Of disparities and diversity: where are we?

There has been remarkable improvement in the health of women over the past century; however, disparities among minority populations persist. While the reasons for the disparities, usually poorer health, are many and complex, such disparities are unacceptable. Because the reasons for disparities are multiple and complex, eliminating health disparities will require a multifaceted approach. Increasing research into health disparities, biologic, sociologic, and health services research, transforming the health care system into a culturally sensitive system, eliminating unequal treatment provided to minority populations, increasing diversity in the health care workforce, and assuring that health care providers provide culturally competent health care are needed.     

Enhancing recruitment and retention of minority young women in community-based clinical research

Women are disproportionately affected by the sexually transmitted infections (STI) epidemic, with African-Americans and Latinos at significantly higher risk for STIs than Caucasians. Successful recruitment and retention strategies used with young minority women in community-based STI prevention or intervention research have not been previously reported. This communication presents eight key strategies learned in the recruitment and retention of 16- to 21-year-old urban women participating in a 12-month randomized clinical trial designed to promote STI screening to decrease the duration of untreated chlamydia and gonorrhea infection. Strategies learned include: (1) Educate clinic staff on the rigors of study design; (2) Facilitate a team effort between clinical and research staff; modify recruitment procedures, as needed; (3) Provide prospective participants the option of enrolling by return appointment; (4) Anticipate a diminishing recruitment pool over time; (5) Set positive recruitment tone at the beginning of each clinic session; (6) Consider participants' mothers as important points of contact; (7) Match communication styles to participant contacts; and (8) Consider a variety of retention techniques. Together, these strategies helped to reinforce participant's commitment to the project, facilitated their attendance at interviews, and encouraged them to adhere to the treatment protocol.     

Successful Research Recruitment Strategies in a Study Focused on Abused Rural Women at Risk for Sexually Transmitted Infections

Introduction: The purpose of this article is to describe the successful recruitment methods of a study focused on a pilot intervention for rural women who were experiencing abuse and who also were at risk for sexually transmitted infections. Initial recruitment into the study was the primary challenge, and strategies to overcome recruitment difficulties are discussed. Methods: Eighty‐seven women were screened, and 20 women were recruited from clinics into a 1‐group pretest/posttest pilot study. The main inclusion criterion for the intervention was a past‐year history of intimate partner violence (IPV). Results: After 1 month of recruitment, only 10 women agreed to be screened for IPV. Several creative strategies were utilized in the revision of the recruitment plan, with the most successful being knitting by the research staff and incentives to participants for screening. An additional 77 women agreed to be screened for study participation within 3 months of implementing the recruitment changes. Discussion: Personal involvement by the research staff and a nonthreatening and welcoming environment were necessary components for timely recruitment. Researcher flexibility and reevaluation allowed for changes to the recruitment plan that ultimately proved successful.     

Ethnic disparities in fertility care: causes and solutions

Despite advances in fertility treatment, there are major ethnic disparities in access to and outcome of fertility care in many countries. For example, Black and Asian women in the UK have significantly lower IVF birth rates than White and Mixed ethnic groups. There is a multitude of causes for ethnic inequalities in fertility care, including systemic, cultural and biological. Lack of infertility knowledge, language barriers, racial discrimination and lack of institutional trust cause access barriers, significant delays in obtaining treatment and higher dropout during and following unsuccessful fertility treatment. Furthermore, some ethnic minority women have a higher burden of diseases such as diabetes and uterine and tubal pathologies. Mitigating these disparities requires concerted effort to improve timely presentation, diagnosis and referral and attention to systemic drivers such as socioeconomic disadvantage amongst certain ethnic minority groups.     

Racial and ethnic disparities in obstetric anesthesia

Racial and ethnic disparities are prevalent within healthcare and have persisted despite advances in medicine and public health. Disparities have been described in the use of neuraxial labor analgesia, with minority women being less likely to use neuraxial labor analgesia than non-minority white women. Minority women are also more likely to have a general anesthetic for cesarean delivery than non-minority women. The origins of these disparities are likely multi-factorial, with patient-, provider-, and systems-level contributors. The purpose of this article is to give an overview of disparities in obstetric anesthesia.     

