The association of perceived discrimination with low back pain

A handful of recent studies have documented perceived discrimination as a correlate of poor physical and mental health status among ethnic and racial minority groups. To date, however, despite a proliferation of research on ethnic disparities in the severity and impact of a number of persistent pain conditions, there have been no reports on associations between perceived discrimination and pain-related symptoms. Using data from a national survey (the National Survey of Midlife Development in the United States; MIDUS), we explore the relationships between perceived discriminatory events and the report of back pain among African-American and white men and women. As expected, African-American participants reported substantially greater perceptions of discrimination than white participants. Moreover, in models that included a variety of physical and mental health variables, episodes of major lifetime discriminatory events were the strongest predictors of back pain report in African-Americans, and perceived day-to-day discrimination was the strongest predictor of back pain report specifically in African-American women. Among white participants, perceptions of discrimination were minimally related or unrelated to back pain. To our knowledge, these are the first data documenting an association between perceived discrimination and report of back pain; the fact that perceptions of discrimination were stronger predictors than physical health variables highlights the potential salience and adverse impact of perceived discrimination in ethnic and racial minority groups.     

Increasing inclusivity in precision medicine research: Views of deaf and hard of hearing individuals

PurposeDeaf/hard of hearing (HoH) individuals can benefit from precision medicine research (PMR) but are underrepresented in mainstream health research and may experience barriers to participation. Understanding their views and concerns about PMR can inform processes to foster inclusion in future studies and reduce health disparities.MethodsWe administered an online disability-accessible survey to explore perceptions of PMR among, inter alia, deaf/HoH individuals. Questions included willingness to participate, interest in results, and barriers and facilitators to participation. Analyses describe results for participants who self-identified their primary condition as being deaf/HoH and compared results for key demographic characteristics.ResultsA total of 267 deaf/HoH participants completed the survey. Interest in PMR was high, although many reported inaccessible facilities and information about medical research; 51% reported that communication with health professionals is a barrier. Concerns about harm, lack of access to benefits, misinformed allocation decisions, and limited disability-relevant knowledge among researchers and health care providers were significant. Differences across racial, ethnic, and sex groups were observed and are discussed.ConclusionStrategies to remove barriers to participation of deaf/HoH individuals in PMR are suggested. Distrust is a major challenge for cohort diversity, and research is needed to identify measures to increase the trustworthiness of PMR endeavors.     

Patients’ perspectives on shared decision making in secondary mental healthcare in Taiwan: A qualitative study

ObjectiveThe aim of this study is to explore patient perspectives on shared decision making in secondary mental healthcare in Taiwan.MethodsQualitative semi-structured interviews were used to explore patient perspectives on shared decision making in secondary mental healthcare in Taiwan. Individual semi-structured interviews were conducted from July to August 2017 with a purposive sample of twenty patients using halfway houses. Data were analysed using thematic analysis.ResultsAnalysis of the interviews identified two themes: barriers to shared decision making; facilitators of shared decision making. Patients perceived that they were not involved in decision making due to: the professional status of health professionals; negative perception of making decisions; and limited time resources. However, patients reported a desire to be involved and felt sufficient information exchange would be a necessary step towards collaboration/sharing decisions about treatment with clinicians.ConclusionThe findings provided an understanding of significant barriers to and facilitators of implementing shared decision making to aid further professional training and the development of national policies.Practice implicationsThe findings could be the basis for developing effective strategies to overcome barriers to shared decision making and improve the process quality of delivering shared decision making.     

HIV vaccine trial participation among ethnic minority communities: barriers, motivators, and implications for recruitment

BACKGROUND: Underrepresentation of ethnic minority communities limits the generalizability of HIV vaccine trial results. We explored perceived barriers and motivators regarding HIV vaccine trial participation among low-socioeconomic ethnic minority respondents at risk for HIV. METHODS: Six focus group interviews were conducted using a semistructured interview guide. Participants (N = 58, mean age = 36 years, 37% female, and 56% Latino/a and 35% African American) were recruited using venue-based sampling in Los Angeles. Data were analyzed using narrative thematic analysis and Ethnograph qualitative software. RESULTS: Perceived barriers to HIV vaccine trial participation, in rank order, were (1) vaccine-induced HIV infection, (2) physical side effects, (3) uncertainty about vaccine efficacy, (4) uncertainty about other vaccine characteristics, (5) mistrust, (6) low perceived HIV risk, (7) study demands, (8) stigma, and (9) vaccine-induced HIV seropositivity. Motivators were (1) protection against HIV infection, (2) free insurance and/or medical care, (3) altruism, and (4) monetary incentives. CONCLUSIONS: Population-specific HIV vaccine trial recruitment and implementation strategies should address trial risks from a family perspective, cultural gender norms, mistrust, low perceived HIV risk, the importance of African-American and Latino/a community participation in HIV vaccine trials, and misconceptions about gaining protection against HIV infection. Increasing the cultural relevance of trial recruitment and implementation should facilitate the participation of Latinos/as and African Americans in HIV vaccine trials.     

