Race in the Reading: A Study of Problematic Uses of Race and Ethnicity in a Prominent Pediatrics Textbook

Health valuation protocol for dual discrete choice experiment (dual-DCE) surveys to estimate the effects of different scenarios and attributes on main effects

INTRODUCTION

A typical health preference study conducts a single discrete choice experiment (DCE). For example, a health valuation study may elicit preferences on an individual's health-related quality of life along five EQ-5D-5L attributes (Mobility, Self-care, Usual Activities, Pain/Discomfort, Anxiety/Depression). Using this protocol, researchers can conduct a dual-DCE survey (ie, with two different full-block DCEs completed sequentially). To demonstrate this protocol, we will conduct 12 dual-DCE surveys in two waves and estimate the effects of different scenarios and descriptive systems on main effects (ie, incremental differences in value between levels).

METHODS AND ANALYSIS

Each of the two DCEs in a dual-DCE survey equates to a stand-alone health valuation study. To demonstrate this protocol, each is an EQ-5D-5L valuation study, including d-efficient blocks of 15 kaizen tasks and 5 paired comparisons. In wave 1 (six surveys, 1000 US adults each), the two DCEs will differ by scenario (1-year episodes ending in recovery or death or no duration/ending described). In wave 2 (six surveys, 200 US adults each), the two DCEs will include the same 5 EQ-5D-5L attributes but differ by the number of additional attributes related to cognition: none, one composite attribute (memory/concentration) and two component attributes (memory, concentration). For each DCE, we will estimate a conditional logit model and test for differences in value using cluster bootstrap techniques. We hypothesise that the values will differ by scenarios and systems. As secondary analyses, we assess the effects of sampling, scenario/system order and DCE order.

ETHICS AND DISSEMINATION

The independent review board (IRB) at Advarra determined that this research project (Pro00080475; 11 July 2024) is exempt from IRB oversight based on the Department of Health and Human Services regulations found at 45 CFR 46.104(d)(2). Furthermore, the IRB determined that the project is not subject to requirements for continuing review. To disseminate our findings, we will prepare multiple manuscripts for publication in peer-reviewed journals and present highlights at scientific meetings, such as the EuroQol Plenary Meeting, International Academy of Health Preference Research and ISPOR.

Examining provider perspectives surrounding cultural competencies: An integrative review

AIM

This review explores the provider perspectives regarding cultural competency to pinpoint common themes that emerge from the existing literature.

BACKGROUND

Cultural competency is vital in healthcare and remains a burgeoning area of interest in the healthcare landscape. Nevertheless, achieving mastery of these competencies remains challenging as health inequities persist that affect the care received by minority populations.

METHODS

This integrative review analyzed themes of provider perspectives regarding cultural competency. Relevant studies were retrieved from PubMed and CINAHL and other articles were obtained through manual searches. Only articles that explored nurse/ provider perspectives were considered.

RESULTS

Four major themes were extracted including culturally sensitive communication perspectives, provider attitudes, identified barriers and recommendations for improvement. Subthemes for culturally sensitive communication perspectives include problematic terminology and overgeneralizations, while subthemes developed for provider attitudes include discomfort, judgment, disbelief, unawareness and awareness. Provider-identified barriers to cultural competency included subthemes of language differences, lack of training, resource constraints and resistance to change. Recommendations for improving cultural competency included recognizing knowledge gaps, developing strategies to increase knowledge and finally obtaining organizational and leadership support.

CONCLUSION

Developing culturally sensitive communication skills is critical to delivering culturally competent care. Provider attitudes are affected by insufficient training, judgment and awareness levels. Negative attitudes could contribute to resistance to change. Provider recommendations to improve cultural competency include the development of a consistent, comprehensive and mandatory training program that identifies specific knowledge gaps. Organizational and leadership support at policy and local levels were necessary to propel meaningful and lasting change.

Equity in Pediatric Hospital-Based Safety and Quality Improvement

There are well-documented inequities in the quality of care and health outcomes of minoritized youth. Patient safety and quality improvement (QI) work with an equity focus has been identified as an important strategy to remedy these existing inequities. In this article, we will present evidence of inequities in pediatric hospital-based care, describe root causes with a focus on structural racism, highlight existing frameworks for applying equity principles to patient safety and QI, and provide best practices and recommendations on evaluating patient safety and QI data towards advancing equity in pediatric hospital-based care.

Color Does Matter: Nursing Assessment of Varying Skin Tones/Pigmentation

BACKGROUND

The observation of color is an integral part of the nursing assessment. However, the current understanding of individual skin qualities and pigmentation has not yet been integrated thoroughly into foundational assessment courses, clinical education, simulation, and textbooks.

