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Brener S, Jiang S, Hazenberg E, Herrera D. A Cyclical Model of Barriers to Healthcare for the Hispanic/Latinx Population. J Racial Ethn Health Disparities 2024; 11:1077-1088. [PMID: 37039976 DOI: 10.1007/s40615-023-01587-5] [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: 12/29/2022] [Revised: 03/24/2023] [Accepted: 03/31/2023] [Indexed: 04/12/2023]
Abstract
As the Hispanic/Latinx population in the United States continues to grow, disparities in health outcomes for this population continue to widen. Worse health outcomes can be attributed to a variety of barriers to healthcare specific to this population, but scant literature exists that presents the connections among them. Many of these barriers to healthcare stem from institutional racism, disparities in socioeconomic status, and xenophobia. To synthesize barriers that hinder the Hispanic/Latinx population from receiving quality healthcare, we propose a cyclical model. The model begins with obstacles present before even visiting a healthcare provider, including structural inequalities, cultural beliefs, documentation status, scheduling, and transportation. Next, the model poses barriers during the visit with a healthcare provider, including problems with provider bias, cultural barriers, and interpretation services. Finally, the model presents barriers that occur after the medical encounter, including payment, medication adherence, indigent care, and follow-up appointments or referrals. Once the patient needs to schedule a follow-up appointment or referral, the cycle restarts with the barriers present before accessing care. All of these barriers to healthcare are areas for potential mitigation of the healthcare disparities that currently disadvantage the Hispanic/Latinx population. The proposed Hispanic Cyclical Healthcare Barrier (HCHB) model helps organize solutions to the barriers, illustrating the need for multiple interventions due to the interconnectedness of the barriers.
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Kheyfets A, Dhaurali S, Feyock P, Khan F, Lockley A, Miller B, Cohen L, Anwar E, Amutah-Onukagha N. The impact of hostile abortion legislation on the United States maternal mortality crisis: a call for increased abortion education. Front Public Health 2023; 11:1291668. [PMID: 38115843 PMCID: PMC10728320 DOI: 10.3389/fpubh.2023.1291668] [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: 09/09/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023] Open
Abstract
The growing restrictive abortion policies nationwide and the Supreme Court decision on Dobbs v. Jackson Women's Health Organization place increasing barriers to abortion access in the United States. These restrictions disproportionately affect low-income people of color, immigrants, and non-English speakers, and have the potential to exacerbate already existing racial inequities in maternal and neonatal outcomes. The United States is facing a Black maternal health crisis where Black birthing people are more than twice as likely to experience maternal mortality and severe maternal morbidity compared to White birthing people. Restrictions creating geographic, transportation, and financial barriers to obtaining an abortion can result in increased rates of maternal death and adverse outcomes across all groups but especially among Black birthing people. Restrictive abortion laws in certain states will decrease already limited training opportunities in abortion care for medical professionals, despite the existing abortion provider shortage. There is an immediate need for federal legislation codifying broad abortion care access into law and expanding access to abortion training across medical education. This commentary explores the impact of restrictive abortion laws on the Black maternal health crisis through multiple pathways in a logic model. By identifying current barriers to abortion education in medical school and residency, we created a list of action items to expand abortion education and access.
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Affiliation(s)
- Anna Kheyfets
- Tufts University School of Medicine, Boston, MA, United States
- Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, United States
| | - Shubhecchha Dhaurali
- Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, United States
| | - Paige Feyock
- Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, United States
- University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - Farinaz Khan
- Collective Energy for Nurturing Training in Reproductive and Sexual Health (CENTRS Health), Albuquerque, NM, United States
| | - April Lockley
- Collective Energy for Nurturing Training in Reproductive and Sexual Health (CENTRS Health), Albuquerque, NM, United States
| | - Brenna Miller
- Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, United States
| | - Lauren Cohen
- Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, United States
| | - Eimaan Anwar
- Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, United States
| | - Ndidiamaka Amutah-Onukagha
- Tufts University School of Medicine, Boston, MA, United States
- Center for Black Maternal Health and Reproductive Justice, Tufts University School of Medicine, Boston, MA, United States
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Holloway TD, Harvanek ZM, Xu K, Gordon DM, Sinha R. Greater stress and trauma mediate race-related differences in epigenetic age between Black and White young adults in a community sample. Neurobiol Stress 2023; 26:100557. [PMID: 37501940 PMCID: PMC10369475 DOI: 10.1016/j.ynstr.2023.100557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/29/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
Black Americans suffer lower life expectancy and show signs of accelerated aging compared to other Americans. While previous studies observe these differences in children and populations with chronic illness, whether these pathologic processes exist or how these pathologic processes progress has yet to be explored prior to the onset of significant chronic illness, within a young adult population. Therefore, we investigated race-related differences in epigenetic age in a cross-sectional sample of young putatively healthy adults and assessed whether lifetime stress and/or trauma mediate those differences. Biological and psychological data were collected from self-reported healthy adult volunteers within the local New Haven area (399 volunteers, 19.8% Black, mean age: 29.28). Stress and trauma data was collected using the Cumulative Adversity Inventory (CAI) interview, which assessed specific types of stressors, including major life events, traumatic events, work, financial, relationship and chronic stressors cumulatively over time. GrimAge Acceleration (GAA), determined from whole blood collected from participants, measured epigenetic age. In order to understand the impact of stress and trauma on GAA, exploratory mediation analyses were then used. We found cumulative stressors across all types of events (mean difference of 6.9 p = 2.14e-4) and GAA (β = 2.29 years [1.57-3.01, p = 9.70e-10] for race, partial η2 = 0.091, model adjusted R2 = 0.242) were significantly greater in Black compared to White participants. Critically, CAI total score (proportion mediated: 0.185 [0.073-0.34, p = 6e-4]) significantly mediated the relationship between race and GAA. Further analysis attributed this difference to more traumatic events, particularly assaultive traumas and death of loved ones. Our results suggest that, prior to development of significant chronic disease, Black individuals have increased epigenetic age compared to White participants and that increased cumulative stress and traumatic events may contribute significantly to this epigenetic aging difference.