Feasibility,acceptability and preliminary impact of mindfulness-based yoga among Hispanic/Latinx adolescents

Background: The Hispanic/Latinx population constitutes the fastest growing ethnic/racial minority group in the United States (U.S.). Compared to their non-Hispanic/Latinx White counterparts, Hispanic/Latinx youth experience more depression and anxiety, and have more unmet mental health needs (88% vs 76%). Emerging research supports the psychological and physical benefits of mind-body awareness training to enhance well-being and mental health, but almost no studies have recruited ethnic/racial minority samples. Purpose: The current study examined the feasibility, acceptability and preliminary impact of a mindfulness-based yoga program among Hispanic/Latinx public high school students. Procedures: Participants (N = 187) were recruited from a local public high school in a large multi-ethnic urban school district in the Southeast U.S. and participated in 6 weekly hour-long sessions of mindfulness-based yoga. Participants completed assessments at pretest and one month after program completion. Main Findings: The sample was predominantly Hispanic/Latinx (95%) and female (64%), on average 15.2 years old (SD = 1.3), and 51% were born outside the U.S. Participants reported on average a 14.2% reduction in depressive symptoms (pretest mean = 5.51, posttest mean = 4.73, p = .032, Cohen's d = 0.2), a 14.9% reduction in anxiety symptoms (pretest mean = 9.90, posttest mean = 8.42, p = .005, Cohen's d = 0.2), and a 21.9% reduction in stress (pretest mean = 9.66, posttest mean = 7.54, p < .001, Cohen's d = 0.5). Conclusion: These findings provide support for the effectiveness of a mindfulness-based yoga program for Hispanic/Latinx adolescents, a medically underrepresented group experiencing significant mental health disparities.     

Between and within race differences in patient-centeredness and activation in mental health care

ObjectivesThe aim of this study was to compare Black and White mental health care patients’ perceptions of their providers’ and their own participation in patient-centered mental health care. Perceptions of patient-centered care (PCC) in relation to the Multidimensional Model of Racial Identity were explored.MethodsBlack and White veterans receiving mental health care (n = 82) completed surveys assessing patient activation, involvement in care, perceptions of PCC, and therapeutic alliance. Black participants (n = 40) also completed the Multidimensional Inventory of Black Identity.ResultsThere were no differences by race in perceived PCC, though Black participants had lower levels of therapeutic alliance with their mental health care provider and were less activated. Black identity centrality, private regard, and public regard were positively related to PCC and elements of PCC such as patient information seeking/sharing.ConclusionsIntragroup identity variables such as racial centrality, regard, and ideology influenced perceived PCC among Black participants. Race identity variables should be explored in future research on racial disparities and PCC.Practice implicationsMental health care providers serving Black patients should create opportunities to discuss racial identity and race-related experiences as part of their efforts to improve therapeutic alliance and increase the patient-centeredness of care.     

Implicit Bias in Pediatric Academic Medicine

Objective

Despite known benefits of diversity, certain racial/ethnic groups remain underrepresented in academic pediatrics. Little research exists regarding unconscious racial attitudes among pediatric faculty responsible for decisions on workforce recruitment and retention in academia. This study sought to describe levels of unconscious racial bias and perceived barriers to minority recruitment and retention among academic pediatric faculty leaders.

