Minority Health and Health Equity Archive
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Item Innovation in Collaboration: The Summer Institute on Youth Mentoring as a university-community partnership(2011) Jones, Kevin R.; Keller, Thomas E.; Wheeler, MarcAbstract available at publisher's web site.Item Race and healthcare disparities: overcoming vulnerablity.(2002) Stone, JohnThe paper summarizes recently published data and recommendations about healthcare disparities experienced by African Americans who have Medicare or other healthcare coverage. Against this background the paper addresses the ethics of such disparities and how disadvantages of vulnerable populations like African Americans are typically maintained in decision making about how to respond to such disparities. Considering how to respond to disparities reveals much that vulnerable populations would bring to the policy-making table, if they can also be heard when they get there. The paper argues that vulnerable populations like African Americans need fair representation in bodies deciding what to do about such disparities and that fairness requires proportional representation at all levels of decisions that affect healthcare--a radical change. In this decision setting, how to provide adequate protection of minorities needs much further attention. The most attractive decision-making model is deliberative democracy. The paper shows that in deliberation, fair representation requires not only having a voice in decisions, but a fair hearing of those voices. Achieving a fair hearing requires changes in norms of communication and training of all to give importance to greetings and other measures of civility and trust building, and to be open to diverse forms of expression. Decisions about how to respond to healthcare disparities would include what programs to initiate for whom, how to evaluate the programs, and what to do in response to such evaluations. Conclusions are that achieving such goals will take a sea change in how healthcare institutions and providers do their business, and that social activism at every level will be needed to effect these changes. The discussion highlights many ethical issues that need much greater attention.Item The health of Latino children: urgent priorities, unanswered questions, and a research agenda.(2002) Flores, Glenn; Fuentes-Afflick, Elena; Barbot, Oxiris; Carter-Pokras, Olivia; Claudio, Luz; Lara, Marielena; McLaurin, Jennie A; Pachter, Lee; Ramos-Gomez, Francisco J; Mendoza, Fernando; Valdez, R Burciaga; Villarruel, Antonia M; Zambrana, Ruth E; Greenberg, Robert; Weitzman, Michael; Gomez, Francisco J RamosLatinos recently became the largest racial/ethnic minority group of US children. The Latino Consortium of the American Academy of Pediatrics Center for Child Health Research, consisting of 13 expert panelists, identified the most important urgent priorities and unanswered questions in Latino child health. Conclusions were drawn when consensus was reached among members, with refinement through multiple iterations. A consensus statement with supporting references was drafted and revised. This article summarizes the key issues, including lack of validated research instruments, frequent unjustified exclusion from studies, and failure to analyze data by pertinent subgroups. Latino children are at high risk for behavioral and developmental disorders, and there are many unanswered questions about their mental health needs and use of services. The prevalence of dental caries is disproportionately higher for Latino children, but the reasons for this disparity are unclear. Culture and language can profoundly affect Latino children's health, but not enough cultural competency training of health care professionals and provision of linguistically appropriate care occur. Latinos are underrepresented at every level of the health care professions. Latino children are at high risk for school dropout, environmental hazards, obesity, diabetes mellitus, asthma, lack of health insurance, nonfinancial barriers to health care access, and impaired quality of care, but many key questions in these areas remain unanswered. This article suggests areas in which more research is needed and ways to improve research and care of Latino children.Item What Latina Patients Don’t Tell Their Doctors: A Qualitative Study(2008) Julliard, Kell; Vivar, Josefi na; Delgado, Carlos; Cruz, Eugenio; Kabak, Jennifer; Sabers, HeidiPURPOSE The treatment a patient receives is greatly affected by what he or she chooses to disclose to a physician. This qualitative study investigated such factors as culture and background that contribute to Latina patients’ nondisclosure of medical information. METHODS Participants were 28 Latina women living in Brooklyn. In-depth interviews in English or Spanish were conducted and documented by extensive notes. We used a grounded theory approach to fi nd emerging themes, which were coded using a continuous iterative process. RESULTS Six primary themes emerged: the physician-patient relationship, language, physician sex and age, time constraints, sensitive health issues, and culture and birthplace. Such qualities as compassion, caring, human interest, and kindness were important to many Latinas, who did not feel safe sharing information if these qualities were absent. Language barriers caused problems with physician-patient interaction, which were complicated by the presence of a translator. Physicians being male or younger could make disclosure diffi cult, especially around issues of sexuality and genital examination. Time constraints and cultural differences sometimes resulted in physicians’ lack of awareness of sensitive areas that patients did not wish to discuss, such as sexuality, family planning, domestic abuse, and use of recreational drugs. Birthplace (foreign born vs US born) played a role in how the women perceived barriers to disclosure. CONCLUSIONS Staff training in techniques for building rapport can foster better communication, increase empathy and compassion, and lead to the