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Affiliation(s)
| | - Zachary M. Harvanek
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Yale Stress Center, Yale University, New Haven, CT, USA
| | - Ke Xu
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Department of Psychiatry, Connecticut Veteran Healthcare System, West Haven, CT, USA
| | | | - Rajita Sinha
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Yale Stress Center, Yale University, New Haven, CT, USA
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Meidert U, Dönnges G, Bucher T, Wieber F, Gerber-Grote A. Unconscious Bias among Health Professionals: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6569. [PMID: 37623155 PMCID: PMC10454622 DOI: 10.3390/ijerph20166569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Unconscious biases are one of the causes of health disparities. Health professionals have prejudices against patients due to their race, gender, or other factors without their conscious knowledge. This review aimed to provide an overview of research on unconscious bias among health professionals and to investigate the biases that exist in different regions of the world, the health professions that are considered, and the research gaps that still exist. METHODS We conducted a scoping review by systematically searching PubMed/MEDLINE, CINAHL, PsycINFO, PsycARTICLES, and AMED. All records were double-screened and included if they were published between 2011 and 2021. RESULTS A total of 5186 records were found. After removing duplicates (n = 300), screening titles and abstracts (n = 4210), and full-text screening (n = 695), 87 articles from 81 studies remained. Studies originated from North America (n = 60), Europe (n = 13), and the rest of the world (n = 6), and two studies were of global scope. Racial bias was investigated most frequently (n = 46), followed by gender bias (n = 11), weight bias (n = 10), socio-economic status bias (n = 9), and mental illness bias (n = 7). Most of the studies were conducted by physicians (n = 51) and nurses (n = 20). Other health care professionals were rarely included in these studies. CONCLUSIONS Most studies show that health professionals have an implicit bias. Racial biases among physicians and nurses in the USA are well confirmed. Research is missing on other biases from other regions and other health professions.
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Affiliation(s)
- Ursula Meidert
- School of Health Sciences, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland; (G.D.); (T.B.); (F.W.); (A.G.-G.)
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Tang HY, Xiong Y, Snow K. Discrimination experienced among Asian/Asian American students amid the COVID-19 pandemic. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-8. [PMID: 37399529 DOI: 10.1080/07448481.2023.2225631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 04/25/2023] [Accepted: 06/01/2023] [Indexed: 07/05/2023]
Abstract
Objective: With the increasing incidents of discrimination toward Asian and Asian Americans (A/AA) in the United States amid the COVID-19 pandemic, this study explored A/AA university students' lived experiences of discrimination during this time and their reactions toward discrimination. Participants: Ten A/AA university students from a major research university in the mid-Atlantic region of the United States participated in the study. Methods: We utilized a phenomenology approach in this study. Results: Two primary structural themes were identified: (1) examples of discrimination and (2) personal reactions to discrimination and microaggression. Conclusion: A/AA university students experienced overt/open discrimination and microaggression amid the COVID-19 pandemic. Their responses to discrimination and microaggressions highlighted the challenges and opportunities presented by the COVID-19-related anti-Asian racism. Implications for university personnel were also discussed.
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Affiliation(s)
- Hsin-Ya Tang
- Department of Counseling and Educational Studies, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yiying Xiong
- Department of Counseling and Educational Studies, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kevin Snow
- Department of Counseling and Human Services, Old Dominion University, Norfolk, Virginia, USA
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Gonzalez CM, Onumah CM, Walker SA, Karp E, Schwartz R, Lypson ML. Implicit bias instruction across disciplines related to the social determinants of health: a scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:541-587. [PMID: 36534295 DOI: 10.1007/s10459-022-10168-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/27/2022] [Indexed: 05/11/2023]
Abstract
One criticism of published curricula addressing implicit bias is that few achieve skill development in implicit bias recognition and management (IBRM). To inform the development of skills-based curricula addressing IBRM, we conducted a scoping review of the literature inquiring, "What interventions exist focused on IBRM in professions related to social determinants of health: education, law, social work, and the health professions inclusive of nursing, allied health professions, and medicine?"Authors searched eight databases for articles published from 2000 to 2020. Included studies: (1) described interventions related to implicit bias; and (2) addressed knowledge, attitude and/or skills as outcomes. Excluded were interventions solely focused on reducing/neutralizing implicit bias. Article review for inclusion and data charting occurred independently and in duplicate. Investigators compared characteristics across studies; data charting focused on educational and assessment strategies. Fifty-one full-text articles for data charting and synthesis, with more than 6568 learners, were selected. Educational strategies included provocative/engagement triggers, the Implicit Association Test, reflection and discussion, and various active learning strategies. Most assessments were self-report, with fewer objective measures. Eighteen funded studies utilized federal, foundation, institutional, and private sources. This review adds to the literature by providing tangible examples of curricula to complement existing frameworks, and identifying opportunities for further research in innovative skills-based instruction, learner assessment, and development and validation of outcome metrics. Continued research addressing IBRM would enable learners to develop and practice skills to recognize and manage their implicit biases during clinical encounters, thereby advancing the goal of improved, equitable patient outcomes.
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Affiliation(s)
- Cristina M Gonzalez
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA.
| | - Chavon M Onumah
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sydney A Walker
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Elisa Karp
- Department of Pediatrics, North Central Bronx Hospital, Bronx, NY, USA
| | | | - Monica L Lypson
- Columbia University Irving Medical Center, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
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Muroff J, Do D, Brinkerhoff CA, Chassler D, Cortes MA, Baum M, Guzman-Betancourt G, Reyes D, López LM, Roberts M, De Jesus D, Stewart E, Martinez LS. Nuestra Recuperación [Our Recovery]: using photovoice to understand the factors that influence recovery in Latinx populations. BMC Public Health 2023; 23:81. [PMID: 36631802 PMCID: PMC9832608 DOI: 10.1186/s12889-023-14983-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Photovoice is a form of visual ethnography intended to engage impacted communities in research followed by action to ameliorate the injustices under study. Photovoice has increased in use, especially in collaboration with Latinx communities addressing health inequities. The Latinx population comprises nearly 18% of the overall United States population and according to the census is projected to reach just under 30% by 2060. This diverse panethnic community faces significant structural barriers in accessing services. Racism and the resulting marginalization, specifically, contributes to limited access to recovery services and treatment. Making meaningful advances in substance use disorder training, intervention and policy necessitates learning alongside the Latinx community. METHODS We partnered with a Latinx serving integrated behavioral health and primary care setting in Boston Massachusetts to explore barriers and facilitators to recovery using photovoice. Spanish-speaking Latinx adults with a substance use disorder participated. The group met for three photovoice sessions over a six-week period. Together group members critically analyzed photographs using the SHOWeD method. RESULTS Findings indicate a sense of purpose and meaning, security, faith and housing are important elements of recovery. The results illustrated the importance of sources of connection in maintaining sobriety. Through this photovoice project, Latinx Spanish speaking participants highlighted barriers and facilitators to their substance use disorder recovery which spanned individual, community, and structural levels. CONCLUSIONS The experiences and voices of the Latinx community are crucial to drive discussions that advance policy (e.g., housing stability and access), enhance providers' understanding of Latinx Spanish-speakers' substance use disorder recovery, and inform culturally and linguistically appropriate services. This study demonstrated that photovoice is highly acceptable and feasible among Latinx clients receiving substance use disorder services. Visual images related to housing, faith, etc. communicate challenges, power structures, as well as hopes to policymakers at multiple levels (e.g., institution/ agency, state).
