Browsing by Subject "Healthcare disparities"

Now showing 1 - 10 of 20
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    A Fork In The Road to Health Equity: Lesson from Odetta
    (American Medical Association, 2022-07-01) Breathett, Khadijah; Medicine, School of Medicine
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    Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity (COOPERATE): Rationale, study design, methods, and sample characteristics
    (Elsevier, 2022-07) Matthias, Marianne S.; Adams, Jasma; Burgess, Diana J.; Daggy, Joanne; Eliacin, Johanne; Flores, Perla; Hirsh, Adam T.; Myers, Laura J.; Perkins, Anthony J.; Menen, Tetla; Procento, Philip; Rand, Kevin L.; Salyers, Michelle P.; Shanahan, Mackenzie L.; Bair, Matthew J.; Medicine, School of Medicine
    Background Chronic pain is associated with profound negative effects, and racial disparities are well-documented in chronic pain treatment. In addition, Black patients report poorer communication with providers and exhibit lower levels of patient activation (self-management self-efficacy) than White patients. Although the causes of healthcare disparities are complex and require intervention at multiple levels, empowering patients is one critical path to achieving health equity. The current study is a coaching intervention focused on increasing patient activation and building communication skills for Black patients with chronic pain. Methods In this randomized controlled trial, 250 Black patients with chronic pain were randomized to either the coaching intervention or an attention control arm. Intervention patients attended 6 telephone-delivered individual coaching sessions over 12 weeks. Coaching focused on clarifying and prioritizing goals and on communication skills, such as agenda setting. The primary outcome is patient activation. Secondary outcomes include communication self-efficacy, pain intensity and interference, and psychological functioning. Discussion Having the knowledge and confidence to participate in one's pain care, coupled with the skills needed to effectively communicate with providers, is essential to optimize chronic pain care. This is particularly important for Black patients who often experience lower quality pain care. Interventions such as COOPERATE hold promise for helping patients to acquire the requisite tools to take greater control of their chronic pain care.
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    Contributory Factors Influencing Interdisciplinary Pediatric Weight Management Program Attendance for Racially Minoritized Youth
    (Springer Nature, 2023) Anastasiadis, William A.; Bazier, Ashley; Gilbert, Elaine; Schwartzkopf, Katherine; Benson, Kari; Perkins, Anthony J.; Naramore, Sara K.; Pediatrics, School of Medicine
    Childhood obesity is a complex medical condition associated with biopsychosocial complications that requires a multifaceted treatment approach. Historically weight management treatment has been challenging to access for racially minoritized youth. This study evaluated factors influencing treatment attendance for racially minoritized youth in a pediatric weight management program between 2018 and 2021. Medical information from 228 participants was collected, including demographics, insurance type, use of telehealth visits, measures of health-related quality of life (HRQOL), distance from the weight management program, and medical history. Although participants entering the weight management program came from across the state, racially minoritized participants from the Indianapolis area were more likely to attend the program. Racially minoritized participants farther from the program were comparatively underrepresented. Relative to families from majority backgrounds, racially minoritized families had the highest public health insurance rates. Specific physical and mental health comorbidities may further increase risk. Results have important implications for pediatric weight management programs to improve access and treatment opportunities for racially minoritized and underserved populations.
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    COVID-19 Among African Americans: An Action Plan for Mitigating Disparities
    (American Public Health Association, 2021-02) Peek, Monica E.; Simons, Russell A.; Parker, William F.; Ansell, David A.; Rogers, Selwyn O.; Tucker Edmonds, Brownsyne; Obstetrics and Gynecology, School of Medicine
    As the COVID-19 pandemic has unfolded across the United States, troubling disparities in mortality have emerged between different racial groups, particularly African Americans and Whites. Media reports, a growing body of COVID-19-related literature, and long-standing knowledge of structural racism and its myriad effects on the African American community provide important lenses for understanding and addressing these disparities.However, troubling gaps in knowledge remain, as does a need to act. Using the best available evidence, we present risk- and place-based recommendations for how to effectively address these disparities in the areas of data collection, COVID-19 exposure and testing, health systems collaboration, human capital repurposing, and scarce resource allocation.Our recommendations are supported by an analysis of relevant bioethical principles and public health practices. Additionally, we provide information on the efforts of Chicago, Illinois' mayoral Racial Equity Rapid Response Team to reduce these disparities in a major urban US setting.
