessed caregiver and provider perspectives on NICU care. Purposive sampling ensured ≥50% of caregivers self-identified as racial and/or ethnic minorities. Interviews were recorded, transcribed verbatim, and audio verified. A coding scheme was developed, raw data were systematically coded, and emerging themes were identified using thematic analyses. RESULTS 23 caregivers and 14 providers were interviewed, including 5 neonatologists, 6 nurses, and 3 residents. Caregivers were predominantly English-speaking (85%); 96% were mothers with a mean age of 32 years. Neonates were predominantly racial and ethnic minorities (62%). Providers were predominantly White (71%) and female (71%). Five themes emerged: (1) ineffective, biased communication between caregivers, providers, and healthcare team may contribute to disparities (2) language barriers and lack of interpreter access play a significant role in perceived negative care; (3) lack of caregiver involvement and role in decision-making may negatively influence NICU outcomes, especially for those not able to be present at the bedside; and (4) multiple biases may affect neonatal health disparities. CONCLUSION Our study highlights the importance of considering both provider and racial and/or ethnic minority caregiver perceptions disparities in NICU care delivery. It adds to the literature as one of the few qualitative studies comparing perceptions of disparate NICU care among both caregivers and providers.
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Affiliation(s)
- Yasmeen Midgette
- Department of Pediatrics, Wake Forest University School of Medicine, One Medical Center Blvd, Winston-Salem, NC 27157.
| | - Elizabeth Halvorson
- Department of Pediatrics, Wake Forest University School of Medicine, One Medical Center Blvd, Winston-Salem, NC 27157.
| | - Allison Chandler
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, 525 Vine St, Winston-Salem, NC 27101.
| | - Aylin Aguilar
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, 525 Vine St, Winston-Salem, NC 27101.
| | - Ashley E Strahley
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, 525 Vine St, Winston-Salem, NC 27101.
| | - Yorjannys Gomez
- Department of Pediatrics, Wake Forest University School of Medicine, One Medical Center Blvd, Winston-Salem, NC 27157.
| | - Rebekah Lassiter
- Department of Pediatrics, Wake Forest University School of Medicine, One Medical Center Blvd, Winston-Salem, NC 27157.
| | - Modupeola Akinola
- Department of Pediatrics, Wake Forest University School of Medicine, One Medical Center Blvd, Winston-Salem, NC 27157.
| | - Shannon Hanson
- Department of Pediatrics, Wake Forest University School of Medicine, One Medical Center Blvd, Winston-Salem, NC 27157.
| | - Kimberly Montez
- Departments of Pediatrics and Social Sciences & Health Policy, Wake Forest University School of Medicine, One Medical Center Blvd, Winston-Salem, NC 27157.
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Álvarez-Cruces DJ, Otondo-Briceño M, Nocceti-de-la-Barra A, Medina-Moreno A, Henríquez-Tejo R. Cultural topics with clinical implications needed in the dental curriculum to develop intercultural competence: A systematic review. J Dent Educ 2024; 88:922-932. [PMID: 38551308 DOI: 10.1002/jdd.13509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/02/2024] [Accepted: 02/23/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVE To identify cultural topics with clinical implications to be incorporated into the dentistry curriculum to develop Intercultural Competence. METHODS Systematic review with PRISMA criteria that exported 216 articles from the Web of Science, Scopus, and SciELO databases from 2012 to 2022, of which 40 were selected. The inclusion criteria were theoretical and empirical scientific articles, of quantitative, qualitative, or mixed methods nature, on cultural topics. RESULTS The data analysis allowed the organization of information into four cultural topics: Development of professional intercultural self-awareness, Individual, family, and cultural implications, Construction of intercultural therapeutic relationships, and Specific clinical aspects, each with particular contents to be developed in the dentistry curriculum. However, some clinical issues have yet to be explored in-depth, leaving research possibilities open to all disciplines in dentistry. Additionally, it is necessary to analyze the cultural bias in the discussion and conclusion of some reviewed articles, as they were conducted from an ethnocentric perspective. Thus, peer reviewers of scientific journals and researchers in these topics must have appropriate training in Intercultural Competence. CONCLUSIONS This review provides a guide and pedagogical sequence of the cultural topics that should be incorporated into the dentistry curriculum to achieve Intercultural Competence, it also highlights a wide range of relevant aspects to consider in establishing an adequate therapeutic relationship. Explicit accreditation criteria contribute to the establishment of Intercultural Competence in the curricula; however, in countries that lack regulations, there is a moral and ethical duty to incorporate the subject so that the future professional can manage and establish inclusive healthcare.
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Affiliation(s)
- Debbie J Álvarez-Cruces
- Departamento de Patología y Diagnóstico, Facultad de Odontología, Universidad de Concepción, Concepcion, Chile
- Facultad de Educación, Universidad Católica de la Santísima Concepción, Concepcion, Chile
| | - Maite Otondo-Briceño
- Facultad de Educación, Universidad Católica de la Santísima Concepción, Concepcion, Chile
| | | | - Alejandra Medina-Moreno
- Departamento de Patología y Diagnóstico, Facultad de Odontología, Universidad de Concepción, Concepcion, Chile
| | - Rocío Henríquez-Tejo
- Departamento de Salud Pública, Facultad de Odontología, Universidad de Concepción, Concepcion, Chile
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Barcelona V, Scharp D, Idnay BR, Moen H, Cato K, Topaz M. Identifying stigmatizing language in clinical documentation: A scoping review of emerging literature. PLoS One 2024; 19:e0303653. [PMID: 38941299 PMCID: PMC11213326 DOI: 10.1371/journal.pone.0303653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/30/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Racism and implicit bias underlie disparities in health care access, treatment, and outcomes. An emerging area of study in examining health disparities is the use of stigmatizing language in the electronic health record (EHR). OBJECTIVES We sought to summarize the existing literature related to stigmatizing language documented in the EHR. To this end, we conducted a scoping review to identify, describe, and evaluate the current body of literature related to stigmatizing language and clinician notes. METHODS We searched PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Embase databases in May 2022, and also conducted a hand search of IEEE to identify studies investigating stigmatizing language in clinical documentation. We included all studies published through April 2022. The results for each search were uploaded into EndNote X9 software, de-duplicated using the Bramer method, and then exported to Covidence software for title and abstract screening. RESULTS Studies (N = 9) used cross-sectional (n = 3), qualitative (n = 3), mixed methods (n = 2), and retrospective cohort (n = 1) designs. Stigmatizing language was defined via content analysis of clinical documentation (n = 4), literature review (n = 2), interviews with clinicians (n = 3) and patients (n = 1), expert panel consultation, and task force guidelines (n = 1). Natural language processing was used in four studies to identify and extract stigmatizing words from clinical notes. All of the studies reviewed concluded that negative clinician attitudes and the use of stigmatizing language in documentation could negatively impact patient perception of care or health outcomes. DISCUSSION The current literature indicates that NLP is an emerging approach to identifying stigmatizing language documented in the EHR. NLP-based solutions can be developed and integrated into routine documentation systems to screen for stigmatizing language and alert clinicians or their supervisors. Potential interventions resulting from this research could generate awareness about how implicit biases affect communication patterns and work to achieve equitable health care for diverse populations.
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Affiliation(s)
- Veronica Barcelona
- Columbia University School of Nursing, New York, New York, United States of America
| | - Danielle Scharp
- Columbia University School of Nursing, New York, New York, United States of America
| | - Betina R. Idnay
- Department of Biomedical Informatics, Columbia University, New York, New York, United States of America
| | - Hans Moen
- Department of Computer Science, Aalto University, Aalto, Finland
| | - Kenrick Cato
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States of America
| | - Maxim Topaz
- Columbia University School of Nursing, New York, New York, United States of America
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Goddard-Eckrich D, Stringer KL, Richer A, Dasgupta A, Brooks D, Cervantes M, Downey DL, Kelleher P, Bell SL, Hunt T, Wu E, Johnson KA, Hall J, Guy-Cupid GAN, Thomas BV, Edwards K, Ramesh V, Gilbert L. 'Yeah, they suck. It's like they don't care about our health.' Medical mistrust among Black women under community supervision in New York city. CULTURE, HEALTH & SEXUALITY 2024:1-16. [PMID: 38915232 DOI: 10.1080/13691058.2024.2358084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 05/17/2024] [Indexed: 06/26/2024]
Abstract
Black women in the USA experience some of the poorest health outcomes and this is especially true for those involved in the carceral system who are at elevated risks for HIV/STIs, reproductive health, and chronic diseases. This study aimed to investigate Black women's experience accessing healthcare services. We conducted semi-structured interviews with 43 women from Project EWORTH under community supervision in New York City. We analysed responses focusing on barriers to healthcare engagement. All interviews were recorded, and data analysis was conducted using NVivo. Themes influencing Black women's ability to engage with healthcare providers and systems included: 1) disclosed provider mistrust/judgement; 2) feeling disrespected by providers and the medical system; 3) mistrust of medical providers/system/hospital/government; 4) lack of health communication; 5) low health literacy; 6) provider gender preference. Findings highlight the need to improve trust and collaboration between healthcare providers and Black women. This study addresses the critical gap in understanding perceptions of discrimination, stigma, and barriers to attaining health care. Funders and accreditation agencies must hold providers and organisations accountable for acquiring and making available diversity, equity and inclusion training for providers, demonstrating increasingly equitable medical relationships through responsiveness to patient feedback, and increasing the number of Black providers.
