Journal of best practices in health professions diversity : research, education and policy最新文献

Background: The current US physician workforce does not reflect the diversity of the patient population it serves. While programs have been designed to support learners underrepresented in medicine, evidence of their efficacy is lacking.

Methods: We designed, implemented, and assessed a medical school admissions preparatory program (MAPP) for premedical students from underrepresented backgrounds, as defined by race, gender identity, and/or socioeconomic status. The program includes workshops, near-peer mentorship, and professional standardized test-preparation materials. We assessed the students' development using a mixed-methods, post-test approach that included surveys and one-on-one interviews. Questions were based on social cognitive career theory. We used independent thematic analysis to extract key themes across interviews.

Results: We surveyed and interviewed 13 of 17 MAPP participants in 2021. The cohort had a mean age of 23.7+/-4; 77% were women; and 23% self-identified as Asian, 15% as Pacific Islander, 15% as Black, 31% as Hispanic, and 23% as American Indian. We found they had little experience with the medical school application process and developed new insights about themselves from participating in MAPP. The primary drivers of growth were (1) guidance in the medical school admission process, (2) near-peer mentorship and interactions, and (3) sense of community with other program participants.

Conclusion: MAPP provided materials and methods that clarified the process and bolstered students' confidence in their ability to complete the application.

Objectives: Cardiovascular disease (CVD) is the leading cause of death in the United States. Among the risk factors for college students, obesity and physical inactivity are disproportionately high among African Americans (AAs), and while studies of the obesity epidemic have increased in recent years, few target AA college-aged students. This study developed and piloted an evidence-based, 15-week, 3-credit hour, CVD risk-prevention and intervention course, Rams Have HEART that used e-learning, web-based technologies, and a mobile application and compared its effects against a control course.

Methods: Two cohorts were recruited in a two-year period; 124 AA college students voluntarily consented to participate in the study, with n = 63 representing the control group and n = 61 representing the intervention. CVD risk factors were assessed by examining blood markers and anthropometric measurements. Demographic, clinical, and survey data (physical measures, blood marker investigation, and self-report surveys) were collected at baseline, post-intervention, and follow-up over the academic year.

Results: The mean blood markers for lipid panel and glucose results were within the established optimal range. Intake of fruits and vegetables increased along with knowledge of CVD risk factors; 86% of students enrolled in the intervention passed the course; 100% (n = 61) would recommend it to future students.

Conclusion: Developing and offering a healthy lifestyle-behavior CVD intervention course to AA college students is feasible and effective in optimizing their awareness of chronic disease risk factors and prompting behavior change.

This investigation challenged the proposition that physician patient-centeredness influences patients' experience-of-care (PEC). A theory-driven, three-factor, multigroup structural equation modeling design, using asymptotic-distribution-free and bootstrap estimation, with two national random and 5,000 bootstrap samples challenged the proposition's plausibility, measurement invariance, replicability, robustness against a competing model, and coherence with theory. The model fit [χ²(39) = 28, p =.900, RMSEA = .001, p = 1.00, CFI = 1.00], explaining 81 percent of PEC's variance; the proposition was invariant across samples, held against the competing model [χ²Δ(7) = 7.82, p = .97]; cross-validated against estimates from the 5,000 bootstrap samples; and agreed with theory. One standardized increase in patient-centeredness increased PEC, likelihood of recommending, and care ratings by .807, .765, and .771. Results converged in sustaining the plausibility of the proposition.

Objective: To determine the relationship between perceived diabetes susceptibility, demographic factors, diet, and physical activity.

Design: This descriptive, correlational study used multilevel modeling in a secondary analysis of data collected in a randomized controlled trial of genetic-risk testing and risk counseling for type 2 diabetes (T2DM) in primary care.

Sample: 409 participants who had undergone genetic-risk testing for T2DM in primary care were randomized into either a standard risk assessment (SRA) arm for type 2 diabetes or an SRA plus results of genetic-risk testing (SRA+G) arm.

Results: Perceived diabetes susceptibility was not significantly related to demographic factors but only to fruit-and-vegetable intake at 12 months after genetic-risk counseling (p = .04). Daily servings of fruits and vegetables had a significant, positive relationship with female gender (p = .006), age (p = .02), and Hispanic ethnicity at 3 (p = .002) and 12 months after baseline (p = .01). Daily servings of fatty foods were inversely related to age at baseline (p = .02) and 3 months later. At all three timepoints, Blacks were consuming more servings of fatty foods than were other groups. A positive relationship between age and moderate activity was significant at 3 months (p = .05). Vigorous activity was inversely related to age; higher among men at all three timepoints; and higher among Hispanics at baseline (p = .0038) and 3 months later (p = .0001).

Conclusions: To plan effective, sustainable interventions, providers must understand the associations among demographic factors, individuals' risk perceptions, and lifestyle changes.

For college students, the transition from adolescence to young adulthood can be a time of increased stress and negative health behaviors, such as poor diet and physical inactivity, that may lead to cardiovascular disease (CVD), the primary cause of death in the United States. Blacks are disproportionately prone to CVD. Perception of disease risk is a critical predictor of engagement in healthy lifestyle activities intended to reduce CVD development. This project examined the relationship between perceived risk of CVD and health behaviors in Black HBCU students aged 18-25 years. All participants (n = 14) perceived that they were not at risk for heart disease within the next 10 years. Almost half (n = 6, 42.86%) had moderately high CVD risk scores, and three (21.43%) were at high risk for developing CVD. Scores on the subscales for dread risk, risk, and unknown risk were 28.29, 37.67, and 43.86, respectively. Total scores for perceived risk of heart disease ranged from 20 to 80. The Spearman's correlation between these Black college students' perceived dread risk and health responsibility was positive and moderately correlated (r_s = 0.62, p = 0.019). A negative and moderate correlation was demonstrated between unknown perceived risk and health responsibility (r_s = -0.54, p = 0.046). Thus, higher risk perception is correlated with greater health responsibility, while low risk perception is correlated with less health responsibility. Barriers to healthy lifestyle behaviors identified by the sample included lack of time and sleep, physical inactivity, cost, convenience of unhealthy foods, and low perception of developing CVD. A major implication is the benefit of implementing interventions to modify risk perception and college-specific barriers that increase CVD risk.