Examining the Gap Between Medical School Matriculation and Graduation Rates Amongst Self-Identified Minorities

PurposeDespite increasing diversity, data indicates that there is a gap between the matriculation or admission of and graduation rates amongst medical students who identify with racial or ethnic minority groups. The purpose of this study was to identify barriers experienced by minority medical students that may account for this gap.MethodsAn IRB approved online survey was created, and distributed electronically to minority medical students, residents, and practicing physicians. Information on demographics, family dynamics, academic struggles, health issues, financial difficulties and faculty diversity was collected via self-report.ResultsParticipants (n = 167) who completed the survey identified as Black/African/African American (60%), Hispanic/Latinx (26%), Asian (8%), and as Other racial or ethnic minority (6%). The majority of survey participants graduated within the traditional 4 years of medical school (83%) and 17% did not. The most frequently reported reason was to pursue academic advancement (42%) which included completing a research year, dual degree, or PhD. The second reason was due to academic deficiencies (38%), either course failure or failure of a board exam. The majority of respondents (59%) also reported not having enough faculty members who were members of racial or ethnic minority groups at their medical school.ConclusionsOur data suggests the majority of racial and ethnic minority medical students graduate within the traditional 4 years of medical school. However, if they do not, it is either due to academic advancement to become a more successful residency applicant, or due to academic issues. The majority of respondents reported that they perceive a lack of racial and ethnic minority faculty members in academics.     

Exploring obstacles to and opportunities for professional success among ethnic minority medical students.

PURPOSE: To explore the barriers and facilitators experienced by ethnic minority medical students in achieving personal and professional success. METHOD: In 2002 and 2003, 43 minority medical students participated in one of six two-hour focus groups located in Philadelphia, Pa; Kansas City, Mo; Baltimore, Md; Miami, Fl; New York, NY; and Los Angeles, Calif. Focus groups consisted of an average of seven (range 5-10) individuals. Eighty-eight percent were of black/African descent, 10% were Hispanic, and 2% were Asian/Pacific Islanders. Students discussed their views of personal and professional success, including opportunities and obstacles, and completed a brief demographic survey. Discussions were audiotaped, transcribed verbatim, and reviewed for thematic content in a three-stage independent review/adjudication process. RESULTS: All 748 comments were grouped into themes relating to definitions of success (35%) and to perceived facilitators (25%) or inhibitors (40%) of success. Participants strove to achieve professional/academic status, financial security, and quality of life. In so doing, participants identified facilitators of success, including support systems, professional exposure, financial aid, and personal characteristics. Lack of financial and social support, challenges with standardized tests, experiences with racial stereotyping and discrimination, and self-imposed barriers were among inhibitors to success. CONCLUSIONS: The opportunities for and barriers to academic success identified by minority students should be heeded by educators and administrators who develop programs and policies to recruit minority medical students and to ensure their professional development. To enhance the institutional climate for diversity, programs that improve cultural awareness and reduce biases among all students, faculty, staff, and administrators are needed.     

Barriers to racial/ethnic minority application and competition for NIH research funding

BACKGROUND: Despite recognition of the need to increase the pool of racial/ethnic minority investigators, racial/ethnic minority representation among National Institutes of Health (NIH)-funded investigators remains low. Racial/ethnic minority investigators bring unique perspectives and experiences that enhance the potential for understanding factors that underlie racial/ethnic variation in health and health status. Identification of barriers to successful minority competition for NIH funding and suggestions for strategies to overcome them were obtained from a concept mapping project and a meeting of minority investigators and investigators at minority-serving institutions. METHODS: Concept mapping, a mixed-methods planning approach that integrates common data collection processes with multivariate statistical analyses, was used in this exploratory project. The concept mapping approach generated a series of related "concept maps" that were used for data interpretation and meeting discussions. RESULTS: Barriers to minority investigator competition for NIH funding identified by concept mapping participants include: (1) inadequate research infrastructure, training and development; (2) barriers to development as independent researchers; (3) inadequate mentoring; (4) insensitivity, misperceptions and miscommunication about the specific needs of investigators involved in research with minority communities; (5) institutional bias in NIH policies; (6) unfair competitive environment; (7) lack of institutional support; (8) lack of support for research topics/methods relevant to research with minority communities; and (9) social, cultural and environmental barriers. DISCUSSION: Data from both the concept mapping and the meeting discussions suggest the need to use a multilevel approach to increase minority representation among funded NIH investigators. Specifically, the NIH should use strategies that overcome barriers at the home institution, within NIH and at the investigator level.     