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Affiliation(s)
- Dawn Goddard-Eckrich
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Kristi L Stringer
- Department of Health and Human Performance, Public Health. Middle Tennessee State University, Murfreesboro, TN, USA
| | - Ariel Richer
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Anindita Dasgupta
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Deidra Brooks
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Melissa Cervantes
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Dget L Downey
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Phoebe Kelleher
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Sydney L Bell
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Timothy Hunt
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Elwin Wu
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Karen A Johnson
- School of Social Work, University of AL, Tuscaloosa, AL, USA
| | - Jennifer Hall
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Gail-Ann N Guy-Cupid
- College of Liberal Arts & Social Sciences, Social Work Program, University of The Virgin Islands, Saint. Thomas/Saint Croix, UVI, USA
| | - Brittany V Thomas
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Kevonyah Edwards
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Vineha Ramesh
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
| | - Louisa Gilbert
- The Social Intervention Group, School of Social Work, Columbia University, NY, NY, USA
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Agénor M, Noh M, Eiduson R, LeBlanc M, Line EC, Goldman RE, Potter J, Austin SB. Barriers to and opportunities for advancing racial equity in cervical cancer screening in the United States. BMC Womens Health 2024; 24:362. [PMID: 38907205 PMCID: PMC11191319 DOI: 10.1186/s12905-024-03151-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 05/17/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND In the United States (U.S.), racially minoritized people have higher rates of cervical cancer morbidity and mortality compared to white individuals as a result of racialized structural, social, economic, and health care inequities. However, cervical cancer screening guidelines are based on studies of predominately white individuals and do not substantially discuss or address racialized cervical cancer inequities and their social determinants, including racism. METHODS We conducted in-depth interviews with health care providers (N = 30) and key informants with expertise in health equity (N = 18). We utilized semi-structured interview guides that addressed providers' views and experiences delivering cervical cancer screening to racially minoritized individuals and key informants' recommendations for advancing racial equity in the development and implementation of cervical cancer screening guidelines. Interviews were analyzed using a template style thematic analysis approach involving deductive and inductive coding, memo writing, and matrix analysis for theme development. RESULTS Most health care providers adopted a universal, one-size-fits-all approach to cervical cancer screening with the stated goal of ensuring racial equality. Despite frequently acknowledging the existence of racialized cervical cancer inequities, few providers recognized the role of social inequities in influencing them, and none discussed the impact of racism. In contrast, key informants overwhelmingly recommended that providers adopt an approach to cervical cancer screening and follow-up care that recognizes the role of racism in shaping racialized cervical cancer and related social inequities, is developed in partnership with racially minoritized communities, and involves person-centered, structurally-competent, and trauma-informed practices that address racially minoritized peoples' unique lived experiences in historical and social context. This racism-conscious approach is not to be confused with race-based medicine, which is an essentialist and racist approach to health care that treats race as a biological variable rather than as a social and political construct. CONCLUSIONS Developers and implementers of cervical cancer screening guidelines should explicitly recognize and address the impact of racism on cervical cancer screening, follow-up care, and outcomes, meaningfully incorporate racially minoritized communities' perspectives and experiences, and facilitate provider- and institutional-level practices that foster racial equity in cervical cancer.
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Affiliation(s)
- Madina Agénor
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA.
- Department of Epidemiology, Brown University School of Public Health, MPH Box G-S121-4, Providence, RI, 02912, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Madeline Noh
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA
| | - Rose Eiduson
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Merrily LeBlanc
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Sociology, Northeastern University, Boston, MA, USA
| | - Emmett C Line
- Teachers College, Columbia University, New York, NY, USA
| | - Roberta E Goldman
- Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Karvonen KL, Smith O, Chambers Butcher BD, Franck LS, McKenzie-Sampson S, McLemore MR, Pantell MS, Rogers EE. Parent and staff perceptions of racism in a single-center neonatal intensive care unit. Pediatr Res 2024; 95:1690-1693. [PMID: 38167642 PMCID: PMC11245384 DOI: 10.1038/s41390-023-02980-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024]
Abstract
IMPACT In alignment with previous literature, NICU parents reported experiencing racism and NICU staff reported witnessing racism in the NICU. Our study also uniquely describes personal experiences with racism by staff in the NICU. NICU staff reported witnessing and experiencing racism more often than parents reported. Black staff reported witnessing and experiencing more racism than white staff. Differences in reporting is likely influenced by variations in lived experience, social identities, psychological safety, and levels of awareness. Future studies are necessary to prevent and accurately measure racism in the NICU.
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Affiliation(s)
- Kayla L Karvonen
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.
- California Preterm Birth Initiative, San Francisco, CA, USA.
| | - Olga Smith
- Independent Researcher, Antioch, CA, USA
| | | | - Linda S Franck
- Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Safyer McKenzie-Sampson
- California Preterm Birth Initiative, San Francisco, CA, USA
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Monica R McLemore
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, USA
| | - Matthew S Pantell
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
- California Preterm Birth Initiative, San Francisco, CA, USA
| | - Elizabeth E Rogers
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
- California Preterm Birth Initiative, San Francisco, CA, USA
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Červený M, Tóthová V. Self-reported cultural competence among Czech and Slovakian nurses: A comparative correlation study. Int Nurs Rev 2024. [PMID: 38650482 DOI: 10.1111/inr.12969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 03/23/2024] [Indexed: 04/25/2024]
Abstract
AIM This study aimed to compare the level of cultural competence among nurses working in clinical practice in Slovakia and the Czech Republic. BACKGROUND Demographic changes have greatly affected the health sector in Slovakia and the Czech Republic. By identifying the level of nurses' cultural competence, many of the complications encountered in caring for patients from different cultures can be avoided. However, few studies have explored the cultural competence of nurses in clinical practice in these countries. METHOD This study was cross-sectional, descriptive, and comparative. It followed the STROBE checklist and used the Cultural Competence Assessment Tool questionnaire to collect data. Descriptive and inferential statistical tests were utilized for data analysis, using SASD 1.5.8 and IBM SPSS Statistics version 28.0.0. RESULTS The sample comprised 424 nurses, with 202 from the Czech Republic and 222 from Slovakia, primarily female. Most nurses in both countries have not received cultural diversity training. Nevertheless, nurses in both countries indicate the necessity of conducting a cultural impact assessment of patients' health. Cultural diversity training significantly increases the level of cultural competence in nurses. DISCUSSION Lower cultural competence scores can negatively impact nursing care for patients from different cultures, leading to additional cultural challenges. IMPLICATIONS FOR NURSING AND HEALTH POLICY The findings highlight the need for enhanced cultural competence among nurses. Nurses need to learn and utilize cultural information to help maximize healthcare for patients from different cultures. By providing nurses with cultural knowledge and skills, they will be able to deliver more effective and culturally competent care to patients from varied cultural backgrounds.
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Affiliation(s)
- Martin Červený
- Faculty of Health and Social Sciences, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, the Czech Republic
| | - Valérie Tóthová
- Faculty of Health and Social Sciences, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, the Czech Republic
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Gould EE, Ganesh SS, Nguyen RM, Breton CV, Bastain TM, Dunton GF, Ceasar RC. The unseen patient: competing priorities between patients and providers when cannabis is used in pregnancy, a qualitative study. Front Glob Womens Health 2024; 5:1355375. [PMID: 38699460 PMCID: PMC11063236 DOI: 10.3389/fgwh.2024.1355375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/25/2024] [Indexed: 05/05/2024] Open
Abstract
Objectives This study aimed to explore competing priorities when cannabis is used during pregnancy from the perspective of providers and Black and Latina people. Maternal cannabis use is increasingly common, but patients and providers alike struggle to navigate it. Methods This pilot used qualitative, constructivist ground theory methods to conduct semi-structured, remote interviews between 16 November 2021, and 7 February 2022 with 7 Black and Latina people who used cannabis during pregnancy, and 10 providers between 15 March 2022, and 6 April 2022, all of who were in Southern California, U.S. Results We identified three main findings: (1) Providers reported barriers to caregiving and relationship building with patients due to maternal cannabis use stigma, (2) Providers prioritized the fetus despite patients' current health system challenges that drove cannabis use, and (3) Both patients and providers engaged in personal research beyond the healthcare system to better understand maternal cannabis use. Discussion Our findings indicate that challenges exist between people who use cannabis during pregnancy and providers. Both groups need accurate, sociocultural sensitive information about maternal cannabis use via a harm reduction lens.
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Affiliation(s)
- Erin E. Gould
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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11
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Parvez M, Barnes L, Gonzalez R, Prestegaard K, Rick TJ. Health Care Students' Perceptions of Bias During Their Clinical Training and Insights on Mitigating It. J Physician Assist Educ 2024; 35:88-93. [PMID: 38377463 DOI: 10.1097/jpa.0000000000000550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
PURPOSE To understand health care students' perception of implicit bias and examine their insights to create a bias-free training environment. METHODS Clinical phase students from one university's 4 health care programs participated in this study. Students were surveyed regarding their knowledge of implicit bias and perception of their experiences in the clinical learning environment. RESULTS The response rate was 50.9%, N = 161. In total, 52.6% reported having prior training on implicit bias, and 55% self-reported that they had personally observed preceptors who exhibited an implicit bias toward patients based on race, ethnicity, or other qualities. There was no statistically significant relationship between those with prior training on implicit bias and being able to identify implicit bias exhibited by preceptors. Participants also expressed their unwillingness to report an incident unless it is confidential due to fear of retribution. CONCLUSION This study found that health care students from one university's 4 health care programs perceived implicit bias in their clinical learning environment, which they believe could be improved by taking intentional steps. Some suggestions provided were "Safe space to report and openly discuss bias," "Education/training on implicit bias," "Time for self-reflection," and "Hiring process that evaluates/trains against implicit bias." The implication of our study is to create a bias-free training environment that will help interrupt the propagation of biases contributing to health disparity. Further research should examine a national population and identify interventional methods and outcomes in multiple health care disciplines.