School-industry partnerships bring invaluable cognitive and material resources to K-12 but might inadvertently contribute to widening the achievement gap. Lack of social capital and industry connections make urban schools less likely to partner. This paper describes the University of Kansas (KU) Medical Center Health Science Academy, a university-industry-K-12 partnership designed to increase the number of underrepresented students in health science careers. Using data gathered from 1) meetings with stakeholders, 2) semi-structured interviews with key informants, and 3) focus groups with students, we present the features that made the process and outcomes of this partnership a success. Preliminary results from our pilot year show that students experienced a positive change in their knowledge and intention to pursue a health career.

Objectives: Marital-role quality (MRQ) is a predictor of mental well-being, sexual intimacy, and maternal attachment. Data on differences in MRQ during pregnancy between women and their male partners who conceived spontaneously or via IVF are inconclusive. This study compared MRQ across pregnancy in these two groups.

Methods: The sample's two groups: (a) 26 women and 26 male partners who conceived via IVF; and (b) 25 women and 20 male partners who conceived spontaneously. All 97 participants completed a MRQ scale during each trimester of pregnancy. Trajectory analyses were conducted to test for between-group differences in the changes in subscales across pregnancy within dyads.

Results: Scores did not reveal any significant differences in subscales in those who conceived via IVF compared to non-IVF groups across the three trimesters in each dyad. The observed effect sizes were small, with exception that males in the non-IVF comparison group had greater concerns during the first trimester than did males in the IVF group (Cohen d= 0.51, moderate effect size).

Conclusions: Though the IVF population perceives pregnancy differently and experiences more anxiety than those who conceive spontaneously, their marital-role quality during pregnancy does not seem to be affected. Their perceptions before conception and in early parenting are worthy of investigation.

Background: Along with clinical technical competence, nurses' interpersonal ability influences patient outcomes. Patient-centeredness, "[p]roviding care that is respectful of, and responsive to, individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions" (IOM, 2001, p. 3), is especially important in assuring that African-American Medicare patients achieve the desired outcomes.

Purposes: This study was designed to measure the effects of nursing patient-centeredness on African-American female Medicare hospital inpatients across national random test and cross-validation samples; specifically, on their experience-of-care, likelihood of recommending the hospital, and ratings of care. The stability of effects was assessed across samples and a competing model challenge further tested the hypothesis.

Hypothesis: Nursing patient-centeredness improves African-American female Medicare hospital patients' experience-of-care and increases the likelihood that they will recommend and highly rate their care.

Results: Supporting the hypothesis, the model fit. Nursing patient-centeredness significantly influenced African-American female Medicare hospital patients' experience-of-care, likelihood of recommending the hospital, and ratings of care (χ² = 39.35, df = 42, p = .588; RMSEA = .000, p =.982 CL90% = .000-.043; CFI = 1.000), explaining 71% of the variance of patients' experience-of-care (p < .001). A unit increase in nursing patient-centeredness increased patients' experience-of-care, likelihood of recommending the hospital, and ratings of hospital care by .842, .778, and .798 standardized units, respectively. These results were stable across both the test and cross-validation samples, and the hypothesized model was sustained when compared to the hypothesized competing model (χ²Δ = 10.974, df = 16, p = .811).

Discussion: Nursing performance is often chiefly associated with clinical or technical competence. Patient-centeredness concerns nurses' ability that affects the quality of their interaction with patients and concomitant outcomes. This study provided empirical evidence that nursing patient-centeredness significantly improves African-American female Medicare hospital patients' experience-of-care and increases the likelihood that they will recommend and highly rate their care.

College students are prone to stress, making them vulnerable to cardiovascular disease (CVD). Harmful health behaviors, such as tobacco or alcohol use, further predispose students to hypertension (HTN). African-Americans (AA) experience increased blood pressure reactivity, and weathering, due to race-related stressors. This interplay makes AA college students good targets for strategies to prevent stress and HTN disease risk. This project examined the relationship between mindfulness, perceived stress and blood pressure among a group of AA college students enrolled in an HBCU healthy heart course. Participants' systolic and diastolic blood pressure averaged 122 mmHg and 76 mmHg, respectively. The Spearman correlation revealed a negative strong relationship between mindfulness and perceived stress (r_s = -0.61, p = 0.004). The coefficient of determination indicated that 37% of the variance in mindfulness was explained by perceived stress. College health practitioners should consider integrating mindfulness into course activities and expanding its treatment modality.

Translational research addressing health disparities brings interventions and medical discoveries into clinical practice to improve health outcomes. However, academic researchers' and clinicians' lack of understanding of methodologies limits the application of basic science to clinical settings. To solve the problem, a multidisciplinary collaboration from two academic institutions offered a workshop building on translational research methodologies to clarify the measures and interventions needed to address health disparities from a research perspective. Three two-day workshops targeted underrepresented minority participants whose research experience and professional development varied. The evaluation surveys administered after the three workshops indicated that workshop 1 which focused on translational and educational research increased participants' knowledge, and made all participants think critically about the subject. Training opportunities focused on translational research can enhance researchers and clinicians' confidence and capabilities to address health disparities.