Health Equity最新文献

Amber Thurman, Candi Miller, Porsha Ngumezi, Josseli Barnica, and Neveah Crain highlight the tragic outcomes of restrictive abortion bans post-Dobbs v. Jackson Women's Health Organization. Their stories underscore the need to shift away from viewing medical institutions as the only sources of reproductive care. The Afiya Center's Livable Black Futures Collective advocates for community-based knowledge through a Reproductive Justice storytelling framework. By emphasizing the injustices faced by Black women and birthing people, these narratives aim to reclaim bodily autonomy, dismantle stigma, and foster resilience, ultimately serving as a powerful catalyst for collective healing and activism against systemic oppression.

Background: The participation of Black individuals in clinical trials remains lower than that of other racial and ethnic groups. Substance abuse adds additional barriers to recruitment and retention. While significant attention has been devoted to identifying barriers to recruitment/retention, efforts have been largely unsuccessful in increasing the participation of Black individuals in clinical trials. This article details Phase 1 efforts to develop sustainable strategies to increase enrollment/recruitment of Black participants in clinical trials through an Innovative Development of Research Engagement Manual.

Methods: Phase 1 involved a literature review and the establishment of an Expert Diversity Advisory Board, which identified barriers to Black individual participation in substance use disorder (SUD) research. Identified barriers included lack of awareness of research, mistrust, lack of comfort with research, lack of information, and time/resource constraints. Focus groups were conducted to assess the importance of the identified factors in 61 Black participants with SUD history.

Results: Among the focus group participants, 37.7% indicated mistrust, 45.9% indicated a lack of knowledge, and 27.9% stated safety concerns as reasons for not engaging with researchers. They considered compensation, research benefits, study duration, privacy, safety, and side effects as vital information that informed their decisions on clinical trial participation. The focus groups identified financial incentives, potential treatment options, and potential for improved awareness about substance abuse treatment as factors that determine retention in a study.

Conclusion: With barriers identified, future efforts will focus on qualitative assessments of focus group material and developing and evaluating the manual.

Background: Where you live impacts your access to all forms of health care, but abortion in particular. In response to restrictions on abortion, communities have organized to support those seeking abortion care via abortion funds. This study documents the services provided by these organizations and examines how they have been shaped by local conditions.

Methods: Data come from a content analysis of the websites of all abortion funds affiliated with the National Network of Abortion Funds and interviews with 22 abortion fund leaders. Content analysis data presented include data about abortion funds' catchment area and what services funds provide.

Results: Types of support offered by abortion funds include procedure funding, practical support, emotional support, other sexual health services, and parenting support. Interviews with fund leaders show that these services are shaped by local policies, cultural and geographic specifics of their catchment area, local clinics, and ties to other organizations in funds' communities.

Discussion: Abortion funds are a diverse group of organizations that provide a variety of services to help patients overcome barriers to abortion. The geographic patterning of their services suggest that funds are responding to local environments, with the greatest variety of services being offered by funds in the South.

Health equity implications: Abortion funds' service offerings clearly respond to the barriers to abortion described in the literature, driven by the needs of their local communities. This is particularly relevant in a post-Dobbs environment, as patients in some parts of the country find abortion even farther out of their reach.

[This corrects the article DOI: 10.1089/heq.2022.0145.].

Objectives: Black patients have the highest mortality rate from endometrial cancer (EC), and yet remain underrepresented in EC research. Thus, currently published symptom patterns may not be comprehensive for this population. The purpose of this study is to analyze symptomatology among Black patients with EC in the Guidelines for Ultrasound in the Detection of Early Endometrial Cancer study and to compare with those undergoing benign hysterectomy.

Methods: This is a retrospective consecutive patient sample of Black individuals undergoing hysterectomy in an academic-affiliated 10-hospital health care system from 2014 to 2020. We collected clinical, sociodemographic, and diagnostic information for 24 months before hysterectomy, using merged structured and abstracted data from electronic health records. We used descriptive statistics to describe the sample and pertinent subgroups-patients with fibroids/enlarged uteri, without postmenopausal bleeding (PMB), and patients <50 years old. Symptom distribution between subgroups was analyzed using chi-square tests and Fisher exact tests.