EVIDENCE ACQUISITION

Literature is scarce regarding racial groups, skin color, and physical assessment for patients across the lifespan, but even more so for the neonatal population. Historically, many nursing textbooks did not provide visual pictures or observational assessment strategies for the assessment of the Black, Indigenous, and people of color (BIPOC) population. This is improving in some nursing textbooks; however, the descriptors of and visual differences and anticipated assessment findings for the BIPOC population are not comprehensive.

RESULTS

Evidence-based assessment findings, which may occur in newborns with varying skin tones/pigmentations, are presented.

IMPLICATIONS FOR PRACTICE AND RESEARCH

The most essential step to having an accurate assessment is acknowledging the importance of color awareness. Color blindness, while thought to support inclusivity, only contributes to exclusion of one of the most important components of a person's being-their color.

Embedded racism: Inequitable niche construction as a neglected evolutionary process affecting health

Racial health disparities are a pervasive feature of modern experience and structural racism is increasingly recognized as a public health crisis. Yet evolutionary medicine has not adequately addressed the racialization of health and disease, particularly the systematic embedding of social biases in biological processes leading to disparate health outcomes delineated by socially defined race. In contrast to the sheer dominance of medical publications which still assume genetic 'race' and omit mention of its social construction, we present an alternative biological framework of racialized health. We explore the unifying evolutionary-ecological principle of niche construction as it offers critical insights on internal and external biological and behavioral feedback processes environments at every level of the organization. We Integrate insights of niche construction theory in the context of human evolutionary and social history and phenotype-genotype modification, exposing the extent to which racism is an evolutionary mismatch underlying inequitable disparities in disease. We then apply ecological models of niche exclusion and exploitation to institutional and interpersonal racial constructions of population and individual health and demonstrate how discriminatory processes of health and harm apply to evolutionarily relevant disease classes and life-history processes in which socially defined race is poorly understood and evaluated. Ultimately, we call for evolutionary and biomedical scholars to recognize the salience of racism as a pathogenic process biasing health outcomes studied across disciplines and to redress the neglect of focus on research and application related to this crucial issue.

An integrative framework and recommendations for the study of DNA methylation in the context of race and ethnicity

Human social epigenomics research is critical to elucidate the intersection of social and genetic influences underlying racial and ethnic differences in health and development. However, this field faces major challenges in both methodology and interpretation with regard to disentangling confounded social and biological aspects of race and ethnicity. To address these challenges, we discuss how these constructs have been approached in the past and how to move forward in studying DNA methylation (DNAm), one of the best-characterized epigenetic marks in humans, in a responsible and appropriately nuanced manner. We highlight self-reported racial and ethnic identity as the primary measure in this field, and discuss its implications in DNAm research. Racial and ethnic identity reflects the biological embedding of an individual's sociocultural experience and environmental exposures in combination with the underlying genetic architecture of the human population (i.e., genetic ancestry). Our integrative framework demonstrates how to examine DNAm in the context of race and ethnicity, while considering both intrinsic factors-including genetic ancestry-and extrinsic factors-including structural and sociocultural environment and developmental niches-when focusing on early-life experience. We reviewed DNAm research in relation to health disparities given its relevance to race and ethnicity as social constructs. Here, we provide recommendations for the study of DNAm addressing racial and ethnic differences, such as explicitly acknowledging the self-reported nature of racial and ethnic identity, empirically examining the effects of genetic variants and accounting for genetic ancestry, and investigating race-related and culturally regulated environmental exposures and experiences.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44155-023-00039-z.

The Use of Race, Ethnicity, and Social Determinants of Health in Three Pediatrics Journals

OBJECTIVE

To evaluate how race, ethnicity, and social determinants of health (SDOH) are reported and discussed in 3 pediatrics journals.

STUDY DESIGN

Bibliometric analysis of original articles that enrolled children as participants between January-June 2021 published in The Journal of Pediatrics, Pediatrics, and JAMA Pediatrics. We recorded in aggregate the inclusion of race, ethnicity, and SDOH data from the methods, results, and discussion sections of each article. We then used χ² analyses and t tests to compare recording and use of race, ethnicity, and SDOH data on a number of factors.

RESULTS

A total of 317 original articles were included with 200 (63.1%) conducted in the US. Researchers presented 116 unique race and ethnicity categories. US studies reported race significantly more frequently than international studies (166/200, 83.0% vs 29/117, 24.8% P < .001), yet only 24.7% (41/166) of US and 10.3% (3/29) of international studies that reported these data interpreted their significance and linked such to their study findings. US federal funding influenced reporting of race and ethnicity but not interpretation. Less than one-half of all studies reported SDOH (147/317, 46.4%), and very few that reported SDOH interpreted the data to study findings in both the US (18/106, 17.0%) and internationally (3/41, 7.3%).

CONCLUSION

Race, ethnicity, and SDOH data are reported without consistent categories, and their significance is not often explained in both US and international articles. Researchers should be more intentional about how and why they collect, report, and interpret these data to help identify health disparities and highlight health inequities.