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Affiliation(s)
- Jordana Muroff
- School of Social Work, Boston University, Boston, MA, USA.
| | - Daniel Do
- grid.189504.10000 0004 1936 7558School of Social Work, Boston University, Boston, MA USA
| | | | - Deborah Chassler
- grid.189504.10000 0004 1936 7558School of Social Work, Boston University, Boston, MA USA
| | - Myrna Alfaro Cortes
- grid.189504.10000 0004 1936 7558School of Public Health, Boston University, Boston, MA USA
| | - Michelle Baum
- grid.189504.10000 0004 1936 7558School of Social Work, Boston University, Boston, MA USA
| | | | - Daniela Reyes
- grid.189504.10000 0004 1936 7558School of Social Work, Boston University, Boston, MA USA
| | - Luz M. López
- grid.189504.10000 0004 1936 7558School of Social Work, Boston University, Boston, MA USA
| | | | | | | | - Linda Sprague Martinez
- grid.189504.10000 0004 1936 7558School of Social Work, Boston University, Boston, MA USA
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Kruse JA, Collins JL, Vugrin M. Educational strategies used to improve the knowledge, skills, and attitudes of health care students and providers regarding implicit bias: An integrative review of the literature. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100073. [PMID: 38745633 PMCID: PMC11080399 DOI: 10.1016/j.ijnsa.2022.100073] [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: 12/16/2021] [Revised: 02/11/2022] [Accepted: 03/02/2022] [Indexed: 11/28/2022] Open
Abstract
Background The thoughts, feelings, and attitudes health care professionals unconsciously have about patients can negatively impact patients' health outcomes. Systematic reviews related to implicit bias in health care providers have uncovered negative implicit bias towards older adults, people of color, people with disabilities, psychiatric patients, patients who are obese, people of low socioeconomic status, and women. Implicit bias impacts the quality, safety, and competence of care delivered; interactions between patients and providers; and patient approval of treatment recommendations. Health care professions students and health care providers need to participate in evidence-based educational strategies to manage and diminish bias. Objective To review the evidence regarding educational strategies used with health care professions students and providers to improve their knowledge of implicit bias, reduce bias, and improve attitudes about bias. Design Integrative review. Methods The literature review was completed in July 2020 with two updates performed in February 2021 and June 2021 using nine databases including Academic Search Complete™, Embase®, ERIC®, Ovid, PubMed®, Scopus®, and Web of Science™. Key terms used related to education, health care professions' students, health care providers, implicit, bias, incivility, microaggression, and microassult. Publications dates from 2011 to 2021 were included. Covidence software was used for the initial screening and for full-text analysis. Results Thirty-nine articles were analysed for this review. The most commonly used educational strategies to instruct about principles of implicit bias include discussion groups, simulation and case-based learning, pre-tests for awareness, use of expert facilitators, commitment to action/change, and debriefing. Common components of successful strategies include thoughtful program planning, careful selection of program facilitators (who are content experts), support of participants, and a system-level investment. Conclusions Diverse educational strategies successfully addressed implicit bias across studies. Recommendations for future studies includes addressing limitations in sampling strategies and data collection to clarify relationships between educational strategies and participant outcomes. Educational opportunities are warranted that challenge health care professionals to explore their implicit bias towards others in an effort to provide care that considers diversity, equity, and inclusion and also limits personal implicit bias.
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Affiliation(s)
| | | | - Margaret Vugrin
- Health Sciences Center- Preston Smith Library, Texas Tech University, United States
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Effects on the Affect Misattribution Procedure are strongly moderated by influence awareness. Behav Res Methods 2022:10.3758/s13428-022-01879-4. [PMID: 35689167 DOI: 10.3758/s13428-022-01879-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 12/20/2022]
Abstract
The Affect Misattribution Procedure (AMP) is used in many areas of psychological science based on the assumption that it not only taps into attitudes and biases but does so without a person's awareness. Across eight preregistered studies (N = 1603) plus meta-analyses, we reexamined the 'implicitness' of AMP effects, and in particular, the idea that people are unaware of the prime's influence on their evaluations. Results indicated that AMP effects and their predictive validity are primarily moderated by a subset of influence-aware trials (within individuals), and high rates of influence awareness (between individuals). Interestingly, an individual's influence-awareness rate on one AMP predicted how they performed on an earlier AMP, even when the two assessed different attitude domains. Taken together, our results suggest that AMP effects are not implicit in the way that has been claimed, a finding that has implications for the procedure, past findings, and theory. All materials and data are available at osf.io/gv7cm.
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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: 62] [Impact Index Per Article: 31.0] [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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Hershberger PJ, Pei Y, Crawford TN, Neeley SM, Wischgoll T, Patel DB, Vasoya MM, Castle A, Mishra S, Surapaneni L, Pogaku AA, Bositty A, Pavlack T. An Interactive Game with Virtual Reality Immersion to Improve Cultural Sensitivity in Health Care. Health Equity 2022; 6:189-197. [PMID: 35402778 PMCID: PMC8985530 DOI: 10.1089/heq.2021.0128] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 11/12/2022] Open
Abstract
Purpose Biased perceptions of individuals who are not part of one's in-groups tend to be negative and habitual. Because health care professionals are no less susceptible to biases than are others, the adverse impact of biases on marginalized populations in health care warrants continued attention and amelioration. Method Two characters, a Syrian refugee with limited English proficiency and a black pregnant woman with a history of opioid use disorder, were developed for an online training simulation that includes an interactive life course experience focused on social determinants of health, and a clinical encounter in a community health center utilizing virtual reality immersion. Pre- and post-survey data were obtained from 158 health professionals who completed the simulation. Results Post-simulation data indicated increased feelings of compassion toward the patient and decreased expectations about how difficult future encounters with the patient would be. With respect to attribution, after the simulation participants were less inclined to view the patient as primarily responsible for their situation, suggesting less impact of the fundamental attribution error. Conclusion This training simulation aimed to utilize components of evidence-based prejudice habit breaking interventions, such as learning more about an individual's life experience to help minimize filling in gaps with stereotyped assumptions. Although training simulations cannot fully replicate or replace the advantages that come with real-world experience, they can heighten awareness in the increase of increasing the cultural sensitivity of clinicians in health care professions for improving health equity.