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    Creation of the American Heart Association Journals Equity, Diversity, and Inclusion Editorial Board: Next Step to Achieving 2024 Impact Goal
    (American Heart Association, 2022) Lewis, Eldrin F.; Beatty, Christine; Boltze, Johannes; Breathett, Khadijah; Clair, Walter K.; de las Fuentes, Lisa; Essien, Utibe R.; Goodell, Heather; Hinson, H. E.; Kershaw, Kiarri N.; Knowles, Joshua W.; Mazimba, Sula; Mujahid, Mahasin; Okafor, Henry E.; Park, Kyung Woo; Schultz, Jonathan; Medicine, School of Medicine
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    Delays in Colorectal Cancer Screening for Latino Patients: The Role of Immigrant Healthcare in Stemming the Rising Global Incidence of Colorectal Cancer
    (Elmer Press, 2024) Montalvan-Sanchez, Eleazar E.; Beas, Renato; Karkash, Ahmad; Godoy, Ambar; Norwood, Dalton Argean; Dougherty, Michael; Medicine, School of Medicine
    The significant global burden of colorectal cancer accentuates disparities in access to preventive healthcare in most low- and middle-income countries (LMICs) as well as large sections of underserved populations within high-income countries. The barriers to colorectal cancer screening in economically transitioning Latin America are multiple. At the same time, immigration from these countries to the USA continues to increase. This case highlights the delays in diagnosis experienced by a recent immigrant from a country with no established colorectal cancer screening program, to an immigrant population in the USA with similar poor screening coverage. We discuss common challenges faced by Latinos in their home countries and the USA, as well as strategies that could be implemented to improve screening coverage in US immigrant populations.
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    Developing a targeted English-language curriculum and materials for Latino caregivers of infants with special needs as part of a NICU pre-discharge education program
    (Office of the Vice Chancellor for Research, 2015-04-17) Connor, Ulla; Rodgers, Rylin; Traversa, Ana; Akers, Jennifer; Gokpinar-Shelton, Esen; Lorch, Matt
    Healthcare disparities in the Latino community are well documented; Latino infants with special healthcare needs are at high risk of mortality or poor health outcomes and have difficulty obtaining specialty care. Poor English-language skills add an additional layer of vulnerability. Existing health-related English-language curricula address adult, not pediatric health concerns. A clear need exists for short-term health-related English-language education programs to develop survival communication skills in low-literacy Limited English Proficiency (LEP) caregivers. International Center for Intercultural Communication (ICIC) and Family Voices Indiana (FVI) are collaborating to develop and facilitate a targeted English-language curriculum for LEP Latino caregivers of infants with special healthcare needs at Riley Children’s Hospital. ICIC brings expertise in English-for-Specific-Purposes (ESP) program development; FVI serves parents of children with special healthcare needs, including LEP parents, and brings the ability to make such a program meaningful and useful to our target population. The first stage of the project is currently ending, and has featured • Needs-analysis data collection onsite through the observation of current education modules with Latino parents at Riley Hospital as well as surveys of relevant healthcare providers and other hospital staff, followed by • The development of a curriculum, instructional materials, and pre-post intervention assessments based on the identified needs. The second stage will feature the actual intervention and will involve working with a minimum of six (6) low-literacy/low-proficiency caregivers to • Improve their health-related English for the specific purposes of communicating with their infants’ physicians and other healthcare staff while at Riley, • Facilitate communication after discharge, • Increase their readiness to engage in community ESL classes, and • Ensure eventual adaptability of the curriculum for ESL caregivers of various language backgrounds, stronger language or literacy skills, a variety of healthcare contexts, and the larger pediatric population. The post-intervention stage will feature data analysis with the purpose of assessing the viability of the curriculum and materials, and will lead to revisions. ICIC will also train FVI facilitators to offer the program to the population they serve. ICIC will then work with Indiana University Research and Technology Corporation (IURTC) to copyright and license the final curriculum and materials.