Care of the Native American woman: strategies for practice, education, and research

Native Americans, the smallest racial minority in the United States, comprise the fastest growing ethnic group and have a myriad of social and health problems. Women play an important role in health care practices and decision making in this community because many tribes are matrilineal. Practice, education, and research strategies should include identification of beliefs and practices specific to the clan or tribe because there is wide variance in values, lifestyles, and taboos from tribe to tribe. Traditional healers, Native American storytelling, and talking circles can be incorporated into the health care of urban Native American women and their families.     

Addressing limited English proficiency and disparities for Hispanic postpartum women

The National Institutes of Health Office of Minority Health challenges health providers to eliminate health disparities for Hispanic women, especially those women with limited English proficiency. This article addresses this challenge by identifying areas of health disparities for low-risk postpartum Hispanic women with limited English proficiency, by describing the legal basis for improving language access, and by proposing implementation of Office of Minority Health national guidelines. Health providers can use a social equity framework to support improvements in communication practices when language differs.     

Social disadvantage and its effect on maternal and newborn health

Social disadvantage impacts the health of women and newborns throughout the life course. Contributing factors such as low educational attainment, unemployment, poverty, and lack of health insurance disproportionately affects minority women of reproductive age in the United States. This article reviews social disadvantage as it contributes to health status and health disparities for mothers and newborns in the United States and highlights the opportunities to improve social and structural determinants of health to address these gaps.     

Strategies for Conducting Adolescent Health Research in the Clinical Setting: The Mount Sinai Adolescent Health Center HPV Experience

BackgroundClinical research with adolescents can be challenging due to issues of informed consent, parental involvement, institutional review board requirements, and adolescent psychosocial development. These requirements present a dilemma, particularly in the area of sexual health research, as adolescents are disproportionately affected by sexually transmitted infections such as human papillomavirus (HPV). To successfully conduct adolescent research in the clinical setting, one requires an awareness of state statutes regarding adolescent confidentiality and consent for medical care, and a close partnership with the IRB.Case StudyIn 2007, the Mount Sinai Adolescent Health Center in collaboration with the Albert Einstein College of Medicine developed a longitudinal research study to examine the natural history of oral, cervical, and anal HPV in an adolescent female population engaged in high-risk sexual behaviors. We use this research project as a case study to explore the ethical, methodological, and clinical issues related to conducting adolescent health research.Summary and ConclusionsSeveral strategies were identified to promote adolescent study participation, including: (1) building a research team that is motivated to work with adolescents; (2) combining research and patient care visits to avoid duplication of services; and (3) establishing a personalized communication network with participants. Using these methods, adolescent sexual health research can successfully be integrated into the clinical setting. While retaining a prospective cohort of adolescents has its challenges, a persistent and multi-disciplinary approach can help improve recruitment, sustain participation, and acquire critical data that will lead to improved healthcare knowledge applicable to understudied populations of adolescents.     

Trust and confirmation in a gynecologic examination situation: a critical incident technique analysis

BACKGROUND: Gynecologic examination is a common measure in reproductive health care. Many women experience the examination as a more or less negative event, with shortcomings in the examiner's behavior. The aim of the study was to describe, in terms of critical incidences, women's experiences concerning the personnel's behavior in the situation of gynecologic examination. METHODS: The informants were strategically chosen and consisted of 30 Swedish women between the ages of 18-82 years old. The data collection method was qualitative research interviews analyzed by critical incident technique. RESULTS: The result consisted of 30 subcategories, five categories, and two main areas - trust and confirmation. The personnel enabled trust when they promoted participation, created confidence, and were supportive. The opposite behavior contributed to the lack of trust. Confirmation described behavior that confirmed, respectively, did not confirm the women. This was shown through the presence or lack of respect and engagement. CONCLUSION: The personnel's positive behavior enabled trust and confirmed the women as individuals, while negative behavior was decisive in an unfavorable way. A complexity of patterns of knowing in nursing was identified. Participation through information that contributed to trust was important and amounted to one fourth of the incidents in the material. Respect and engagement, which confirmed the women, facilitated a positive caring relationship. The examination situation can be improved through reflection of the personnel's own behavior and further research about women's own experiences.     