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Affiliation(s)
- Paul J. Hershberger
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Yong Pei
- Department of Computer Science and Engineering, Wright State University College of Engineering and Computer Science, Dayton, Ohio, USA
| | - Timothy N. Crawford
- Department of Population and Public Health Sciences and Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Sabrina M. Neeley
- School of Education and Health Sciences, University of Dayton, Dayton, Ohio, USA
| | - Thomas Wischgoll
- Department of Computer Science and Engineering, Wright State University College of Engineering and Computer Science, Dayton, Ohio, USA
| | - Dixit B. Patel
- Department of Computer Science and Engineering, Wright State University College of Engineering and Computer Science, Dayton, Ohio, USA
| | - Miteshkumar M. Vasoya
- Department of Computer Science and Engineering, Wright State University College of Engineering and Computer Science, Dayton, Ohio, USA
| | - Angie Castle
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Sankalp Mishra
- Department of Computer Science and Engineering, Wright State University College of Engineering and Computer Science, Dayton, Ohio, USA
| | - Lahari Surapaneni
- Department of Computer Science and Engineering, Wright State University College of Engineering and Computer Science, Dayton, Ohio, USA
| | - Aman A. Pogaku
- Department of Computer Science and Engineering, Wright State University College of Engineering and Computer Science, Dayton, Ohio, USA
| | - Aishwarya Bositty
- Department of Computer Science and Engineering, Wright State University College of Engineering and Computer Science, Dayton, Ohio, USA
| | - Todd Pavlack
- Manager Distance Learning and Instructional Designer, Wright State University, Dayton, Ohio, USA
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Vela MB, Erondu AI, Smith NA, Peek ME, Woodruff JN, Chin MH. Eliminating Explicit and Implicit Biases in Health Care: Evidence and Research Needs. Annu Rev Public Health 2022; 43:477-501. [PMID: 35020445 PMCID: PMC9172268 DOI: 10.1146/annurev-publhealth-052620-103528] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Health care providers hold negative explicit and implicit biases against marginalized groups of people such as racial and ethnic minoritized populations. These biases permeate the health care system and affect patients via patient–clinician communication, clinical decision making, and institutionalized practices. Addressing bias remains a fundamental professional responsibility of those accountable for the health and wellness of our populations. Current interventions include instruction on the existence and harmful role of bias in perpetuating health disparities, as well as skills training for the management of bias. These interventions can raise awareness of provider bias and engage health care providers in establishing egalitarian goals for care delivery, but these changes are not sustained, and the interventions have not demonstrated change in behavior in the clinical or learning environment. Unfortunately, the efficacy of these interventions may be hampered by health care providers’ work and learning environments, which are rife with discriminatory practices that sustain the very biases US health care professions are seeking to diminish. We offer a conceptual model demonstrating that provider-level implicit bias interventions should be accompanied by interventions that systemically change structures inside and outside the health care system if the country is to succeed in influencing biases and reducing health inequities.
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Affiliation(s)
- Monica B Vela
- Department of Medicine, Section of Academic Internal Medicine, University of Illinois College of Medicine in Chicago, Chicago, Illinois, USA;
| | - Amarachi I Erondu
- Department of Internal Medicine and Pediatrics, University of California, Los Angeles Medical Center, Los Angeles, California, USA
| | - Nichole A Smith
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Monica E Peek
- Department of Medicine, Section of General Internal Medicine and Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, Illinois, USA
| | - James N Woodruff
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Marshall H Chin
- Department of Medicine and Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, Illinois, USA
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13
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Liu FF, Coifman J, McRee E, Stone J, Law A, Gaias L, Reyes R, Lai CK, Blair IV, Yu CL, Cook H, Lyon AR. A Brief Online Implicit Bias Intervention for School Mental Health Clinicians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:679. [PMID: 35055506 PMCID: PMC8776032 DOI: 10.3390/ijerph19020679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/24/2021] [Accepted: 12/25/2021] [Indexed: 02/01/2023]
Abstract
Clinician bias has been identified as a potential contributor to persistent healthcare disparities across many medical specialties and service settings. Few studies have examined strategies to reduce clinician bias, especially in mental healthcare, despite decades of research evidencing service and outcome disparities in adult and pediatric populations. This manuscript describes an intervention development study and a pilot feasibility trial of the Virtual Implicit Bias Reduction and Neutralization Training (VIBRANT) for mental health clinicians in schools-where most youth in the U.S. access mental healthcare. Clinicians (N = 12) in the feasibility study-a non-randomized open trial-rated VIBRANT as highly usable, appropriate, acceptable, and feasible for their school-based practice. Preliminarily, clinicians appeared to demonstrate improvements in implicit bias knowledge, use of bias-management strategies, and implicit biases (as measured by the Implicit Association Test [IAT]) post-training. Moreover, putative mediators (e.g., clinicians' VIBRANT strategies use, IAT D scores) and outcome variables (e.g., clinician-rated quality of rapport) generally demonstrated correlations in the expected directions. These pilot results suggest that brief and highly scalable online interventions such as VIBRANT are feasible and promising for addressing implicit bias among healthcare providers (e.g., mental health clinicians) and can have potential downstream impacts on minoritized youth's care experience.
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Affiliation(s)
- Freda F. Liu
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 6200 NE 74th Street, Suite 100, Seattle, WA 98115, USA; (J.C.); (E.M.); (R.R.); (H.C.); (A.R.L.)
| | - Jessica Coifman
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 6200 NE 74th Street, Suite 100, Seattle, WA 98115, USA; (J.C.); (E.M.); (R.R.); (H.C.); (A.R.L.)
| | - Erin McRee
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 6200 NE 74th Street, Suite 100, Seattle, WA 98115, USA; (J.C.); (E.M.); (R.R.); (H.C.); (A.R.L.)
| | - Jeff Stone
- Department of Psychology, University of Arizona, 1503 E University Blvd. Building 68, Tucson, AZ 85721, USA;
| | - Amy Law
- Learning Gateway, University of Washington School of Medicine, 850 Republican St., Bldg. C-4, Seattle, WA 98109, USA;
| | - Larissa Gaias
- Department of Psychology, University of Massachusetts, Lowell, 850 Broadway Street, Lowell, MA 01854, USA;
| | - Rosemary Reyes
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 6200 NE 74th Street, Suite 100, Seattle, WA 98115, USA; (J.C.); (E.M.); (R.R.); (H.C.); (A.R.L.)
| | - Calvin K. Lai
- Department of Psychological and Brain Sciences, Washington University in St. Louis, CB 1125, One Brookings Drive, St. Louis, MO 63130, USA;
| | - Irene V. Blair
- Department of Psychology and Neuroscience, University of Colorado Boulder, Muenzinger D244, 345 UCB, Boulder, CO 80309, USA;
| | - Chia-li Yu
- Department of Psychology, Pennsylvania State University, 140 Moore Building, University Park, State College, PA 16802, USA;
| | - Heather Cook
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 6200 NE 74th Street, Suite 100, Seattle, WA 98115, USA; (J.C.); (E.M.); (R.R.); (H.C.); (A.R.L.)
| | - Aaron R. Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 6200 NE 74th Street, Suite 100, Seattle, WA 98115, USA; (J.C.); (E.M.); (R.R.); (H.C.); (A.R.L.)
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Garcia JF, Peters AL, Raymond JK, Fogel J, Orrange S. Equity in Medical Care for People Living With Diabetes. Diabetes Spectr 2022; 35:266-275. [PMID: 36082008 PMCID: PMC9396720 DOI: 10.2337/dsi22-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Disparities and inequities exist for individuals with diabetes in marginalized communities of color, especially among people with low socioeconomic status. Although these barriers are apparent, only a few care models have been designed for and examined in racially and ethnically diverse individuals. This article reviews models that have been developed and examined in a variety of different populations and focuses on how to implement elements from these programs in clinical practice. Health equity-promoting ideas and approaches that can be applied throughout the life span (children to seniors) are also included. As diabetes health care providers, researchers, educators, policymakers, and advocates, we must now combine our efforts and focus on historically excluded populations to bridge the gap to essential diabetes care.