Results: The sample included 3,455 hysterectomy patients, 12% with EC (n = 404). Among EC patients, 77% had PMB and 7% had no bleeding history. EC patients were symptomatic beyond bleeding, with fibroids/enlarged uteri (70%), pelvic/abdominal pain (38%), anemia (30%), and more. Young patients (8% of all EC cases) had more pelvic/abdominal pain (61% vs. 36%, p = 0.017) and anemia requiring transfusion (33% vs. 6%, p < 0.001) compared with older patients. Subgroup symptom presentations overlapped between those with and without cancer, with few symptoms differing by >20%.

Conclusions: PMB alone is rarely the only presenting symptom among Black patients with EC; symptoms overlap heavily with patients presenting with benign disease. Young patients, those with fibroids/enlarged uteri, and those without PMB represent subgroups with nuanced presentations, for whom EC should be considered.

Background: Reproductive health, including menstrual health, is a critical element of the overall well-being of women. Knowledge of menstrual health increases personal empowerment and self-care. This review explores adult women's knowledge of menstrual and reproductive health.

Methods: A systematic literature review was conducted across ProQuest, PubMed, MEDLINE, Scopus, CINAHL, and AMED, targeting original, peer-reviewed articles published between 2013 and 2023. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols 2020 guidelines, 649 articles were screened. Eighteen cross-sectional studies met the inclusion criteria after critical appraisal using the Joanna Briggs Institute checklist for analytical cross-sectional studies.

Results: Mean percentages of overall correct knowledge were provided in a limited number of studies, with scores ranging between 35.6% and 57.3%. In this review, mean values were calculated to represent categorical analysis of adult women's correct knowledge of ovulation, menstruation, and female physiology. The following values represent women's correct knowledge of these factors: timing of ovulation (43.7%), definition of ovulation (75.3%), identify physical signs of ovulation (52.4%), definition of menstruation (92.8%), identify menstrual cycle length (58.9%), identify duration of menstruation (44.6%), identify physical changes that might occur 2 weeks prior to menstruation (76.8%), identify female reproductive anatomy (68.9%), identify the term reproductive "hormones" (37%); identify the hormone estrogen (30.4%), identify the hormone progesterone (24%), correct knowledge of reproductive functional biology (51.2%), and correct knowledge of factors affecting reproductive health (62.8%).

Conclusion: Adult women's knowledge of reproductive and menstrual health remains lower than expected due to various personal, cultural, and social factors. Developing educational and health promotion interventions is crucial to improving women's reproductive knowledge globally.

[This corrects the article DOI: 10.1089/heq.2022.0032.].

Background: Patient-provider communication (PPC) increasingly occurs in online patient portals. Variations in portal usage might worsen communication inequities for pregnant people of color (POC), widening the digital divide. The objective of this study was to examine the relationships between respectful PPC, patient portal usage, and digital health literacy (DHL) in pregnant POC.

Methods: A multimethod cross-sectional survey design was used. Ordered logistic regression was performed to determine the relationship between PPC and portal use, controlling for trimester prenatal care was initiated, insurance type, age, gestational age, and parity. The moderating effect of Digital Health Literacy Instrument (DHLI) was tested on the association between portal usage and PPC.

Results: A total of 130 self-identified pregnant POC participated in the study. Participants who did not use the portal had 68% lower odds of rating higher quality PPC (odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.12-0.86, p = 0.02). Participants with public versus private insurance had 62% lower odds of rating high-quality PPC (OR = 0.38, 95% CI = 0.14-0.99, p = 0.04). For portal users, DHL moderated the association between PPC and portal use - eHealth Literacy Scale (adjusted OR [aOR] = 1.06, 95% CI = 1.01-1.12, p = 0.02) and DHLI (aOR = 2.36, 95% CI = 1.12-4.95, p = 0.02). The moderation effect of DHLI was also significant among limited portal users (aOR = 2.32, 95% CI = 1.04-5.19, p = 0.04).

Conclusion: Addressing the digital divide for pregnant POC requires further investigation into portal non-users with consideration to insurance type, DHL, and social determinants of health.

Achieving health equity requires data systems that recognize and reflect provider diversity. The National Provider Identifier (NPI) system underpins United States health care administration, yet its gender data standards remain outdated, conflating sex and gender and lacking inclusive options. These deficiencies undermine research, equity initiatives, and the visibility of transgender and nonbinary providers. In an era of growing political hostility to diversity, administrative neutrality is insufficient. The National Plan and Provider Enumeration System must establish itself as a model of gender-inclusive policy by separating sex and gender variables, expanding identity categories, and implementing transparent, regularly updated standards grounded in science.