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Affiliation(s)
- Mehnaz Parvez
- Mehnaz Parvez, MBBS, MS, is an associate professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
- Lisa Barnes, MPAS-PAC, is a physician assistant, Colon & Rectal Surgery Associates, Minneapolis, Minnesota
- Rebecca Gonzalez, MPAS-PAC, is a physician assistant, Spine and Orthopedic Center, Santa Barbara, California
- Keanna Prestegaard, MPAS-PAC, is a physician assistant, Summit Orthopedics, Woodbury, Minnesota
- Tara J. Rick, PhD, MPAS-PAC, is a physician assistant, University of Minnesota Physicians, Greater Minneapolis - St. Paul Area Research Associate in Cancer Survivorship, University of Minnesota, Minneapolis, Minnesota. She is also an adjunct professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
| | - Lisa Barnes
- Mehnaz Parvez, MBBS, MS, is an associate professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
- Lisa Barnes, MPAS-PAC, is a physician assistant, Colon & Rectal Surgery Associates, Minneapolis, Minnesota
- Rebecca Gonzalez, MPAS-PAC, is a physician assistant, Spine and Orthopedic Center, Santa Barbara, California
- Keanna Prestegaard, MPAS-PAC, is a physician assistant, Summit Orthopedics, Woodbury, Minnesota
- Tara J. Rick, PhD, MPAS-PAC, is a physician assistant, University of Minnesota Physicians, Greater Minneapolis - St. Paul Area Research Associate in Cancer Survivorship, University of Minnesota, Minneapolis, Minnesota. She is also an adjunct professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
| | - Rebecca Gonzalez
- Mehnaz Parvez, MBBS, MS, is an associate professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
- Lisa Barnes, MPAS-PAC, is a physician assistant, Colon & Rectal Surgery Associates, Minneapolis, Minnesota
- Rebecca Gonzalez, MPAS-PAC, is a physician assistant, Spine and Orthopedic Center, Santa Barbara, California
- Keanna Prestegaard, MPAS-PAC, is a physician assistant, Summit Orthopedics, Woodbury, Minnesota
- Tara J. Rick, PhD, MPAS-PAC, is a physician assistant, University of Minnesota Physicians, Greater Minneapolis - St. Paul Area Research Associate in Cancer Survivorship, University of Minnesota, Minneapolis, Minnesota. She is also an adjunct professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
| | - Keanna Prestegaard
- Mehnaz Parvez, MBBS, MS, is an associate professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
- Lisa Barnes, MPAS-PAC, is a physician assistant, Colon & Rectal Surgery Associates, Minneapolis, Minnesota
- Rebecca Gonzalez, MPAS-PAC, is a physician assistant, Spine and Orthopedic Center, Santa Barbara, California
- Keanna Prestegaard, MPAS-PAC, is a physician assistant, Summit Orthopedics, Woodbury, Minnesota
- Tara J. Rick, PhD, MPAS-PAC, is a physician assistant, University of Minnesota Physicians, Greater Minneapolis - St. Paul Area Research Associate in Cancer Survivorship, University of Minnesota, Minneapolis, Minnesota. She is also an adjunct professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
| | - Tara J Rick
- Mehnaz Parvez, MBBS, MS, is an associate professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
- Lisa Barnes, MPAS-PAC, is a physician assistant, Colon & Rectal Surgery Associates, Minneapolis, Minnesota
- Rebecca Gonzalez, MPAS-PAC, is a physician assistant, Spine and Orthopedic Center, Santa Barbara, California
- Keanna Prestegaard, MPAS-PAC, is a physician assistant, Summit Orthopedics, Woodbury, Minnesota
- Tara J. Rick, PhD, MPAS-PAC, is a physician assistant, University of Minnesota Physicians, Greater Minneapolis - St. Paul Area Research Associate in Cancer Survivorship, University of Minnesota, Minneapolis, Minnesota. She is also an adjunct professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
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Lee AHY, Mayes KD, Marsh R, Toledo-Cornell C, Goralnick E, Wilson M, Sanchez LD, Bukhman A, Baymon D, Im D, Chen PC. Analysis of health inequities in transfers of admitted patients from an academic emergency department to partner community hospital. Am J Emerg Med 2024; 75:143-147. [PMID: 37950982 DOI: 10.1016/j.ajem.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/19/2023] [Accepted: 11/01/2023] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Many academic medical centers (AMC) transfer patients who require admission but not tertiary care to partner community hospitals from their emergency departments (ED). These transfers alleviate ED boarding but may worsen existing healthcare disparities. We assessed whether disparities exist in the transfer of patients from one AMC ED to a community hospital General Medical Service. METHODS We performed a retrospective cohort study on all patients screened for transfer between April 1 and December 31, 2021. During the screening process, the treating ED physician determines whether the patient meets standardized clinical criteria and a patient coordinator requests patient consent. We collected patient demographics data from the electronic health record and performed logistic regression at each stage of the transfer process to analyze how individual characteristics impact the odds of proceeding with transfer. RESULTS 5558 patients were screened and 596 (11%) ultimately transferred. 1999 (36%) patients were Black or Hispanic, 698 (12%) had a preferred language other than English, and 956 (17%) were on Medicaid or uninsured. A greater proportion of Black and Hispanic patients were deemed eligible for interhospital transfer compared to White patients and a greater proportion of Hispanic patients completed transfer to the community hospital (p < 0.017 after Bonferroni correction). After accounting for other demographic variables, patients older than 50 (OR 1.21, 95% CI 1.04-1.40), with a preferred language other than English (OR 1.27, 95% CI 1.00-1.62), and from a priority neighborhood (OR 1.38, 95% CI 1.18-1.61) were more likely to be eligible for transfer, while patients who were male (OR 1.50, 95% CI 1.10-2.05) and younger than 50 (OR 1.85, 95% CI 1.20-2.78) were more likely to consent to transfer (p < 0.05). CONCLUSION Health disparities exist in the screening process for our interfacility transfer program. Further investigation into why these disparities exist and mitigation strategies should be undertaken.
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Affiliation(s)
- Andy Hung-Yi Lee
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA; Department of Emergency Medicine, UCLA Ronald Reagan Medical Center, 757 Westwood Plaza, Los Angeles, CA, USA.
| | - Katherine Dickerson Mayes
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA
| | - Regan Marsh
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA
| | - Christina Toledo-Cornell
- Harvard Medical School, 25 Shattuck St., Boston, MA, USA; Department of Internal Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, USA
| | - Eric Goralnick
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA
| | - Michael Wilson
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, USA; Department of Emergency Medicine, Brigham and Women's Faulkner's Hospital, 1153 Centre St, Jamaica Plain, MA, USA
| | - Alice Bukhman
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, USA; Department of Emergency Medicine, Brigham and Women's Faulkner's Hospital, 1153 Centre St, Jamaica Plain, MA, USA
| | - Damarcus Baymon
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA
| | - Dana Im
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA
| | - Paul C Chen
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, USA
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13
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Oppelt TF, Polsonetti B, Caron MF, Collins-Carriveau C, Fischer N, Gofman L, Ghazipura M. Patient Perceptions of their COVID-19 Inpatient Hospital Experience: a Survey Exploring Inequities in Healthcare Delivery. J Racial Ethn Health Disparities 2023; 10:2775-2782. [PMID: 36417149 PMCID: PMC9684944 DOI: 10.1007/s40615-022-01454-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/14/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Compared with White patients, Black and Latinx patients have higher infection, hospitalization, and mortality rates from COVID-19; yet, little is known about their perspective before, during, and after a COVID-19 hospitalization. The objective of this study conducted in White, Black, and Latinx patients was to assess perceptions of their COVID-19-related hospitalization from onset of symptoms through the post-discharge period to identify disparities in their perceived care. METHODS A cross-sectional observational study using an online survey from May 19 to June 23, 2021, was conducted by The Harris Poll in 200 White, 200 Black, and 201 Latinx patients hospitalized for COVID-19 in the US. Main measures obtained included baseline demographic variables, socioeconomic status, and social determinants of health. Survey questions were specific to key aspects of the patient experience before, during, and after a COVID-19-related hospitalization. RESULTS Compared with White patients, Latinx and Black patients faced unique challenges in their healthcare journey including higher likelihood of delaying their hospitalization (10% Black vs. 4% White patients, respectively, P = 0.025), lower perceived satisfaction with care (82% Latinx vs 91% White patients, P = 0.002), and lower trust in providers following their hospitalization (85% White vs. 65% Latinx [P = 0.027] and 73% Black [P = 0.050] patients). CONCLUSIONS Patient perceptions of their COVID-19 hospitalization experience revealed disparities in perceived quality of care among minority groups. These findings offer insights that health inequities still exist, and strategies need to be taken to make health care delivery more equitable.
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D'Costa I, Truong M, Russell L, Adams K. Employee perceptions of race and racism in an Australian hospital. Soc Sci Med 2023; 339:116364. [PMID: 37977016 DOI: 10.1016/j.socscimed.2023.116364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/09/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Racism contributes to health inequities faced by people of colour and marginalised groups. Despite widespread recognition of the impacts of racism, mitigating strategies and legislation have been largely unsuccessful. Research into racism in healthcare has mostly examined personal experiences of healthcare workers and patients, assuming that the definitions of racism and race are similarly understood by all. However, ethnicity and race are often conflated, and racism seen as primarily interpersonal and ahistorical. PURPOSE This paper explores hospital employee understandings of racism, its impacts and how to reduce it. METHODS Forty-nine staff within one Australian hospital participated in individual qualitative interviews regarding the definition, impact, and ways of reducing racism. Interviews were analysed with a reflexive thematic analytic approach using a Postcolonial framework. RESULTS Participants described racism as being experienced by marginalised groups of people in Australia. They identified that racism has detrimental effects on health and wellbeing. Not all were clear regarding what constituted racism: it was not described as an ideology created to justify colonial distribution of power and resources. Some thought that racism was individual prejudice while others noted it was also structural in nature. Participants commonly defined race as involving physical or cultural differences, suggesting that discredited historical and colonial concepts of race continue in Australian society. While many felt that education was the best way to reduce racism and its impacts, some participants noted that being educated did not necessarily change racist behaviour. CONCLUSIONS The lack of accurate understanding of the concept of race and racism likely contributes to the relatively poor effect of current strategies to combat racism. As an initial part of deeper systemic anti-racist reform, this research supports calls for anti-racist education to clarify the definition of racism as an ideology.