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Affiliation(s)
| | | | | | | | - Sharon Orrange
- University of Southern California, Los Angeles, CA
- Corresponding author: Sharon Orrange,
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15
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Sources of Ethnocultural empathy: personality, intergroup relations, affects. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02286-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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16
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Cheng HL, Wong YJ, Li PFJ, McDermott RC. COVID-19 racism, anxiety, and racial/ethnic attitudes among Asian American college students. COUNSELLING PSYCHOLOGY QUARTERLY 2021. [DOI: 10.1080/09515070.2021.1988514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Hsiu-Lan Cheng
- Department of Counseling Psychology, University of San Francisco, San Francisco, CA, USA
| | - Y. Joel Wong
- Department of Counseling & Educational Psychology, Indiana University Bloomington, Bloomington, IN, USA
| | - P. F. Jonah Li
- Department of Counseling & Educational Psychology, Indiana University Bloomington, Bloomington, IN, USA
| | - Ryon C. McDermott
- Department of Counseling and Instructional Sciences, University of South Alabama, Mobile, AL, USA
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17
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Barber Doucet H, Ward VL, Johnson TJ, Lee LK. Implicit Bias and Caring for Diverse Populations: Pediatric Trainee Attitudes and Gaps in Training. Clin Pediatr (Phila) 2021; 60:408-417. [PMID: 34308661 DOI: 10.1177/00099228211035225] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to determine the attitudes, skill level, and preferred educational interventions of pediatric residents related to implicit bias and caring for diverse patient populations. A cross-sectional survey of pediatric residents at a single, large urban residency program was utilized. Surveys were completed by 88 (55%) residents who were 69% female and 35% non-White or mixed race. Almost all residents felt that it was very or extremely important to receive training on health disparities, diverse patient populations, and implicit bias. Self-assessment of skill level revealed that residents felt confident in areas often covered by cultural competency curricula, such as interpreter use, but were less confident in other areas. The top 3 areas identified for further training included implicit bias, working with transgender and gender nonconforming patients, and weight bias. For the majority of diversity and bias-related skills, prior training was significantly correlated with higher skill level (P < .05).
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Affiliation(s)
| | | | | | - Lois K Lee
- Boston Children's Hospital, Boston, MA, USA
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18
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Gonzalez CM, Noah YS, Correa N, Archer-Dyer H, Weingarten-Arams J, Sukhera J. Qualitative analysis of medical student reflections on the implicit association test. MEDICAL EDUCATION 2021; 55:741-748. [PMID: 33544914 PMCID: PMC8119345 DOI: 10.1111/medu.14468] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Health professions educators use the Implicit Association Test (IAT) to raise awareness of implicit bias in learners, often engendering strong emotional reactions. Once an emotional reaction ensues, the gap between learner reaction and strategy identification remains relatively underexplored. To better understand how learners may identify bias mitigation strategies, the authors explored perspectives of medical students during the clinical portion of their training to the experience of taking the IAT, and the resulting feedback. METHODS Medical students in Bronx, NY, USA, participated in one 90-minute session on implicit bias. The focus of analysis for this study is the post-session narrative assignment inviting them to take the race-based IAT and describe both their reaction to and the implications of their IAT results on their future work as physicians. The authors analysed 180 randomly selected de-identified essays completed from 2013 to 2019 using an approach informed by constructivist grounded theory methodology. RESULTS Medical students with clinical experience respond to the IAT through a continuum that includes their reactions to the IAT, acceptance of bias along with a struggle for strategy identification, and identification of a range of strategies to mitigate the impact of bias on clinical care. Results from the IAT invoked deep emotional reactions in students, and facilitated a questioning of previous assumptions, leading to paradigm shifts. An unexpected contrast to these deep and meaningful reflections was that students rarely chose to identify a strategy, and those that did provided strategies that were less nuanced. CONCLUSION Despite accepting implicit bias in themselves and desiring to provide unbiased care, students struggled to identify bias mitigation strategies, a crucial prerequisite to skill development. Educators should endeavour to expand instruction to bridge the chasm between students' acceptance of bias and skill development in management of bias to improve the outcomes of their clinical encounters.
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Affiliation(s)
- Cristina M Gonzalez
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Yuliana S Noah
- Department of Pediatrics, Jacobi Medical Center, Bronx, NY, USA
| | - Nereida Correa
- Department of Obstetrics and Gynecology, Albert Einstein College of Medicine and Jacobi Medical Center, Bronx, NY, USA
| | - Heather Archer-Dyer
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Javeed Sukhera
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Rethinking Bias to Achieve Maternal Health Equity: Changing Organizations, Not Just Individuals. Obstet Gynecol 2021; 137:935-940. [PMID: 33831936 PMCID: PMC8055190 DOI: 10.1097/aog.0000000000004363] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/18/2021] [Indexed: 12/11/2022]
Abstract
To reduce and eliminate Black–White maternal health disparities, we must enact solutions that address systemic biases. In this article, we address the limitations of existing implicit bias interventions as a strategy for achieving maternal health equity. We then focus on how institutionally sanctioned racial stereotyping harms Black maternal health and marginalizes a key group in the fight for health equity—Black physicians. Finally, we provide strategies to address racial bias in perinatal health care and structural barriers impeding Black physicians' success.
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Nahin RL. Pain Prevalence, Chronicity and Impact Within Subpopulations Based on Both Hispanic Ancestry and Race: United States, 2010-2017. THE JOURNAL OF PAIN 2021; 22:826-851. [PMID: 33636375 DOI: 10.1016/j.jpain.2021.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/22/2021] [Accepted: 02/09/2021] [Indexed: 12/15/2022]
Abstract
We provide national surveillance estimates of pain chronicity, severity and impact in adult subpopulations defined by both Hispanic Ancestry and Race. Data are from 144,434 adults who completed validated questionnaires in the 2010-2017 National Health Interview Survey asking about pain status within the last 3 (N = 84,664) or 6 months (N = 59,770). Multivariable logistic regression was used to assess the relationship between pain and ethnicity/race. Compared to White Puerto Rican participants, White participants with Central/South American and Mexican ancestry had reduced odds of reporting Category 3-4 pain and High-Impact Chronic Pain (HICP), while those of Cuban ancestry had reduced odds of only HICP - eg, White participants with Mexican ancestry had 32% lower odds of having Category 3-4 pain and 50% lower odds of having HICP. While no differences were seen between White Puerto Rican and White Non-Hispanic participants for Category 3-4 pain, White Non-Hispanics had 40% lower odds of reporting HICP. Asian Non-Hispanic and Black Non-Hispanic participants had significantly lower odds of reporting Category 3-4 pain and HICP compared to White Puerto Rican participants, eg, Black Non-Hispanic participants had 26% lower odds off having Category 3-4 pain and 42% lower odds of having HICP. Perspective: By examining pain status in discrete demographic groups based on Hispanic Ancestry and Race, this report further documents substantial difference in health status among underserved populations and provides a baseline for continuing surveillance research on pain, with the eventual goal of eliminating disparities in pain assessment and treatment.