establishment of trusting relationships in which disclosure is more likely.Item When rumours derail a mass deworming exercise(2007) Dodoo, Alexander; Adjei, Sam; Couper, Mary; Hugman, Bruce; Edwards, RalphThe role of misleading or scaremongering news media reports in causing drug crises is well known. Pharmacovigilance systems can play an important educational and preventive role through safety monitoring of products and effective communication about safety issues with health professionals and the general public. That failure to use an existing pharmacovigilance system in implementation planning and weaknesses in communications about medication could lead to mass hysteria and civil unrest might thus seem implausible. But this reaction happened in several regions of Ghana on Feb 12, 2007.Item Promising Practices For Patient-Centered Communication With Vulnerable Populations: Examples From Eight Hospitals(The Commonwealth Fund -- Institute for Ethics, American Medical Association, 2006) Wynia, Matthew; Matiasek, JenniferABSTRACT: As patient populations become increasingly diverse, health care organizations are looking for innovative ways to communicate effectively across cultures, languages, and health literacy levels. This study identified eight hospitals from across the country that have demonstrated a commitment to providing patient-centered communication with vulnerable patient populations. Through site visits and focus group discussions, the authors draw out “promising practices” from the hospital’s efforts to lower language barriers and ensure safe, clear, and effective health care interactions. The promising practices include: having passionate champions to advocate for communication programs; collecting information on patient needs; engaging communities; developing a diverse and skilled workforce; involving patients; spreading awareness of cultural diversity; providing effective language assistance services; addressing low health literacy; and tracking performance over time. Hospital and health system leaders can use these practices as starting points to encourage patient-centered communication in their own organizations.Item Racial Differences in Trust and Lung Cancer Patients’ Perceptions of Physician Communication(2006) S. Gordon, Howard; L. Steet Jr., Richard; F. Sharf, Barbara; Kelly, P. Adam; Souchek, JuliannePurpose Black patients report lower trust in physicians than white patients, but this difference is poorly studied. We examined whether racial differences in patient trust are associated with physician-patient communication about lung cancer treatment. Patients and Methods Data were obtained for 103 patients (22% black and 78% white) visiting thoracic surgery or oncology clinics in a large Southern Veterans Affairs hospital for initial treatment recommendation for suspicious pulmonary nodules or lung cancer. Questionnaires were used to determine patients’ perceptions of the quality of the physicians’ communication and were used to assess patients’ previsit and postvisit trust in physician and trust in health care system. Patients responded on a 10-point scale. Results Previsit trust in physician was statistically similar in black and white patients (mean score, 8.2 v 8.3, respectively; P =.80), but black patients had lower postvisit trust in physician than white patients (8.0 v 9.3, respectively; P =.02). Black patients, compared with white patients, judged the physicians’ communication as less informative (7.3 v 8.5, respectively; P = .03), less supportive (8.1 v 9.3, respectively; P = .03), and less partnering (6.4 v 8.2, respectively; P = .001). In mixed linear regression analysis, controlling for clustering of patients by physician, patients’ perceptions of physicians’ communication were statistically significant (P = .005) predictors of postvisit trust, although patient race, previsit trust, and patient and visit characteristics were not significant (P = .05) predictors. Conclusion Perceptions that physician communication was less supportive, less partnering, and less informative accounted for black patients’ lower trust in physicians. Our findings raise concern that black patients may have lower trust in their physicians in part because of poorer physician-patient communication.Item 2005 National Healthcare Disparities Report(Agency for Healthcare Research and Quality, 2005) UNSPECIFIEDKey Themes and Highlights From the National Healthcare Disparities Report Twenty years ago, the Department of Health and Human Services (HHS) released the Report of the Secretary’s Task Force on Black and Minority Health. That report documented many disparities in health and led to interventions to improve the health and health care of minorities. This year, the Agency for Healthcare Research and Quality (AHRQ) is pleased to release the third National Healthcare Disparities Report (NHDR). This annual report provides a comprehensive national overview of disparities in health care among racial, ethnic, and socioeconomic groups in the general U.S. population and within priority populations and tracks the success of activities to reduce disparities. It is a companion report to the National Healthcare Quality Report (NHQR), a comprehensive overview of quality of health care in America. A major advantage of an annual report series is its ability to track changes over time. This year, data are presented that begin tracking trends across a broad array of measures of health care quality and access for many racial, ethnic, and socioeconomic groups. In addition, the 2005 report begins to examine the issue of whether the Nation is making progress toward eliminating health care disparities. The NHDR tracks disparities in both quality of health care and access to health care. Measures of health care quality mirror those in the NHQR and encompass four dimensions of quality—effectiveness, patient safety, timeliness, and patient centeredness. Measures of health care access are unique to this report and encompass two dimensions of access—facilitators and barriers to care and health care utilization.