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Affiliation(s)
- Ieta D'Costa
- School of Medicine, Nursing and Health Science, Monash University, Clayton, Melbourne, Australia.
| | - Mandy Truong
- Monash Nursing and Midwifery, Adjunct Research Fellow, Monash University, Clayton, Melbourne, Australia.
| | - Lynette Russell
- Monash Indigenous Studies Centre, School of Philosophical, Historical, and International Studies, Monash University, Clayton, Melbourne, Australia.
| | - Karen Adams
- Indigenous Health Unit, School of Medicine, Nursing and Health Sciences, Monash University, Clayton, Melbourne, Australia.
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15
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Khalifeh R, D’Hoore W, Saliba C, Salameh P, Dauvrin M. Healthcare bias and health inequalities towards displaced Syrians in Lebanon: a qualitative study. Front Public Health 2023; 11:1273916. [PMID: 38098832 PMCID: PMC10720425 DOI: 10.3389/fpubh.2023.1273916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/06/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction According to Lebanese official data, Lebanon hosts over 1.5 million displaced Syrians (DS). Research shows that migrants encounter barriers when accessing healthcare. The social determinants of health (SDOH) related to migration are an additional challenge for DS in Lebanon, though bias plays a significant factor in exacerbating health inequalities. This study aims to identify DS perception of healthcare biases in the Lebanese healthcare system, and its consequences on DS' accessing and receiving quality healthcare in Lebanon. Methods A qualitative analysis using in-depth, semi-structured interviews was utilized. 28 semi-structured interviews were conducted with doctors (n = 12) and nurses (n = 16) in 2021. Six group interviews were conducted with DS (n = 22) in Lebanese healthcare facilities. The recruitment of participants relied on reasoned and targeted sampling. Thematic analysis was performed to identify common themes in participants' experiences with DS accessing Lebanese healthcare. Results The findings indicated that there were barriers to accessing healthcare related to the SDOH, such as transportation and financial resources. The results also suggested that DS perceived health biases, including discriminatory behavior from Lebanese healthcare providers, stereotypes and racism leading to health inequalities. Conclusion Based on the perceptions and experiences reported by participants, the underlying causes of biases are due to the fragility of the Lebanese healthcare system when facing a humanitarian crisis as well as a collapsing infrastructure torn by past wars and the current socio-political and financial crises in the country. Global initiatives are required to provide the necessary resources needed for offering equitable health services. Such initiatives involve addressing biases, health inequities, discrimination, and the lack of a Lebanese infrastructure system for the provision of healthcare. Addressing health inequalities remains a major health objective in achieving health equity on the micro level (cultural awareness and competencies) and macro level (equitable distribution of resources, implementation of a universal health coverage) in order to guarantee quality healthcare services to DS.
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Affiliation(s)
- Riwa Khalifeh
- Institute of Health and Society (IRSS), UCLouvain, Brussels, Belgium
- Legal Way for Advocacy and Research, Beirut, Lebanon
| | - William D’Hoore
- Institute of Health and Society (IRSS), UCLouvain, Brussels, Belgium
| | - Christiane Saliba
- Faculty of Public Health—Section 2 (CERIPH), Lebanese University, Fanar, Lebanon
| | - Pascale Salameh
- School of Medicine, Lebanese American University, Byblos, Lebanon
- Institut National de Santé Publique d’Épidémiologie Clinique et de Toxicologie-Liban (INSPECT LB), Beirut, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
| | - Marie Dauvrin
- Institute of Health and Society (IRSS), UCLouvain, Brussels, Belgium
- Belgian Health Care Knowledge Center, KCE, Brussels, Belgium
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Holton C, Banerjee S, Morgan P, McCune NM, Cook A, Thomas J, Vesey A. Centering Health Equity Through the Social Determinants of Health, Interprofessional Education, and Sustainable Partnerships With Historically Black Colleges and Universities: Envisioning Upstream and Downstream Impacts. Creat Nurs 2023; 29:343-353. [PMID: 38062729 DOI: 10.1177/10784535231212477] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The social determinants of health (SDOH) framework identifies barriers to health care, education, financial stability, and other conditions that exist across socially determined parameters, often to the detriment of Communities of Color. Postsecondary healthcare students must be aware of these disparities. In order to address upstream and downstream healthcare equity, the SDOH framework must be leveraged as a cross-disciplinary curricular innovation to support interprofessional education. Historically Black Colleges and Universities have unrealized potential to develop extraordinary healthcare leaders; partnerships integrating SDOH can be a powerful force to advance health equity in the United States.
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Catalao R, Zephyrin L, Richardson L, Coghill Y, Smylie J, Hatch SL. Tackling racism in maternal health. BMJ 2023; 383:e076092. [PMID: 37875287 DOI: 10.1136/bmj-2023-076092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Affiliation(s)
- Raquel Catalao
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Laurie Zephyrin
- Advancing Health Equity, Commonwealth Fund, New York, NY, USA
| | - Lisa Richardson
- Institute of Women and Ethnic Studies, UNO Research and Technology Foundation, New Orleans, USA
| | - Yvonne Coghill
- Excellence in Action, Workforce Race Equality, NHS London, UK
| | - Janet Smylie
- Well Living House, Li Ka Shing Knowledge Institute, Unity Health, Toronto Canada
- Dalla Lana School of Public Health and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, UK
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Hua P, Shakoor S, Fenton SJ, Freestone M, Weich S, Bhui K. Racialised staff-patient relationships in inpatient mental health wards: a realist secondary qualitative analysis of patient experience data. BMJ MENTAL HEALTH 2023; 26:e300661. [PMID: 37852630 PMCID: PMC10583032 DOI: 10.1136/bmjment-2023-300661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/24/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND The current study is a secondary analysis of qualitative data collected as part of EURIPIDES, a study which assessed how patient experience data were used to improve the quality of care in National Health Service (NHS) mental health services. OBJECTIVE We undertook a detailed realist secondary qualitative analysis of 10 interviews in which expressions of racialisation were unexpectedly reported. This theme and these data did not form part of the primary realist evaluation. METHODS Interviews were originally conducted with the patients (18-65 years: 40% female, 60% male) from four different geographically located NHS England mental health trusts between July and October 2017. Secondary qualitative data analysis was conducted in two phases: (1) reflexive thematic analysis and retroduction; (2) refinement of context-mechanism-outcome configurations to explore the generative mechanisms underpinning processes of racialisation and revision of the initial programme theory. FINDINGS There were two main themes: (1) absence of safe spaces to discuss racialisation which silenced and isolated patients; (2) strained communication and power imbalances shaped a process of mutual racialisation by patients and staff. Non-reporting of racialisation and discrimination elicited emotions such as feeling othered, misunderstood, disempowered and fearful. CONCLUSIONS The culture of silence, non-reporting and power imbalances in inpatient wards perpetuated relational racialisation and prevented authentic feedback and staff-patient rapport. CLINICAL IMPLICATIONS Racialisation in mental health trusts reflects lack of psychological safety which weakens staff-patient rapport and has implications for authentic patient engagement in feedback and quality improvement processes. Larger-scale studies are needed to investigate racialisation in the staff-patient relationships.
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Affiliation(s)
- Phuong Hua
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Sania Shakoor
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Sarah-Jane Fenton
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Mark Freestone
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, Oxford, UK
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Shaikh HJF, Anderson DE, Chait AR, Ramirez G, Bronstein RD, Goldblatt JP, Giordano BD, Maloney MD, Nicandri GT, Voloshin I, Mannava S. Use of Area Deprivation Index to Predict Minimal Clinically Important Difference for Patient Reported Outcomes Measurement Information System After Arthroscopic Rotator Cuff Repair. Am J Sports Med 2023; 51:2815-2823. [PMID: 37551708 DOI: 10.1177/03635465231187904] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
BACKGROUND Socioeconomic disparities correlate with worse outcomes after arthroscopic rotator cuff repair. However, use of a surrogate to describe socioeconomic disadvantage has been a challenge. The Area Deprivation Index (ADI) is a tool that encompasses 17 socioeconomic variables into a single metric based on census location. HYPOTHESIS Higher ADI would result in a worse minimal clinically important difference (MCID) for the Patient Reported Outcomes Measurement Information System (PROMIS) and have less improvement in range of motion (ROM) following arthroscopic rotator cuff repair (ARCR). STUDY DESIGN Cohort study; Level of evidence, 3. METHOD A retrospective review was performed for patients who underwent arthroscopic rotator cuff repair. Patients in the most socioeconomically disadvantaged quartile (ADIHigh) were compared with the least disadvantaged quartile (ADILow) in the ability to reach MCID. Demographic and surgical features were assessed for attainment of MCID. RESULTS In total 1382 patients were identified who underwent ARCR, of which a total of 306 patients met final inclusion criteria. A higher percentage of patients within the ADIHigh cohort identified as "Black" or "other" race and had government-issued insurance compared with the ADILow cohort (P < .05). The ADIHigh cohort had significantly worse postoperative forward flexion compared with the ADILow cohort (145.0°± 32.5° vs 156.3°± 23.4°; P = .001) despite starting with comparable preoperative ROM (P = .17). Logistic regression showed that ADI was the only variable significant for predicting achievement of MCID for all 3 PROMIS domains, with the ADIHigh cohort having significantly worse odds of achieving MCID Physical Function (odds ratio [OR], 0.31; P = .001), Pain Interference (OR, 0.21; P = .001), and Depression (OR, 0.28; P = .001). Meanwhile, age, sex, body mass index, and smoking history were nonsignificant. Moreover, "other" for race and Medicare insurance were significant for achievement of MCID Depression but not Physical Function or Pain Interference. Finally, ADI was the main feature for predictive logistic regression modeling. CONCLUSION ADI served as the only significant predictor for achieving MCID for all 3 PROMIS domains after arthroscopic rotator cuff repair. Patients who face high levels of socioeconomic disadvantage have lower rates of achieving MCID. In addition, patients with greater neighborhood disadvantage demonstrated significantly worse improvement in active forward flexion. Further investigation is required to understand the role of ADI on physical therapy compliance and to identify the barriers that prevent equitable postoperative care.