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Affiliation(s)
- Richard L Nahin
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland.
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21
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Olsen LD, Gebremariam H. Disciplining empathy: Differences in empathy with U.S. medical students by college major. Health (London) 2020; 26:475-494. [PMID: 33076717 DOI: 10.1177/1363459320967055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Citing their students' low levels of empathy, medical educators have scrambled to implement curricula with the hopes of buffering against the corrosive effects of biomedical and clinical experiences in medical school. The assumption undergirding these studies by social scientists and medical educators alike is that immersion in biomedical education and clinical experience erodes students' empathic capacities, and that exposure to humanities and social sciences content will amend these losses. But we do not know if this assumption is correct. In this project, we empirically assess this assumption by utilizing a unique data set constructed from student applicant and survey data from the American Medical College Application Service (AMCAS) and the Association of American Medical Colleges (AAMC). We test whether medical school students (N = 8255) from the United States (U.S.) with different academic backgrounds represented by their college major have different levels of empathy, net of demographic control variables. We report two findings. First, we find that students who majored in humanities or interpretive social sciences disciplines have higher empathy scores than their peers who majored in the positivistic social sciences and STEM (science, technology, engineering, and mathematics) disciplines. Second, we find that the relationship between empathy and time in medical school is more nuanced than we would expect from the existing literature.
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Affiliation(s)
- Lauren D Olsen
- Department of Sociology, Temple University, Philadelphia, PA, USA
| | - Hana Gebremariam
- Department of Sociology, Temple University, Philadelphia, PA, USA
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22
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Floríndez LI, Floríndez DC, Como DH, Secola R, Duker LIS. Differing interpretations of health care encounters: A qualitative study of non-Latinx health care providers' perceptions of Latinx patient behaviors. PLoS One 2020; 15:e0236706. [PMID: 32760146 PMCID: PMC7410271 DOI: 10.1371/journal.pone.0236706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 07/13/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Due to provider shortages, it is probable that non-Latinx health care providers (HCPs) will treat Latinx patients. Because of this discrepancy, both providers and patients are likely to experience barriers and cultural differences during medical encounters. This article discusses select cultural factors and behaviors such as language, communication styles, and health care practices of Latinx families through the lens of their non-Latinx HCPs. The purpose of this study was to examine how non-Latinx HCPs perceive and describe certain behaviors they observe during healthcare visits with Latinx patients and families, and to illustrate how those behaviors can alternatively be interpreted as representing Latinx cultural norms. METHODS This qualitative study used a template coding approach to examine narrative interviews conducted with 18 non-Latinx HCPs to report how they described interactions with and the behaviors of their Latinx patients. Template codes were based on well-established Latinx cultural norms (e.g., familismo, respeto, personalismo, simpatía, confianza). RESULTS Many HCP descriptions of Latinx patient behaviors were coded into the Latinx cultural values categories (familismo, personalismo, simpatía, respeto, and confianza) by the research team. Results suggest that HCPs were not aware of how several of their patients' behaviors may be culturally grounded, and that cultural differences between HCPs and their Latinx patients may exist. DISCUSSION Understanding how Latinx-specific cultural norms may be exhibited by Latinx patients and their families during healthcare encounters has potential to improve providers' understanding of patient behavior, helping to promote culturally congruent care for Latinxs.
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Affiliation(s)
- Lucía I. Floríndez
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | | | - Dominique H. Como
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Rita Secola
- Hematology Oncology Service Line, Emergency Department, Children’s Hospital, Los Angeles, CA, United States of America
| | - Leah I. Stein Duker
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
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23
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Zestcott CA, Spece L, McDermott D, Stone J. Health Care Providers’ Negative Implicit Attitudes and Stereotypes of American Indians. J Racial Ethn Health Disparities 2020; 8:230-236. [DOI: 10.1007/s40615-020-00776-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 11/30/2022]
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Abstract
Racial bias is pervasive throughout society and can impact children and adolescents in the health care, education, and criminal justice systems. This article provides a state-of-the-science review of implicit bias in health care. It also reviews the evidence of how bias impacts children in other aspects of society, explores bias as it relates to the broader context of structural racism in America, and summarizes the impact of bias and discrimination on youth academic, behavioral, and health outcomes. Evidence-based strategies are provided to help pediatricians identify and confront their own personal biases.
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25
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Lowe C, Beach MC, Roter DL. Individuation and implicit racial bias in genetic counseling communication. PATIENT EDUCATION AND COUNSELING 2020; 103:804-810. [PMID: 31708237 PMCID: PMC7138711 DOI: 10.1016/j.pec.2019.10.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Genetic counselors (GCs) can frame information in either general terms (i.e., population risks) or individual terms (i.e., tailoring to specific client characteristics). We investigated whether informational framing might reflect GCs' implicit racial bias. METHODS We analyzed previously videotaped genetic counseling sessions with white and minority (Black and Latino) simulated clients (SCs) and modeled the relationship between sixty GCs' implicit racial bias, as measured by the Implicit Association Test (IAT), and informational framing (general or individual) as characterized by the Roter Interaction Analysis System. RESULTS Higher (more pro-white) IAT scores predicted less informational individuation for minority relative to white SCs. Similarly, higher IAT predicted fewer facilitation and activation statements to minority relative to white SCs. With higher IAT-scoring GCs, minority SCs disclosed less psychosocial and lifestyle information, and asked fewer medical questions (all p < 0.05). CONCLUSION GCs' racial implicit bias may be associated with less individualized communication style when counseling minority clients. PRACTICE IMPLICATIONS Future research should address whether increasing informational individuation can ameliorate negative consequences of implicit bias and help providers reframe perceptions of minority patients in individual rather than categorical terms.
