Journal of Health Care for the Poor and Underserved最新文献

Objective: Black birthing people are three times more likely to die from pregnancy-related causes than White birthing people. This disparity is related to racism and implicit bias. The project's goal was to evaluate the effect of a novel anti-racism curriculum on the ability of health care providers to address implicit biases.

Methods: Attendees of grand rounds education for the Department of Obstetrics and Gynecology at one academic institution were eligible. Pre- and post-intervention surveys were conducted annually. Results were analyzed through paired t-tests.

Results: Anti-racism curriculum participants had a statistically significant difference in their understanding of disparities and comfort speaking about instances of bias after participation. There was no significant difference in knowledge of historical context.

Conclusion: Although most participants had previous anti-racism training, participants lacked comfort discussing disparities with peers and those in positions of leadership prior to this curriculum, which empowered participants to address racism in actionable ways.

Historically Black colleges and universities (HBCUs) have long been places where students of color have been able to find community, support, and a sense of home as they move through the college experience. Like most college experiences, challenges and concerns are present, including those surrounding substance use, addiction, and recovery. Today, HBCUs continue to provide refuge to students of color with added addiction and recovery support through the expansion into the realm of collegiate recovery. Collegiate recovery community programs (CRC/Ps) at HBCUs differ from those found at predominantly White institutions (PWIs) and may offer insight into engaging students of color on other campuses. This article is a brief overview of the first established CRC/P at an HBCU. Implications for research, development, and replication are discussed.

Objective: We conducted a scoping review of 45 peer-reviewed articles to characterize the intersection of housing instability and homelessness, care, and services in rural North America. We sought gaps in literature related to geographically based health disparities among people experiencing housing instability and identify practices that may promote better health outcomes. We offer practical implications for health care and service provision for people experiencing housing instability in rural areas.

Methods: We reviewed the literature and according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) standards.

Results: We identified 45 articles matching the inclusion criteria for full-text review. Emerging themes included subpopulations and demographics, physical and behavioral health, and services.

Conclusions: More information is needed on housing instability in rural settings such as housing instability among unsheltered individuals, Native Americans, and older persons. Solutions to end homelessness should consider tailoring resources and services to the rural context.

Increasing engagement in hepatitis C virus (HCV) care and treatment will help mitigate HCV incidence, morbidity, and mortality in the United States. This study aimed to understand the multilevel factors affecting engagement in HCV care after implementation of a subscription-based payment model for HCV treatment. Semi-structured interviews were conducted with patients with chronic HCV from a federally qualified health center in New Orleans, Louisiana. We used a convenience sampling method to recruit patients for the study. The interviews conducted between May 2020 and February 2021 explored factors influencing linkage to and retention in HCV care, using the socio-ecological model as the guiding framework. An analysis of the interviews with 39 patients revealed multilevel barriers to care, including instability, provider attitudes, prior care experiences, and the corrections system. Facilitators identified included personal health journey, network HCV experiences, and HCV awareness. A multilevel approach to facilitate engagement in HCV care is imperative.

In burnout surveys, five to 15% of respondents prefer not to identify (PNTI) gender, race, or ethnicity and are often ignored in survey findings, yet this group of respondents appears to have the highest burnout rates. While stress is higher in workers who are Black, Indigenous, or other People of Color (BIPOC), burnout is often reported to be lower than in non-Hispanic White workers. Hypothesized reasons for not identifying include personal safety, perceived vulnerability, and believing little will occur in response to findings. Messaging survey safety, revising demographic queries, and acting upon findings may encourage individuals to identify race, gender, and ethnicity. If more respondents identified race, ethnicity, and gender, this would allow us to gain a fuller understanding of the lived experiences of all health care worker groups; the impact this may have on burnout rates in under-represented groups remains to be determined.

There is a need for qualified medical interpreters in lesser-spoken languages at free or sliding-scale clinics and community-based organizations. We describe the process and cost of training qualified medical interpreters (QMIs) and developing the QMI Workforce Program at no charge to free or sliding-scale clinics/CBOs so they can offer language-concordant health care for patients with limited English proficiency.

There are more than six million violent crimes annually in the United States, with persons from communities of color and lower socioeconomic status at highest risk. This article introduces the Trauma Recovery Center model of care for underserved victims that provides comprehensive mental health and case management services to all survivors of violence.

Objective: The prevalence of adverse childhood experiences (ACEs) increased during the COVID-19 pandemic, but rural-urban differences have not yet been analyzed. This study examines rural-urban disparities in the prevalence of and predictors of experiencing ACEs during COVID-19.

Methods: Using data from the 2021-2022 National Health Interview Survey, rural-urban differences in the type and number of ACEs and the odds of having experienced four or more ACEs were analyzed.

Findings: Rural children were more likely to experience most ACEs; there were no significant differences for racial discrimination. After adjustment, there were no rural-urban differences in the odds of having four or more ACEs. Children with a lower household income had greater odds of experiencing four or more ACEs than those with a higher income, regardless of rurality.

Conclusions: The findings of this study may be helpful in guiding stakeholders considering the populations in need of resources for impacts of ACEs, particularly rural children and children in poverty.

Recently, several states renewed efforts to implement Medicaid premiums. If implemented, premiums will substantially reduce enrollment. To explore the role that race/ethnicity and deservingness of beneficiaries may play in shaping public opinion towards Medicaid premiums, and how ideology and racial resentment may affect public attitudes, this study relied on a national survey (N=4,177) that contained an experiment using racially/ethnically identifiable names and different life circumstances of potential beneficiaries. The experiment highlighted the malleability of public attitudes related to Medicaid, identifying consistently lower levels of support for Medicaid premiums for people with a disability and single mothers compared with people with substance use disorder and single women across various analyses. No differences based on the race/ethnicity of the beneficiary presented were found. Liberals and those low in racial resentment were consistently less supportive of premiums than their counterparts. The findings help elucidate the continuing struggle over the nature of Medicaid.

Type 2 diabetes disproportionately affects low-income and racially marginalized communities. Several social and economic factors intersect to create and reproduce this unequal burden. This qualitative study explores how low-wage workers experience and navigate diabetes management in the workplace. Our findings highlight how unpredictable work schedules, lack of access to sick leave, and inflexible work environments with limited worker autonomy create significant barriers to diabetes self-management. These challenges are compounded by limited control over work conditions and societal norms that emphasize personal responsibility. To address these disparities, we propose multi-level interventions, including educational campaigns on workplace rights, policy changes promoting flexible scheduling and paid sick leave, raising the minimum wage to improve economic security, and routine screenings by health care providers to explore workplace factors that may be affecting diabetes control.