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Affiliation(s)
- Hashim J F Shaikh
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, Rochester, New York, USA
| | - Devon E Anderson
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, Rochester, New York, USA
| | - Alexander R Chait
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, Rochester, New York, USA
| | - Gabriel Ramirez
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, Rochester, New York, USA
| | - Robert D Bronstein
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, Rochester, New York, USA
| | - John P Goldblatt
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, Rochester, New York, USA
| | - Brian D Giordano
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, Rochester, New York, USA
| | - Michael D Maloney
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, Rochester, New York, USA
| | - Gregg T Nicandri
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, Rochester, New York, USA
| | - Ilya Voloshin
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, Rochester, New York, USA
| | - Sandeep Mannava
- Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, Rochester, New York, USA
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van Vliet LM, Stouthard J, Gröschel LC, Meijers MC. Effect of Clinician-Expressed Empathy in Advanced Cancer on Different Ethnic Groups: Results from an Experimental Video-Vignette Study. J Palliat Med 2023; 26:1109-1114. [PMID: 37162756 DOI: 10.1089/jpm.2022.0602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
Background: In advanced cancer, clinician-expressed empathy can improve patients' psychological outcomes. It remains unknown whether all patients benefit equally from empathy. Objective: To explore whether the effect of clinician-expressed empathy on patients' psychological outcomes is moderated by patient ethnicity. Methods: Using an experimental video-vignette design, 160 participants watched a consultation-video with/without added empathy. Using regression analysis, the moderating effect of ethnicity (non-Western- vs. Dutch/Western-immigration background) on the relationship between empathy and psychological outcomes was assessed. Results: The main effect of empathy on satisfaction (p = 0.001), trust (p = 0.002), and self-efficacy (p < 0.001) was moderated by ethnicity (satisfaction, p = 0.050; trust, p = 0.066; self-efficacy, p = 0.075). No main effect of empathy nor moderation by ethnicity was found for anxiety (state anxiety: p = 0.284, p = 0.319; current anxiety: p = 0.357, p = 0.949). No main effects of ethnicity (satisfaction, p = 0.942; trust, p = 0.724; self-efficacy, p = 0.244; state anxiety, p = 0.812; current anxiety p = 0.523) were found. Conclusion: In advanced cancer, non-Western patients might benefit most from empathy. Dutch Trial Registration Number: NTR NL8992.
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Affiliation(s)
- Liesbeth M van Vliet
- Department of Health, Medical, and Neuropsychology, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Jacqueline Stouthard
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Lara C Gröschel
- Department of Health, Medical, and Neuropsychology, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Maartje C Meijers
- Department of Health, Medical, and Neuropsychology, Institute of Psychology, Leiden University, Leiden, Netherlands
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21
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Ceasar RC, Gould E, Stal J, Laughter J, Tran M, Wang SD, Granacki J, Ziltzer RS, Santos JJ. Legislation has Changed But Issues Remain: Provider Perceptions of Caring for People Who Use Cannabis During Pregnancy in Safety Net Health Settings, a Qualitative Pilot Study. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:400-408. [PMID: 37529758 PMCID: PMC10389248 DOI: 10.1089/whr.2023.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/03/2023]
Abstract
Objective To identify perceptions of cannabis use and risk among maternal health providers who provide care for people who use cannabis during pregnancy in safety-net health settings. Methods Using qualitative, constructivist ground theory methods, we conducted semistructured remote interviews with 10 providers (2 midwives, 6 OB/GYN physicians, and 2 OB/GYN residents) in Southern California, United States, between March 15, 2022, and April 6, 2022. We selected participants through selective sampling using a convenience sample and snowball approach. Providers were eligible for the study if they self-reported via survey to being a maternal health provider (e.g., physician, doula, midwife, and so on) providing care in a safety-net health setting and had cared for people who used cannabis during pregnancy in the last year. Analysis drew upon grounded theory methods to document the socio-structural contexts that contribute to provider perceptions about cannabis. This study was approved by the University of Southern California Institutional Review Board (UP-21-00282-AM009). Results We identified three categories of provider perceptions of cannabis use and risk during pregnancy: (1) Relying on self-education, (2) Taking a case-by-case approach, and (3) Avoiding cannabis discussions to maintain an alliance with patients. Findings indicate that provider reluctance to counsel patients about cannabis in favor of preserving a therapeutic relationship can overlook the lack of resources and access to health care alternatives available to low-income patients that can shape self-medicating. Conclusions Nonpunitive policies and training on cannabis use are critical steps for supporting providers to counsel patients who use cannabis during pregnancy, alongside a harm reduction approach that acknowledges the broader socio-structural contexts and barriers facing patients who disclose use.
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Affiliation(s)
- Rachel Carmen Ceasar
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Erin Gould
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Julia Stal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jen Laughter
- Department of Sociology, California State University, Fullerton, Fullerton, California, USA
| | - Michelle Tran
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Shirlene D. Wang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jordan Granacki
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ryan S. Ziltzer
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jasmeen Joy Santos
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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22
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Schmidt IM, Shohet M, Serrano M, Yadati P, Menn-Josephy H, Ilori T, Eneanya ND, Cleveland Manchanda EC, Waikar SS. Patients' Perspectives on Race and the Use of Race-Based Algorithms in Clinical Decision-Making: a Qualitative Study. J Gen Intern Med 2023; 38:2045-2051. [PMID: 36811702 PMCID: PMC9945816 DOI: 10.1007/s11606-023-08035-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/30/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Clinical algorithms that incorporate race as a modifying factor to guide clinical decision-making have recently been criticized for propagating racial bias in medicine. Equations used to calculate lung or kidney function are examples of clinical algorithms that have different diagnostic parameters depending on an individual's race. While these clinical measures have multiple implications for clinical care, patients' awareness of and their perspectives on the application of such algorithms are unknown. OBJECTIVE To examine patients' perspectives on race and the use of race-based algorithms in clinical decision-making. DESIGN Qualitative study using semi-structured interviews. PARTICIPANTS Twenty-three adult patients recruited at a safety-net hospital in Boston, MA. APPROACH Interviews were analyzed using thematic content analysis and modified grounded theory. KEY RESULTS Among the 23 study participants, 11 were women and 15 self-identified as Black or African American. Three categories of themes emerged: The first theme described definitions and the individual meanings participants ascribed to the term race. The second theme described perspectives on the role and consideration of race in clinical decision-making. Most study participants were unaware that race has been used as a modifying factor in clinical equations and rejected the incorporation of race in these equations. The third theme related to exposure to and experience of racism in healthcare settings. Experiences described by non-White participants ranged from microaggressions to overt acts of racism, including perceived racist encounters with healthcare providers. In addition, patients alluded to a deep mistrust in the healthcare system as a major barrier to equitable care. CONCLUSIONS Our findings suggest that most patients are unaware of how race has been used to make risk assessments and guide clinical care. Further research on patients' perspectives is needed to inform the development of anti-racist policies and regulatory agendas as we move forward to combat systemic racism in medicine.
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Affiliation(s)
- Insa M Schmidt
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Evans Biomedical Research Center, 5th Floor, 650 Albany Street, Boston, MA, 02118, USA.
| | - Merav Shohet
- Department of Anthropology, Boston University College of Arts and Sciences, Boston, MA, USA
| | - Mariana Serrano
- UMass Memorial Health's Office for Diversity, Equity, Inclusion and Belonging, Boston, MA, USA
| | - Pranav Yadati
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Evans Biomedical Research Center, 5th Floor, 650 Albany Street, Boston, MA, 02118, USA
| | - Hanni Menn-Josephy
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Evans Biomedical Research Center, 5th Floor, 650 Albany Street, Boston, MA, 02118, USA
| | - Titilayo Ilori
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Evans Biomedical Research Center, 5th Floor, 650 Albany Street, Boston, MA, 02118, USA
| | - Nwamaka D Eneanya
- Division of Renal-Electrolyte and Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Global Medical Office Fresenius Medical Care, Waltham, MA, USA
| | - Emily C Cleveland Manchanda
- Department of Emergency Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Sushrut S Waikar
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Evans Biomedical Research Center, 5th Floor, 650 Albany Street, Boston, MA, 02118, USA
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23
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Dantas-Silva A, Santiago SM, Surita FG. Racism as a Social Determinant of Health in Brazil in the COVID-19 Pandemic and Beyond. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:221-224. [PMID: 37339640 PMCID: PMC10281767 DOI: 10.1055/s-0043-1770135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
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24
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Presswala B, De Souza LR. The diagnostic experience of polycystic ovary syndrome: A scoping review of patient perspectives. PATIENT EDUCATION AND COUNSELING 2023; 113:107771. [PMID: 37141692 DOI: 10.1016/j.pec.2023.107771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/02/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Polycystic Ovary Syndrome (PCOS) is a common endocrine condition with a complex diagnostic process. The present study aims to understand patient perceptions of the process of PCOS diagnosis, and how challenges during diagnosis can influence patient understanding of PCOS and trust in healthcare providers (HCPs). METHODS A scoping review framework was followed. Six databases were searched for patient experiences of PCOS diagnosis, between January 2006 - July 2021. Data extraction and thematic analyses were conducted. RESULTS Of the 338 studies screened, 21 studies fulfilled the inclusion criteria. Patient experiences of the diagnostic process were stratified into three themes: emotional, negotiating, and incomplete. As a result of these experiences, patients begin to perceive their HCPs as lacking knowledge and empathy. CONCLUSION There are prevailing gaps in how PCOS diagnostic criteria are understood and applied in the clinical setting, leading to a lengthy diagnostic process. Additionally, poor HCP communication negatively affects patient trust in HCPs. PRACTICE IMPLICATIONS Practicing patient-centered care and empowering patients by addressing their specific information needs are essential to improving the diagnostic experience and care of individuals living with PCOS. These recommendations may also apply to the diagnosis of other complex chronic conditions.