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Affiliation(s)
- Chenery Lowe
- Johns Hopkins University, Department of Health, Behavior, and Society, Baltimore, MD, USA; National Human Genome Research Institute, Medical Genomics and Metabolic Genetics Branch, Bethesda, MD, USA.
| | - Mary Catherine Beach
- Johns Hopkins University, Department of Health, Behavior, and Society, Baltimore, MD, USA; Johns Hopkins University, Department of Internal Medicine, Baltimore, Maryland, USA
| | - Debra L Roter
- Johns Hopkins University, Department of Health, Behavior, and Society, Baltimore, MD, USA
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26
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Lowe CL, Beach MC, Roter DL. Genetic counselor implicit bias and its effects on cognitive and affective exchanges in racially discordant simulations. J Genet Couns 2020; 29:332-341. [PMID: 32144859 DOI: 10.1002/jgc4.1243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/14/2020] [Indexed: 11/10/2022]
Abstract
Previous studies have linked clinicians' implicit racial bias with less patient-centered communication between healthcare providers and patients in a variety of healthcare contexts. The current study extends this research by exploring the influence of implicit racial bias in genetic counselors' (GCs') facilitation of simulated clients' cognitive and emotional processing during genetic counseling sessions. We conducted a secondary analysis of a nationally representative sample of genetic counseling sessions of White and ethnic and/or racial minority (Black and Latinx) simulated clients with a subset of 60 GCs who had completed a Race Implicit Association Test (IAT). Linguistic Inquiry Word Count (LIWC) was applied to session transcripts to identify word use by the simulated client consistent with emotional and cognitive processing. The Roter Interaction Analysis System (RIAS) was used to link GC statements consistent with facilitation of emotional and cognitive processing, as used in previous studies. Multiple linear regression analyses were performed to relate LIWC and RIAS variables to GC IAT scores, client race/ethnicity, and statistical interaction between GC IAT scores and client race/ethnicity. GCs used more cognitive facilitation strategies with ethnic and/or racial minority than with White clients (p = .04). There were no statistically significant associations between GCs' pro-White implicit bias and GCs' facilitation of cognitive and emotional processing or clients' use of positive, negative, or cognitive process words. While implicit bias may affect some communication processes, our analysis did not show a relationship between GC IAT score and how GCs help clients process emotional or cognitive information conveyed during a session. It is also possible that the LIWC measure of cognitive and emotional processing is not a sensitive enough measure to capture an implicit bias effect if indeed one is present.
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Affiliation(s)
- Chenery L Lowe
- Department of Health, Behavior, and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD, USA
| | - Mary Catherine Beach
- Department of Health, Behavior, and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Internal Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Debra L Roter
- Department of Health, Behavior, and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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27
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Merino Y, Thomas T, Lightfoot A, Eng E, Simán F, Thatcher K, Chapman M. "They were just waiting for me to mess up": A critical discourse analysis of immigrant Latinx teens' perceptions of power dynamics. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:605-622. [PMID: 31705821 PMCID: PMC7033028 DOI: 10.1002/jcop.22276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 06/10/2023]
Abstract
This paper explores Latinx adolescents' perceptions of power dynamics with authority around them. We seek to inform how community-based professionals engage with and seek to understand members of this population. We conducted a critical discourse analysis of data collected during a community action photovoice project with 13 Latinx adolescents living in a metropolitan region of the southeastern United States. Participants felt they were under greater surveillance scrutiny by authority figures in social and academic spaces than their non-Latino peers. They discussed ways their movements were at times constrained because others presumed they were deviant, and how that affected their identity development. Judgments and assumptions held by both powerful adults and oppressed groups alike serve to reinscribe social stratification that places Latinx adolescents at a power disadvantage relative to their white peers. These experiences and understandings of power relations shape the circuitous racial dispossession of youth.
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Affiliation(s)
- Yesenia Merino
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tainayah Thomas
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alexandra Lightfoot
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Eugenia Eng
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Kari Thatcher
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mimi Chapman
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Stone J, Moskowitz GB, Zestcott CA, Wolsiefer KJ. Testing active learning workshops for reducing implicit stereotyping of Hispanics by majority and minority group medical students. STIGMA AND HEALTH 2020; 5:94-103. [PMID: 33134507 DOI: 10.1037/sah0000179] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present research tested if having first year medical students complete active learning workshops would reduce their implicit stereotyping of Hispanics as medically noncompliant. The workshops were tested with 78-majority (White) group, 16-target minority (Hispanic, African-American and American-Indian) group, and 42-non-target minority (Asian-American and foreign born students from East Asia and Southeast Asia) group students in the 2018 and 2021 classes in the American Southwest. Prior to the workshops, students completed an implicit association test (IAT), and then participated in two workshops that covered the psychology of intergroup bias, the role of implicit bias in patient care, and activities for learning six strategies for controlling the implicit stereotyping of patients. The results showed that before the workshops, the level of implicit stereotyping of Hispanics was significant for the majority and non-target minority group students, but it was not significant for the target minority group students. After the workshops, target minority students again showed no bias, and implicit stereotyping was significantly lower for the majority group students, but not for the non-target minority students. The results suggest that the workshops may have been effective for majority group and target minority group students, but that more cultural tailoring of the materials and activities may be necessary to address implicit bias among some minority group medical students.
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Blackmon SM, Neville HA, Jones Thomas A. Ideology Matters: College Students’ Emotional Reactions to the Killing of Trayvon Martin. COUNSELING PSYCHOLOGIST 2019. [DOI: 10.1177/0011000019893089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Building on previous theory and research, we explored the associations among race, intergroup ideologies and emotional reactions to the killing of Trayvon Martin and the acquittal of George Zimmerman among 298 Black and White college students. We also examined the indirect effect of ethnocultural empathy on the links between race, intergroup ideologies, and emotional responding. Using latent class analysis, we identified three latent intergroup ideological classes: Racial Hierarchy-Enhancing Ideology, Universal Hierarchy-Enhancing Ideology (i.e., above sample mean color-blind racial ideology and or social dominance orientation) and Critical Reflection Attenuating Ideology (i.e., above sample mean critical consciousness). Membership in the Critical Reflection Attenuating Ideology group was associated with greater prosocial emotional responding as compared to the two hierarchy-enhancing latent groups. Finally, ethnocultural empathy had an indirect effect on the links between race, latent intergroup ideological classes, and emotional responding.