Addressing disparities in maternal health care in Pakistan: gender, class and exclusion

ABSTRACT: BACKGROUND: After more than two decades of the Safe Motherhood Initiative and Millennium Development Goals aimed at reducing maternal mortality, women continue to die in childbirth at unacceptably high rates in Pakistan. While an extensive literature describes various programmatic strategies, it neglects the rigorous analysis of the reasons these strategies have been unsuccessful, especially for women living at the economic and social margins of society. A critical gap in current knowledge is a detailed understanding of the root causes of disparities in maternal health care, and in particular, how gender and class influence policy formulation and the design and delivery of maternal health care services. Taking Pakistan as a case study, this research builds upon two distinct yet interlinked conceptual approaches to understanding the phenomenon of inequity in access to maternal health care: social exclusion and health systems as social institutions. METHODS: This four year project consists of two interrelated modules that focus on two distinct groups of participants: (1) poor, disadvantaged women and men and (2) policy makers, program managers and health service providers. Module one will employ critical ethnography to understand the key axes of social exclusion as related to gender, class and zaat and how they affect women's experiences of using maternal health care. Through health care setting observations, interviews and document review, Module two will assess policy design and delivery of maternal health services. DISCUSSION: This research will provide theoretical advances to enhance understanding of the power dynamics of gender and class that may underlie poor women's marginalization from health care systems in Pakistan. It will also provide empirical evidence to support formulation of maternal health care policies and health care system practices aimed at reducing disparities in maternal health care in Pakistan. Lastly, it will enhance inter-disciplinary research capacity in the emerging field of social exclusion and maternal health and help reduce social inequities and achieve the Millennium Development Goal No. 5.     

Multisystem factors contributing to disparities in preventive health care among lesbian women

Lesbians experience significant health disparities in preventive care utilization and health outcomes compared to heterosexual women. In this study, a multisystems ecologic approach is taken to identify barriers to access, treatment, and preventive care among lesbian women. Recommendations include increasing knowledge of lesbian health care needs, developing cultural sensitivity and competence in communication and care for lesbian women, and creating practice environments that convey respect, acceptance, and welcome to all women, regardless of sexual orientation.     

Why do women volunteer to participate in clinical studies?

The purpose of this study was to determine why young women volunteer to participate in clinical studies. Questionnaires were sent to 126 healthy fertile women, who during 1 year had undertaken contraceptive pill trials in the Reproductive Medicine Unit, of the University Hospital of South Manchester. An 85% response rate was obtained. Most of these women worked, were married and had children. Study recruitment was most effective by 'word of mouth', posters within the hospital not attracting many volunteers. They volunteered to take part because of the perceived financial gain from 'reasonable expenses' payable. Only 11.2% expressed a desire to assist in medical research or have their own health checked. The sex of the study investigator was not crucial to their participation; 94.4% were willing to participate in future pill trials. Therefore, when planning a clinical study requiring healthy volunteers, reasonable expenses are an essential compensation to aid the recruitment process.     

Combining ethical considerations with recruitment and follow-up strategies for partner violence victimization research

In general, the literature on research ethics and the literature on recruitment and retention of research participants tend to be separated by different purposes and principles. This article uses multiple methods to compile information about research ethics with vulnerable participants as well as with recruitment and follow-up strategies, including (a) literature reviews, (b) key informant interviews, (c) focus group interviews, (d) a pilot study to test ideas for study implementation, and (e) documentation of recruitment and follow-up efforts for a longitudinal study of 757 women with partner violence victimization experiences. This article shows how considering research ethics may actually enhance recruitment and follow-up strategies with women experiencing partner violence victimization.     

ACOG Committee Opinion No. 307. Partner consent for participation in women's reproductive health research

Recent advances in reproductive medicine include treatment of subfertility as well as investigation of agents that may serve as both contraceptives and potential prophylaxis against sexually transmitted diseases, including potential protection from human immunodeficiency virus (HIV). Although there is no doubt regarding the need for informed consent by women participating in trials evaluating the safety and effectiveness of these novel agents and treatments, there has been some debate regarding the necessity and propriety of requiring consent from the partners of women involved in certain types of clinical trials involving reproductive health. Issues of partner consent are unique to research surrounding women 's reproductive health as opposed to research pertaining to women's health, in general. This is due, in part, to a valid concern about a potential effect of the research on the partner. There are, therefore, legitimate reasons to obtain partner consent for a woman's participation in a clinical trial. In the absence of such reason, partner consent should not be mandated.     