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Affiliation(s)
- Batul Presswala
- Faculty of Health Sciences, McMaster University, 1280 Main St. West, MDCL 3500, Hamilton, ON L8S 4K1, Canada; Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON K1A 0K9, Canada.
| | - Leanne R De Souza
- Human Biology Program, Health Studies Program, University College, University of Toronto, Room 281, 15 King's College Circle, Toronto, ON M5S 3H7, Canada
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25
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McGINTY BETH. The Future of Public Mental Health: Challenges and Opportunities. Milbank Q 2023; 101:532-551. [PMID: 37096616 PMCID: PMC10126977 DOI: 10.1111/1468-0009.12622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 09/30/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points Social policies such as policies advancing universal childcare to expand Medicaid coverage of home- and community-based care for seniors and people with disabilities and for universal preschool are the types of policies needed to address social determinants of poor mental health. Population-based global budgeting approaches like accountable care and total cost of care models have the potential to improve population mental health by incentivizing health systems to control costs while simultaneously improving outcomes for the populations they serve. Policies expanding reimbursement for services delivered by peer support specialists are needed. People with lived experience of mental illness are uniquely well suited to helping their peers navigate treatment and other support services.
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26
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Reyes AM, Royan R, Feinglass J, Thomas AC, Stey AM. Patient and Hospital Characteristics Associated With Delayed Diagnosis of Appendicitis. JAMA Surg 2023; 158:e227055. [PMID: 36652227 PMCID: PMC9857818 DOI: 10.1001/jamasurg.2022.7055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Importance Racial disparities in timely diagnosis and treatment of surgical conditions exist; however, it is poorly understood whether there are hospital structural measures or patient-level characteristics that modify this phenomenon. Objective To assess whether patient race and ethnicity are associated with delayed appendicitis diagnosis and postoperative 30-day hospital use and whether there are patient- or systems-level factors that modify this association. Design, Setting, and Participants This population-based, retrospective cohort study used data from the Healthcare Cost and Utilization Project's state inpatient and emergency department (ED) databases from 4 states (Florida, Maryland, New York, and Wisconsin) for patients aged 18 to 64 years who underwent appendectomy from January 7, 2016, to December 1, 2017. Data were analyzed from January 1, 2016, to December 31, 2017. Exposure Delayed diagnosis of appendicitis, defined as an initial ED presentation with an abdominal diagnosis other than appendicitis followed by re-presentation within a week for appendectomy. Main Outcomes and Measures A mixed-effects multivariable Poisson regression model was used to estimate the association of delayed diagnosis of appendicitis with race and ethnicity while controlling for patient and hospital variables. A second mixed-effects multivariable Poisson regression model quantified the association of delayed diagnosis of appendicitis with postoperative 30-day hospital use. Results Of 80 312 patients who received an appendectomy during the study period (median age, 38 years [IQR, 27-50 years]; 50.8% female), 2013 (2.5%) experienced delayed diagnosis. In the entire cohort, 2.9% of patients were Asian or Pacific Islander, 18.8% were Hispanic, 10.9% were non-Hispanic Black, 60.8% were non-Hispanic White, and 6.6% were other race and ethnicity; most were privately insured (60.2%). Non-Hispanic Black patients had a 1.41 (95% CI, 1.21-1.63) times higher adjusted rate of delayed diagnosis compared with non-Hispanic White patients. Patients at hospitals with a more than 50% Black or Hispanic population had a 0.73 (95% CI, 0.59-0.91) decreased adjusted rate of delayed appendicitis diagnosis compared with hospitals with a less than 25% Black or Hispanic population. Conversely, patients at hospitals with more than 50% of discharges of Medicaid patients had a 3.51 (95% CI, 1.69-7.28) higher adjusted rate of delayed diagnosis compared with hospitals with less than 10% of discharges of Medicaid patients. Additional factors associated with delayed diagnosis included female sex, higher levels of patient comorbidity, and living in a low-income zip code. Delayed diagnosis was associated with a 1.38 (95% CI, 1.36-1.61) increased adjusted rate of postoperative 30-day hospital use. Conclusions and Relevance In this cohort study, non-Hispanic Black patients had higher rates of delayed appendicitis diagnosis and 30-day hospital use than White patients. Patients presenting to hospitals with a greater than 50% Black and Hispanic population were less likely to experience delayed diagnosis, suggesting that seeking care at a hospital that serves a diverse patient population may help mitigate the increased rate of delayed diagnosis observed for non-Hispanic Black patients.
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Affiliation(s)
- Ana M Reyes
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Surgery, University of Miami and Jackson Memorial Hospital, Miami, Florida
| | - Regina Royan
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joe Feinglass
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Arielle C Thomas
- Department of Surgery, Medical College of Wisconsin, Milwaukee.,American College of Surgeons, Chicago, Illinois
| | - Anne M Stey
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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27
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Bokek-Cohen Y. Does racism toward nurses increase as treatment invasiveness rises? Nurs Inq 2023:e12547. [PMID: 36755498 DOI: 10.1111/nin.12547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/10/2023]
Abstract
One of the unspoken issues in public discourse in most countries is the racism of patients toward nurses who originate from a different ethnic group than theirs. The aim of the present study is to examine whether patients' racism toward nurses increases as the invasiveness of treatment rises. This study was conducted in Israel, a highly conflictual society where Jews and Arabs live together and meet in the same health facilities. Despite the tension and sometimes animosity caused by the political situation, members of each group regularly encounter members of the other group during the provision of health-care, both as patients and as medical and nursing staff. A study questionnaire which presented nine nursing treatments of diverse levels of invasiveness was filled out by Arab and Jewish participants. They were asked to convey their preference for an Arab or a Jewish nurse for each treatment. Results of Logistic Regression Analyses reveal that in both sectors, racism toward nurses increases as the treatment invasiveness rises. These findings are discussed in light of the concept of social distance, and serve as an empirical basis for several proposed practical recommendations for eradicating racism against nurses.
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Affiliation(s)
- Ya'arit Bokek-Cohen
- Department of Behavioral Sciences, Israel Academic College of Ramat-Gan, Ramat Gan, Israel.,School of Nursing, The Academic College of Tel-Aviv-Jaffa, Tel Aviv, Israel
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28
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Odzakovic E, Huus K, Ahlberg BM, Bradby H, Hamed S, Thaper-Björkert S, Björk M. Discussing racism in healthcare: A qualitative study of reflections by graduate nursing students. Nurs Open 2023; 10:3677-3686. [PMID: 36692244 PMCID: PMC10170953 DOI: 10.1002/nop2.1619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 11/02/2022] [Accepted: 01/13/2023] [Indexed: 01/25/2023] Open
Abstract
AIM The aim is to illustrate and analyse reflections from graduate nursing students over their experience of discussing racism in healthcare in an educational intervention. DESIGN A qualitative, descriptive design was adopted. METHODS Data were collected through written reflections and analysed through content analysis. In total, 81 students participated in the intervention; 39 paediatric and 42 public health care nursing students. Of those, 27 participants gave consent to have their written reflections included in the study. RESULTS Three main categories were developed in the content analysis of student reflections: (a) the implicit embeddedness of racism in healthcare organization; (b) the effect of racism on interactions with patients; and (c) a growing awareness of one's own understanding of racism. This study indicates that student nurses discussed racism as relevant to understanding good clinical practice for the benefit of patients and work-based wellbeing of staff. This recognition of the organizational nature of racism warrants nursing leaders and managers to include racism as a social determinant of health in the undergraduate and graduate curricula to educate the next generation of nursing about racism.
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Affiliation(s)
- Elzana Odzakovic
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Karina Huus
- CHILD Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Beth Maina Ahlberg
- Department of Sociology, Uppsala University, Uppsala, Sweden.,Skaraborg Institute for Research and Development, Skövde, Sweden
| | - Hannah Bradby
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | - Sarah Hamed
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | | | - Maria Björk
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,CHILD Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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29
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Berenguel Chacón P, Plaza del Pino FJ, Molina-Gallego B, Ugarte-Gurrutxaga MI. The Perception of Nurses about Migrants after the COVID-19 Pandemic: Close Contact Improves the Relationship. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1200. [PMID: 36673961 PMCID: PMC9858903 DOI: 10.3390/ijerph20021200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/06/2023] [Accepted: 01/08/2023] [Indexed: 06/17/2023]
Abstract
Nurses have faced during the COVID-19 pandemic a tough professional situation in which they have had to work in a resource-limited context and with a high probability of COVID-19 transmission. In today's multicultural societies, care for immigrant patients is also included. In our study, we have delved into the perception of hospital nurses towards migrant people in the context of the COVID-19 pandemic. We used a qualitative methodology with a phenomenological approach. Semi-structured interviews were conducted with 16 nurses. Seven categories emerged and were distributed in the three blocks of the interviews: (a) perception before the pandemic: prejudices make a mark and communication problems; (b) perception after the pandemic: prejudices weaken and communication worsens; and (c) how to improve care: improve communication, more nurses, and no need for training. The approach in the interpersonal relationship between nurses and patients during the pandemic has improved health care. Proposals arise to overcome the language barrier such as the incorporation of intercultural translators-mediators and professionals of foreign origin. There is a lack of awareness of the need for training in cultural competence on the part of the nurses in the study.