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Disparities in Postmastectomy Breast Reconstruction: A Systematic Review of the Literature and Modified Framework for Advancing Research Toward Intervention. Ann Plast Surg 2019; 81:495-502. [PMID: 29851727 DOI: 10.1097/sap.0000000000001503] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND As the United States' population diversifies, eliminating disparities in health and healthcare has become increasingly important across all disciplines of medicine, including plastic and reconstructive surgery. This is evidenced by the growing body of literature in recent years focusing on disparities in postmastectomy breast reconstruction. No study to date has evaluated whether this research is progressing appropriately to promote tangible evidence-based interventions to reduce these disparities. METHODS A systematic literature review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was performed to identify studies focusing on disparities in postmastectomy breast reconstruction. A previously established public health framework for advancing health disparities research was used to inform analysis of the quality and progression of the included studies. This triphasic framework categorizes disparities research as follows: detecting (identifies and measures disparities in vulnerable populations), understanding (establishes determinants of disparities), or reducing (proposes and evaluates interventions for eliminating disparities). RESULTS Ninety-five studies were identified between 1979 and 2016, with 61 (64.2%) published after 2010. The majority of studies (51.6%) were retrospective cohort or case-control studies (American Society of Plastic Surgery level III evidence). Fifty-eight (63.7%), 31 (34.1%), and 2 (2.2%) studies provided detecting-, understanding- and reducing-phase disparities research, respectively. Non-plastic and reconstructive surgery journals accounted for 70.5% of all articles and for most higher phase research articles, publishing 83.9% and 100% of second and third phase studies, respectively. Disparity categories investigated included race/ethnicity, age, income, insurance status/type, geography, and education level, with race/ethnicity being the most common (73.7%). The most commonly measured outcome was percent of subpopulation receiving reconstruction (63, 66.3%), followed by reconstruction type (14, 16.7%). Patient-, provider-, system-, and research-level factors were all identified as potential targets for interventions to reduce disparities. CONCLUSIONS Despite a recent increase in literature focusing on postmastectomy breast reconstruction disparities, the majority focuses on identifying vulnerable populations with inadequate progression to second (understanding) and third (reducing) phases. Increasing research funding, availability of language-concordant and culturally concordant educational materials, and advocacy and sociopolitical awareness within the plastic surgery community is necessary to advance research on postmastectomy breast reconstruction and, ultimately, eliminate it.
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Lightfoot AF, Thatcher K, Simán FM, Eng E, Merino Y, Thomas T, Coyne-Beasley T, Chapman MV. "What I wish my doctor knew about my life": Using photovoice with immigrant Latino adolescents to explore barriers to healthcare. QUALITATIVE SOCIAL WORK : QSW : RESEARCH AND PRACTICE 2019; 18:60-80. [PMID: 32973399 PMCID: PMC7510170 DOI: 10.1177/1473325017704034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Latinos in the USA have reported more frequent discriminatory treatment in healthcare settings when compared to their White counterparts. In particular, foreign-born Latinos report discrimination more than Latinos born in the USA. Such patient-reported racial/ethnic discrimination appears to contribute to specific health consequences, including treatment seeking delays, interruptions in care, and medical mistrust. Immigrant Latino adolescents in the USA experience a variety of health disparities, yet little is known about their views of the healthcare experience, their perceptions of discriminatory treatment, or ways in which they would like their relationships with healthcare providers to be different. METHODS This work, based in a larger interdisciplinary social work-led initiative, used photovoice with two groups of immigrant Latino adolescents to explore the topic "what I wish the doctor knew about my life." The findings were used to engage healthcare stakeholders as part of a pilot intervention aimed at decreasing provider bias toward immigrant Latino youth. RESULTS/DISCUSSION Findings illuminated ways that the immigrant experience affects the lives and health of Latino adolescents in North Carolina. To improve their health, it is critical to understand, from their perspectives, the ways their lives can be complicated by experiences of migration, stereotypes, and cross-cultural communication challenges and how their interactions with authority figures in one sector, such as education, influence interactions in health care. Understanding the healthcare barriers faced by immigrant Latino youth is critical to any effort to improve the system of care for immigrant Latino populations.
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Affiliation(s)
- Alexandra F Lightfoot
- Department of Health Behavior, Gillings School of Global Public Health Center for Health Promotion and Disease, Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kari Thatcher
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Eugenia Eng
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yesenia Merino
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tainayah Thomas
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tamera Coyne-Beasley
- Division of General Pediatrics and Adolescent Medicine, School of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Mimi V Chapman
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Willging C, Gunderson L, Shattuck D, Sturm R, Lawyer A, Crandall C. Structural competency in emergency medicine services for transgender and gender non-conforming patients. Soc Sci Med 2018; 222:67-75. [PMID: 30605801 DOI: 10.1016/j.socscimed.2018.12.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 12/20/2018] [Accepted: 12/22/2018] [Indexed: 11/19/2022]
Abstract
In this formative qualitative research, we draw upon the concepts of structural vulnerability and structural competency to examine how transgender and gender non-conforming (TGGNC) patients and healthcare personnel experience service delivery in Emergency Departments (EDs), and how this experience can be improved upon. Between October 2016 and June 2017, we undertook 31 semi-structured interviews with TGGNC patients (n = 11) and physicians (n = 6), nurses (n = 7), and non-clinical staff (n = 7) in four community-based EDs in New Mexico. Our iterative coding and analysis process resulted in eight sets of findings: (1) reasons why TGGNC patients seek care from EDs; (2) perceptions about and experiences of TGGNC patients; (3) relevance of gender identity and sex at birth; (4) bureaucracy and communication; (5) spatial considerations; (6) preparing providers and staff to care for TGGNC patients; (7) the lack of resources for structural prescriptions; and (8) respect, humanity, and sameness. Findings suggest that structural issues adversely impact the health and wellbeing of TGGNC patients and service-delivery practices in the ED. We describe study implications for training ED personnel and modifying this practice setting to prevent delayed care and ensure appropriate services for TGGNC patients in need of structurally competent emergency medicine.
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Affiliation(s)
- Cathleen Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106, USA; Department of Anthropology, University of New Mexico, MSC01-1040, 1 University of New, Mexico, Albuquerque, NM, 87131, USA.
| | - Lara Gunderson
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106, USA; Department of Anthropology, University of New Mexico, MSC01-1040, 1 University of New, Mexico, Albuquerque, NM, 87131, USA.
| | - Daniel Shattuck
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106, USA; Department of Anthropology, University of New Mexico, MSC01-1040, 1 University of New, Mexico, Albuquerque, NM, 87131, USA.
| | - Robert Sturm
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106, USA; New Mexico Community AIDS Partnership, 903 West Alameda #764, Santa Fe, NM, 87501, USA.
| | - Adrien Lawyer
- Transgender Resource Center of New Mexico, 149 Jackson Street, NE, Albuquerque, NM, 87108, USA.
| | - Cameron Crandall
- Department of Emergency Medicine, University of New Mexico, MSC11-6025, 700 Camino de Salud, Albuquerque, NM, 87131, USA.
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Hicken MT, Kravitz-Wirtz N, Durkee M, Jackson JS. Racial inequalities in health: Framing future research. Soc Sci Med 2018; 199:11-18. [PMID: 29325781 PMCID: PMC5915332 DOI: 10.1016/j.socscimed.2017.12.027] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Margaret T Hicken
- Institute for Social Research, University of Michigan, United States.
| | - Nicole Kravitz-Wirtz
- Department of Emergency Medicine, University of California, Davis, United States
| | - Myles Durkee
- Department of Psychology, University of Michigan, United States
| | - James S Jackson
- Institute for Social Research, University of Michigan, United States
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Payne BK, Vuletich HA, Lundberg KB. The Bias of Crowds: How Implicit Bias Bridges Personal and Systemic Prejudice. PSYCHOLOGICAL INQUIRY 2017. [DOI: 10.1080/1047840x.2017.1335568] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- B. Keith Payne
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Heidi A. Vuletich
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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