Scoping Review of Racial and Ethnic Representation of Participants in Mental Health Research Conducted in the Perinatal Period During the COVID-19 Pandemic

ObjectiveTo identify the racial and ethnic representation of participants in mental health research conducted in the perinatal period during the COVID-19 pandemic.Data SourcesMEDLINE, CINAHL, Cochrane Library, PsycINFO, Scopus, Web of Science.Study SelectionWe included peer-reviewed research articles in which researchers reported mental health outcomes of women during the perinatal period who were living in the United States or Canada during the COVID-19 pandemic. We included 25 articles in the final review.Data ExtractionWe extracted the citation, publication date, design, aim, country of origin, participant characteristics, sampling method, method of measurement of race and ethnicity, and mental health outcome(s).Data SynthesisThe combined racial and ethnic representation of the 16,841 participants in the included studies was White (76.5%), Black (9.8%), other/multiracial (6.2%), Asian (3.9%), Hispanic/Latina (2.6%), Indigenous or Ethnic Minority Canadian (0.9%), and Native American or Alaska Native (0.1%). Most studies were conducted in the United States, used a cross-sectional design, and incorporated social media platforms to recruit participants. Depression, anxiety, and stress were the most frequently assessed mental health outcomes.ConclusionRelatively few women of color who were pregnant or in the postpartum period during the pandemic participated in mental health research studies. Future studies should develop intentional recruitment strategies to increase participation of women of color. Researchers should use updated guidance on reporting race and ethnicity to accurately represent every participant, minimize misclassification of women of color, and report meaningful results.     

Substance use and mental health disparities among sexual minority girls: results from the Pittsburgh girls study

PurposeTo examine substance use and mental health disparities between sexual minority girls and heterosexual girls.MethodsData from the Pittsburgh Girls Study were analyzed. All girls were 17 years old. Girls were included if they were not missing self-reported sexual orientation and mental health data (N = 527). Thirty-one girls (6%) endorsed same-sex romantic orientation/identity or current same-sex attraction. Bivariate analyses were conducted to test group differences in the prevalence of substance use and suicidal behavior, and group differences in depression, anxiety, borderline personality disorder (BPD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms.ResultsCompared with heterosexual girls, sexual minority girls reported higher past-year rates of cigarette, alcohol, and heavy alcohol use, higher rates of suicidal ideation and self-harm, and higher average depression, anxiety, BPD, ODD, and CD symptoms.ConclusionsSexual minority girls are an underrepresented group in the health disparities literature, and compared with heterosexual girls, they are at higher risk for mental health problems, most likely because of minority stress experiences such as discrimination and victimization. The disparities found in this report highlight the importance of discussing sexual orientation as part of a comprehensive preventive care visit.     

Dilemmas and conflicts in clinical research on women''s reproductive health

With growing interest in research on women's reproductive health, community-based organisations working among women are seen as having a special role to play. They enjoy local women's confidence and trust and can be sources of reliable data. Reflecting on the experiences of SARTHI, a rural grass roots organisation in western India, this paper questions the research process adopted for carrying out community-based, clinical research in women's reproductive health. It challenges the 'top-down' imposition of a narrowly-focused methodology which requires the community to keep pace with the study rather than the other way around, and creates unreal service-delivery conditions which cannot be sustained after the study. The paper under-scores the need for a methodology that looks beyond the study, pays as much attention to process as to results, and is an ongoing exercise operating within the realities of service provision.     

Race and ethnic disparities in fetal mortality, preterm birth, and infant mortality in the United States: an overview

Infant mortality, fetal mortality, and preterm birth all represent important health challenges that have shown little recent improvement. The rate of decrease in both fetal and infant mortality has slowed in recent years, with little decrease since 2000 for infant mortality, and no significant decrease from 2003 to 2005 for fetal mortality. The percentage of preterm births increased by 36% from 1984 to 2006, and then decreased by 4% from 2006 to 2008. There are substantial race and ethnic disparities in fetal and infant mortality and preterm birth, with non-Hispanic black women at greatest risk of unfavorable birth outcomes, followed by American Indian and Puerto Rican women. Infant mortality, fetal mortality, and preterm birth are multifactorial and interrelated problems with similarities in etiology, risk factors and disease pathways. Preterm birth prevention is critical to lowering the infant mortality rate, and to reducing race and ethnic disparities in infant mortality.