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Affiliation(s)
- Paula Berenguel Chacón
- Centre for Migration Studies and Intercultural Relations, University of Almería, 04120 Almería, Spain
| | - Fernando Jesús Plaza del Pino
- Centre for Migration Studies and Intercultural Relations, University of Almería, 04120 Almería, Spain
- Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain
| | - Brigida Molina-Gallego
- Research Group Nursing, Pain and Care (ENDOCU), Campus Tecnológico Fábrica de Armas, University of Castilla la Mancha, 45071 Toledo, Spain
- Faculty of Physiotherapy and Nursing, Toledo Campus, University of Castilla la Mancha, 45071 Toledo, Spain
| | - María Idoia Ugarte-Gurrutxaga
- Research Group Nursing, Pain and Care (ENDOCU), Campus Tecnológico Fábrica de Armas, University of Castilla la Mancha, 45071 Toledo, Spain
- Faculty of Physiotherapy and Nursing, Toledo Campus, University of Castilla la Mancha, 45071 Toledo, Spain
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30
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McCuistian C, Kimball SL, Buitron de la Vega P, Godfrey LB, Fortuna LR, Valentine SE. Consideration of racism experiences in the implementation of trauma-focused therapy in primary care. Health Serv Res 2022; 57 Suppl 2:235-248. [PMID: 35521941 PMCID: PMC9660427 DOI: 10.1111/1475-6773.13998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To understand providers' perceptions of how a patient's experience of racism may impact the successful implementation of a brief posttraumatic stress disorder (PTSD) treatment in the safety net integrated primary care setting. To conduct a developmental formative evaluation prior to a hybrid type I effectiveness-implementation trial. DATA SOURCES AND STUDY SETTING From October 2020 to January 2021, in-depth qualitative interviews were conducted with integrated primary care stakeholders (N = 27) at the largest safety net hospital in New England, where 82% of patients identify as racial or ethnic minorities. STUDY DESIGN Interviews with clinical stakeholders were used to (a) contextualize current patient and provider experiences and responses to racism, (b) consider how racism may impact PTSD treatment implementation, (c) gather recommendations for potential augmentation to the proposed PTSD treatment (e.g., culturally responsive delivery, cultural adaptation), and (d) gather recommendations for how to shift the integrated primary care practice to an antiracist framework. DATA COLLECTION/EXTRACTION METHODS Interview data were gathered using remote data collection methods (video conferencing). Participants were hospital employees, including psychologists, social workers, primary care physicians, community health workers, administrators, and operations managers. We used conventional content analysis. PRINCIPAL FINDINGS Clinical stakeholders acknowledged the impact of racism, including racial stress and trauma, on patient engagement and noted the potential need to adapt PTSD treatments to enhance engagement. Clinical stakeholders also characterized the harms of racism on patients and providers and provided recommendations such as changes to staff training and hiring practices, examination of racist policies, and increases in support for providers of color. CONCLUSIONS This study contextualizes providers' perceptions of racism in the integrated primary care practice and provides some suggestions for shifting to an antiracist framework. Our findings also highlight how racism in health care may be a PTSD treatment implementation barrier.
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Affiliation(s)
- Caravella McCuistian
- Department of Psychiatry and Behavioral SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Sarah L. Kimball
- Section of General Internal MedicineBoston Medical CenterBostonMassachusettsUSA
- Boston University School of MedicineBostonMassachusettsUSA
| | - Pablo Buitron de la Vega
- Section of General Internal MedicineBoston Medical CenterBostonMassachusettsUSA
- Boston University School of MedicineBostonMassachusettsUSA
| | - Laura B. Godfrey
- Department of PsychiatryBoston Medical CenterBostonMassachusettsUSA
| | - Lisa R. Fortuna
- Department of Psychiatry and Behavioral SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Sarah E. Valentine
- Boston University School of MedicineBostonMassachusettsUSA
- Department of PsychiatryBoston Medical CenterBostonMassachusettsUSA
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31
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Brown‐Johnson C, Cox J, Shankar M, Baratta J, De Leon G, Garcia R, Hollis T, Verano M, Henderson K, Upchurch M, Safaeinili N, Shaw JG, Fortuna RJ, Beverly C, Walsh M, Somerville CS, Haverfield M, Israni ST, Verghese A, Zulman DM. The Presence 5 for Racial Justice Framework for anti-racist communication with Black patients. Health Serv Res 2022; 57 Suppl 2:263-278. [PMID: 35765147 PMCID: PMC9660409 DOI: 10.1111/1475-6773.14015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To identify communication practices that clinicians can use to address racism faced by Black patients, build trusting relationships, and empower Black individuals in clinical care. DATA SOURCES Qualitative data (N = 112 participants, August 2020-March 2021) collected in partnership with clinics primarily serving Black patients in Leeds, AL; Memphis, TN; Oakland, CA; and Rochester, NY. STUDY DESIGN This multi-phased project was informed by human-centered design thinking and community-based participatory research principles. We mapped emergent communication and trust-building strategies to domains from the Presence 5 framework for fostering meaningful connection in clinical care. DATA COLLECTION METHODS Interviews and focus group discussions explored anti-racist communication and patient-clinician trust (n = 36 Black patients; n = 40 nonmedical professionals; and n = 24 clinicians of various races and ethnicities). The Presence 5 Virtual National Community Advisory Board guided analysis interpretation. PRINCIPAL FINDINGS The emergent Presence 5 for Racial Justice (P5RJ) practices include: (1) Prepare with intention by reflecting on identity, bias, and power dynamics; and creating structures to address bias and structural determinants of health; (2) Listen intently and completely without interruption and listen deeply for the potential impact of anti-Black racism on patient health and interactions with health care; (3) Agree on what matters most by having explicit conversations about patient goals, treatment comfort and consent, and referral planning; (4) Connect with the patient's story, acknowledging socioeconomic factors influencing patient health and focusing on positive efforts; (5) Explore emotional cues by noticing and naming patient emotions, and considering how experiences with racism might influence emotions. CONCLUSION P5RJ provides a framework with actionable communication practices to address pervasive racism experienced by Black patients. Effective implementation necessitates clinician self-reflection, personal commitment, and institutional support that offers time and resources to elicit a patient's story and to address patient needs.
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Affiliation(s)
- Cati Brown‐Johnson
- Evaluation Sciences Unit, Division of Primary Care and Population HealthStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Joy Cox
- Meta Platforms, Inc.One Hacker WayMenlo ParkCaliforniaUSA
| | - Megha Shankar
- Division of General Internal Medicine, Department of MedicineUC San DiegoSan DiegoCaliforniaUSA
| | | | - Gisselle De Leon
- Division of Primary Care and Population HealthStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Raquel Garcia
- Division of Primary Care and Population HealthStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Taylor Hollis
- UAB Marnix E. Heersink School of MedicineBirminghamAlabamaUSA
| | - Mae Verano
- Division of Primary Care and Population HealthStanford University School of MedicinePalo AltoCaliforniaUSA
| | | | | | - Nadia Safaeinili
- Health Policy and ManagementUC Berkeley School of Public HealthBerkeleyCaliforniaUSA
| | - Jonathan Glazer Shaw
- Division of Primary Care and Population HealthStanford University School of MedicinePalo AltoCaliforniaUSA
| | | | - Clyde Beverly
- Presence 5 for Racial Justice Community Advisory BoardStanford University School of MedicinePalo AltoCaliforniaUSA
| | | | | | - Marie Haverfield
- Communication StudiesCollege of Social Studies, San Jose State UniversitySan JoseCaliforniaUSA
| | | | - Abraham Verghese
- Presence CenterStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Donna M. Zulman
- Division of Primary Care and Population HealthStanford University School of MedicinePalo AltoCaliforniaUSA
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Nichol BAB, Hurlbert AC, Read JCA. Predicting attitudes towards screening for neurodegenerative diseases using OCT and artificial intelligence: Findings from a literature review. J Public Health Res 2022; 11:22799036221127627. [PMID: 36310821 PMCID: PMC9597051 DOI: 10.1177/22799036221127627] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/02/2022] [Indexed: 11/25/2022] Open
Abstract
Recent developments in artificial intelligence (AI) and machine learning raise the possibility of screening and early diagnosis for neurodegenerative diseases, using 3D scans of the retina. The eventual value of such screening will depend not only on scientific metrics such as specificity and sensitivity but, critically, also on public attitudes and uptake. Differential screening rates for various screening programmes in England indicate that multiple factors influence uptake. In this narrative literature review, some of these potential factors are explored in relation to predicting uptake of an early screening tool for neurodegenerative diseases using AI. These include: awareness of the disease, perceived risk, social influence, the use of AI, previous screening experience, socioeconomic status, health literacy, uncontrollable mortality risk, and demographic factors. The review finds the strongest and most consistent predictors to be ethnicity, social influence, the use of AI, and previous screening experience. Furthermore, it is likely that factors also interact to predict the uptake of such a tool. However, further experimental work is needed both to validate these predictions and explore interactions between the significant predictors.
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Affiliation(s)
- Beth AB Nichol
- Department of Social Work, Education,
and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK,Beth AB Nichol, Department of Social Work,
Education, and Community Wellbeing, Northumbria University, Coach Lane,
Newcastle upon Tyne NE7 7XA, UK.
| | - Anya C Hurlbert
- Biosciences Institute, Newcastle
University, Newcastle upon Tyne, UK
| | - Jenny CA Read
- Biosciences Institute, Newcastle
University, Newcastle upon Tyne, UK
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Burnett-Bowie SAM, Zeidman JA, Soltoff AE, Carden KT, James AK, Armstrong KA. Attitudes and Actions Related to Racism: the Anti-RaCism (ARC) Survey Study. J Gen Intern Med 2022; 37:2337-2344. [PMID: 35157198 PMCID: PMC9360374 DOI: 10.1007/s11606-021-07385-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/22/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Racism negatively impacts health and well-being. Members of the medical community must intervene to address racism. OBJECTIVE To assess whether attitudes about the impact of racism on health or society are associated with intervening around racism. DESIGN Cross-sectional survey of a large department of medicine in an urban academic setting. PARTICIPANTS Interns, residents, fellows, and faculty. MAIN MEASURES The primary outcome was the likelihood of intervening around an observed racist encounter or a racist policy. Predictor variables included age, gender identity, race/ethnicity, and attitudes about racism. KEY RESULTS Although the majority of the 948 respondents endorsed the impact of racism on health and other societal effects, levels of endorsement were lower among older individuals, or those reporting male gender identity or selecting other race. Higher endorsement of the impact of racism on health was associated with increased odds of speaking up about a racist encounter or racist policy, with odds ratios from 1.18 to 1.30 across scenarios. Likelihood of speaking up about racism did not differ by racial or ethnic group, but older individuals were generally more likely to speak up and individuals between 20 and 29 years of age were more likely to speak with someone other than leadership or the source of a racist encounter. CONCLUSIONS Awareness of the effects of racism on health is associated with increased likelihood of intervening when a racist encounter is observed or a racist policy is noted. Including information on the impact of racism on health and creating safe spaces to discuss racism may increase the likelihood of bystander intervention in anti-racism strategies.