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    Disparities in Access to Liver Transplant Referral and Evaluation among Patients with Hepatocellular Carcinoma in Georgia
    (American Association for Cancer Research, 2024) Ross-Driscoll, Katherine; Ayuk-Arrey, Arrey-Takor; Lynch, Raymond; McCullough, Lauren E.; Roccaro, Giorgio; Nephew, Lauren; Hundley, Jonathan; Rubin, Raymond A.; Patzer, Rachel; Surgery, School of Medicine
    Liver transplantation offers the best survival for patients with early-stage hepatocellular carcinoma (HCC). Prior studies have demonstrated disparities in transplant access; none have examined the early steps of the transplant process. We identified determinants of access to transplant referral and evaluation among patients with HCC with a single tumor either within Milan or meeting downstaging criteria in Georgia.Population-based cancer registry data from 2010 to 2019 were linked to liver transplant centers in Georgia. Primary cohort: adult patients with HCC with a single tumor ≤8 cm in diameter, no extrahepatic involvement, and no vascular involvement. Secondary cohort: primary cohort plus patients with multiple tumors confined to one lobe. We estimated time to transplant referral, evaluation initiation, and evaluation completion, accounting for the competing risk of death. In sensitivity analyses, we also accounted for non-transplant cancer treatment.Among 1,379 patients with early-stage HCC in Georgia, 26% were referred to liver transplant. Private insurance and younger age were associated with increased likelihood of referral, while requiring downstaging was associated with lower likelihood of referral. Patients living in census tracts with ≥20% of residents in poverty were less likely to initiate evaluation among those referred [cause-specific hazard ratio (csHR): 0.62, 95% confidence interval (CI): 0.42-0.94]. Medicaid patients were less likely to complete the evaluation once initiated (csHR: 0.53, 95% CI: 0.32-0.89).Different sociodemographic factors were associated with each stage of the transplant process among patients with early-stage HCC in Georgia, emphasizing unique barriers to access and the need for targeted interventions at each step. Significance: Among patients with early-stage HCC in Georgia, age and insurance type were associated with referral to liver transplant, race, and poverty with evaluation initiation, and insurance type with evaluation completion. Opportunities to improve transplant access include informing referring providers about insurance requirements, addressing barriers to evaluation initiation, and streamlining the evaluation process.
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    Healthcare Access and Delivery During the COVID-19 Pandemic for Black Veterans with Chronic Pain: a Qualitative Study
    (Springer, 2023) Matthias, Marianne S.; Burgess, Diana J.; Eliacin, Johanne; Medicine, School of Medicine
    Background: The COVID-19 pandemic led to significant disruptions in healthcare and rapid increases in virtual healthcare delivery. The full effects of these shifts remain unknown. Understanding effects of these disruptions is particularly relevant for patients with chronic pain, which typically requires consistent engagement in treatment to maximize benefit, and for Black patients, given documented racial disparities in pain treatment and telehealth delivery. Objective: To understand how Black patients with chronic pain experienced pandemic-related changes in healthcare delivery. Design: In-depth, semi-structured qualitative interviews PARTICIPANTS: Black veterans with chronic pain. Key results: Participants described decreased ability to self-manage their chronic pain, obtain nonpharmacological services such as physical therapy, see their primary care providers, and schedule surgery. Most did not believe telehealth met their needs, describing feeling inadequately assessed for their pain and noting that beyond renewing prescriptions, telehealth visits were not that useful. Some believed their communication with their providers suffered from a lack of in-person contact. Others, however, were willing to accept this tradeoff to prevent possible exposure to COVID-19, and some appreciated the convenience of being able to access healthcare from home. Conclusions: Black patients with chronic pain described mostly negative effects from the shift to telecare after the pandemic's onset. Given existing disparities and likely persistence of virtual care, research on the longer-term effects of virtual pain care for Black patients is needed.
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    A Mixed-method Analysis of Community-Engaged Theatre Illuminates Black Women’s Experiences of Racism and Addresses Healthcare Inequities by Targeting Provider Bias
    (Sage, 2020) Wasmuth, Sally; Pritchard, Kevin; Milton, Cierra; Smith, Emily; Occupational Therapy, School of Health and Human Sciences
    Theatre has been a powerful means of eliciting social change. This paper describes methods and outcomes of a theatre project to reduce healthcare inequities experienced by Black women. We conducted narrative interviews with a convenience sample of Black women and conducted thematic analysis of interview transcripts to learn about their experiences of healthcare and to inform development of a professional theatrical production. To assess the impact of the performance on the audience, we used a single post-test concurrent mixed-methods design using a self-created Likert-type survey that included space for open-ended responses. Ten Black women completed narrative interviews. Thematic analysis revealed 5 main themes: being ignored, being accused, being talked-down to, fearing harm, and being hurt. Narratives were used to create a script that centered on these themes, and that was professionally produced and performed. Audience members (n = 113, 25% healthcare providers) produced a mean total post-test score of 19.28 (agree/strongly agree) on a 25-point survey with 2 items scoring in the 2 to 3 range (disagree/not sure). Thematic analysis data revealed the extent to which Black women experienced discrimination in multiple settings. Quantitative survey data suggested audience members conceptually understood and were aware of inequity, but open-ended responses revealed this information was new for some, and prior knowledge for others. The audience reported planning to change personal behaviors that may contribute to inequity. Participants were unsure if they had contributed to inequity in the past. The performance stimulated conversation about implicit bias and discrimination and encouraged audience members to examine their contributions to the problem. Future pre-post studies are needed to better assess the impact of the performance. Theatre has the potential to illuminate the extent and nature of discrimination in healthcare and society, and to foster conversations that allow audience members to consider their own potential contributions to discrimination.