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Affiliation(s)
- Sherri-Ann M Burnett-Bowie
- Endocrine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Blossom Street, Thier 1051, Boston, MA, 02114-2696, USA.
| | - Jessica A Zeidman
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexander E Soltoff
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kylee T Carden
- Department of Physics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Aisha K James
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Katrina A Armstrong
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Ng CH, Lim WH, Chin YH, Yong JN, Zeng RW, Chan KE, Tan DJH, Fu CE, Tang ASP, Goh LH, Devi K, Chew NWS, Mak LYL, Tamaki N, Huang DQ, Noureddin M, Siddiqui MS, Loomba R, Sanyal AJ, Muthiah M. Living in the non-alcoholic fatty liver disease silent epidemic: a qualitative systematic review of patients' perspectives. Aliment Pharmacol Ther 2022; 56:570-579. [PMID: 35791632 DOI: 10.1111/apt.17121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/04/2022] [Accepted: 06/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) affects one-fourth of the global population. Yet, the care of these patients is limited and awareness of NAFLD remains low in the general public. Investigations into the lives of these patients are often forgotten and traditional quantitative studies only paint part of the picture. AIM To assess the first-hand accounts of these individuals and their perspective on living with NAFLD. METHODS A systematic search was conducted on Medline, Embase, CINAHL, PsycINFO and Web of Science database for qualitative literature regarding patients' perspectives on NAFLD. An inductive thematic analysis was conducted to generate themes and supportive subthemes. RESULTS We incuded eight articles in the review. There were three major themes including the impact on the quality of life, knowledge and information, and attitudes and perceptions on care. The impact of the quality of life details the emotional and physical distress of NAFLD. Knowledge and information include the lack of sufficient communication between healthcare providers and patients with a distinct knowledge gap. Attitudes and perceptions on care extrapolate the current active participation of patients and needs of the patients and the future care that they desire. CONCLUSION This review synthesises first-hand accounts of individuals with NAFLD. With the growing burden of NAFLD, future public interventions must consider individual views for success to be found. The identified themes serve as a forefront for consideration for public policies. Ultimately, NAFLD is a multisystem disease, which must be managed by a multidisciplinary team.
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Affiliation(s)
- Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jie Ning Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Clarissa Elysia Fu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ansel Shao Pin Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lay Hoon Goh
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kamala Devi
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas W S Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
| | - Lung-Yi Loey Mak
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Nobuharu Tamaki
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, San Diego, California, USA.,Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Mazen Noureddin
- Cedars-Sinai Fatty Liver Program, Division of Digestive and Liver Diseases, Department of Medicine, Comprehensive Transplant Center, Cedars-Sinai Medical Centre, Los Angeles, California, USA
| | - Mohammad Shadab Siddiqui
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, San Diego, California, USA
| | - Arun J Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore
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35
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Hamed S, Bradby H, Ahlberg BM, Thapar-Björkert S. Racism in healthcare: a scoping review. BMC Public Health 2022; 22:988. [PMID: 35578322 PMCID: PMC9112453 DOI: 10.1186/s12889-022-13122-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Racism constitutes a barrier towards achieving equitable healthcare as documented in research showing unequal processes of delivering, accessing, and receiving healthcare across countries and healthcare indicators. This review summarizes studies examining how racism is discussed and produced in the process of delivering, accessing and receiving healthcare across various national contexts. METHOD The PRISMA guidelines for scoping reviews were followed and databases were searched for peer reviewed empirical articles in English across national contexts. No starting date limitation was applied for this review. The end date was December 1, 2020. The review scoped 213 articles. The results were summarized, coded and thematically categorized in regards to the aim. RESULTS The review yielded the following categories: healthcare users' experiences of racism in healthcare; healthcare staff's experiences of racism; healthcare staff's racial attitudes and beliefs; effects of racism in healthcare on various treatment choices; healthcare staff's reflections on racism in healthcare and; antiracist training in healthcare. Racialized minorities experience inadequate healthcare and being dismissed in healthcare interactions. Experiences of racism are associated with lack of trust and delay in seeking healthcare. Racialized minority healthcare staff experience racism in their workplace from healthcare users and colleagues and lack of organizational support in managing racism. Research on healthcare staff's racial attitudes and beliefs demonstrate a range of negative stereotypes regarding racialized minority healthcare users who are viewed as difficult. Research on implicit racial bias illustrates that healthcare staff exhibit racial bias in favor of majority group. Healthcare staff's racial bias may influence medical decisions negatively. Studies examining healthcare staff's reflections on racism and antiracist training show that healthcare staff tend to construct healthcare as impartial and that healthcare staff do not readily discuss racism in their workplace. CONCLUSIONS The USA dominates the research. It is imperative that research covers other geo-political contexts. Research on racism in healthcare is mainly descriptive, atheoretical, uses racial categories uncritically and tends to ignore racialization processes making it difficult to conceptualize racism. Sociological research on racism could inform research on racism as it theoretically explains racism's structural embeddedness, which could aid in tackling racism to provide good quality care.
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Affiliation(s)
- Sarah Hamed
- Department of Sociology, Uppsala University, Uppsala, Sweden.
| | - Hannah Bradby
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | - Beth Maina Ahlberg
- Department of Sociology, Uppsala University, Uppsala, Sweden.,Skaraborg Institute for Research and Development, Skövde, Sweden
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Vaismoradi M, Fredriksen Moe C, Ursin G, Ingstad K. Looking through racism in the nurse-patient relationship from the lens of culturally congruent care: A scoping review. J Adv Nurs 2022; 78:2665-2677. [PMID: 35441739 PMCID: PMC9544978 DOI: 10.1111/jan.15267] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/19/2022] [Accepted: 04/05/2022] [Indexed: 02/06/2023]
Abstract
AIM This review aimed to identify the nature of racism in the nurse-patient relationship and summarize international research findings about it. DESIGN A scoping review of the international literature. DATA SOURCES The search process encompassed three main online databases of PubMed (including MEDLINE), Scopus and Embase, from 2009 until 2021. REVIEW METHODS The scoping review was informed by the Levac et al.'s framework to map the research phenomenon and summarize current empirical research findings. Also, the review findings were reflected in the three-dimensional puzzle model of culturally congruent care in the discussion section. RESULTS The search process led to retrieving 149 articles, of which 10 studies were entered into data analysis and reporting results. They had variations in the research methodology and the context of the nurse-patient relationship. The thematical analysis of the studies' findings led to the development of three categories as follows: bilateral ignition of racism, hidden and manifest consequences of racism and encountering strategies. CONCLUSION Racism threatens patients' and nurses' dignity in the healthcare system. There is a need to develop a framework of action based on the principles of culturally congruent care to eradicate racism from the nurse-patient relationship in the globalized context of healthcare. IMPACT Racism in the nurse-patient relationship has remained a relatively unexplored area of the nursing literature. It hinders efforts to meet patients' and families' needs and increases their dissatisfaction with nursing care. Also, racism from patients towards nurses causes emotional trauma and enhances job-related stress among nurses. Further research should be conducted on this culturally variant phenomenon. Also, the participation of patients and nurses should be sought to prohibit racism in healthcare settings.
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Affiliation(s)
| | | | - Gøril Ursin
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Kari Ingstad
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
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37
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Ahlberg BM, Hamed S, Bradby H, Moberg C, Thapar-Björkert S. "Just Throw It Behind You and Just Keep Going": Emotional Labor when Ethnic Minority Healthcare Staff Encounter Racism in Healthcare. FRONTIERS IN SOCIOLOGY 2022; 6:741202. [PMID: 35097059 PMCID: PMC8789661 DOI: 10.3389/fsoc.2021.741202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/09/2021] [Indexed: 06/14/2023]
Abstract
Encountering racism is burdensome and meeting it in a healthcare setting is no exception. This paper is part of a larger study that focused on understanding and addressing racism in healthcare in Sweden. In the paper, we draw on interviews with 12 ethnic minority healthcare staff who described how they managed emotional labor in their encounters with racism at their workplace. Data were analyzed using thematic analysis. The analysis revealed that experienced emotional labor arises from two main reasons. The first is the concern and fear that ethnic minority healthcare staff have of adverse consequences for their employment should they be seen engaged in discussing racism. The second concerns the ethical dilemmas when taking care of racist patients since healthcare staff are bound by a duty of providing equal care for all patients as expressed in healthcare institutional regulations. Strategies to manage emotional labor described by the staff include working harder to prove their competence and faking, blocking or hiding their emotions when they encounter racism. The emotional labor implied by these strategies could be intense or traumatizing as indicated by some staff members, and can therefore have negative effects on health. Given that discussions around racism are silenced, it is paramount to create space where racism can be safely discussed and to develop a safe healthcare environment for the benefit of staff and patients.
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Affiliation(s)
- Beth Maina Ahlberg
- Department of Sociology, Uppsala University, Uppsala, Sweden
- Skaraborg Institute for Research and Development, Skövde, Sweden
| | - Sarah Hamed
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | - Hannah Bradby
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | - Cecilia Moberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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