Natural history of insomnia symptoms in the transition from childhood to adolescence: population rates,health disparities,and risk factors

Study ObjectivesTo determine the sociodemographic, behavioral, and clinical risk factors associated with the persistence, remission, and incidence of insomnia symptoms in the transition from childhood to adolescence.MethodsThe Penn State Child Cohort is a random, population-based sample of 700 children (5–12 years at baseline), of whom 421 were followed-up as adolescents (12–23 years at follow-up). Subjects underwent polysomnography, clinical history, physical exam, and parent- and self-reported scales at baseline and follow-up. Insomnia symptoms were defined as a parent- or self-report of difficulty falling and/or staying asleep.ResultsThe 421 subjects with baseline (Mage = 8.8 years) and follow-up (Mage = 17 years) data were 53.9% male and 21.9% racial/ethnic minorities. The persistence of childhood insomnia symptoms (CIS) was 56% (95% CI = 46.5–65.4), with only 30.3% (95% CI = 21.5–39.0) fully remitting. The incidence of adolescent insomnia symptoms was 31.1% (95% CI = 25.9–36.3). Female sex, racial/ethnic minority, and low socioeconomic status as well as psychiatric/behavioral or neurological disorders, obesity, smoking, and evening chronotype were associated with a higher persistence or incidence of insomnia symptoms.ConclusionsCIS are highly persistent, with full remission occurring in only a third of children in the transition to adolescence. Sex-, racial/ethnic-, and socioeconomic-related disparities in insomnia occur as early as childhood, while different mental/physical health and lifestyle/circadian risk factors play a key role in the chronicity of CIS versus their incidence in adolescence. CIS should not be expected to developmentally remit and should become a focus of integrated pediatric/behavioral health strategies.     

Community involvement and adolescent mental health: moderating effects of race/ethnicity and neighborhood disadvantage

Social development and stress process theories suggest that participation in one's community can function as a protective factor for mental health, especially for youth from socioeconomically disadvantaged areas. However, the effects of community involvement on adolescent mental health could vary across racial/ethnic groups and levels of neighborhood disadvantage. The objectives of this paper are to: (1) examine the effects of various types of community involvement on adolescent mental health, and (2) assess the extent to which race/ethnicity and neighborhood disadvantage moderate the effects of community involvement on adolescent mental health. Using data from two waves (1994/95 and 1996) of the National Longitudinal Study of Adolescent Health (“Add Health,” N=7,863), multilevel (hierarchical) linear models were estimated that tested for interaction effects of race/ethnicity and neighborhood disadvantage. The types of community participation that impacted adolescent mental health varied across racial/ethnic groups. Neighborhood interaction and religious participation were salient for both White and Hispanic teens, but the impact of religious participation for Whites was moderated by neighborhood disadvantage. Non‐sport extracurricular activities and employment were the salient factors for Black teens, both of which were moderated by neighborhood disadvantage. The findings from this study have implications for community‐level and clinical interventions to prevent and/or treat mental health problems among adolescents. Social integration interventions should take into account adolescents' cultural backgrounds and socioeconomic contexts in order to be effective. © 2008 Wiley Periodicals, Inc.     

A Little Effort Can Withstand the Hardship: Fielding an Internet-Based Intervention to Prevent Depression among Urban Racial/Ethnic Minority Adolescents in a Primary Care Setting

Background

This study explored the implementation of Chicago Urban Resiliency Building (CURB), a randomized clinical trial designed as an Internet-based primary care depression prevention intervention for urban African American and Latino adolescents.

Midwives’ perceived barriers in communicating about depression with ethnic minority clients

ObjectiveThis study aimed to assess the most influential barriers midwives perceive in communicating about depression-related symptoms with ethnic minority clients.MethodsIn-depth interviews were held with midwives (N = 8) and Moroccan-Dutch women (N = 6) suffering from perinatal depression to identify the most salient communication barriers. Subsequently, an online survey among midwives (N = 60) assessing their perceived barriers and the occurrence of these barriers in practice was administered. Composite scores using the QUOTE methodology were calculated to determine influential barriers.ResultsThree types of barriers emerged from the interviews. Educational-related barriers, client-related barriers and midwife-related barriers. Results of the survey showed that the most influential barriers were educational-related barriers (e.g. lack of culturally sensitive depression screening instruments) and client-related barriers (e.g. cultural taboo about talking about depression).ConclusionCulturally sensitive screening instruments for depression and patient education materials should be developed to mitigate the educational-related barriers to communicating about depression. Patient education materials should also target the clients’ social environment (e.g. husbands) to help break the cultural taboo about depression.Practice implicationsBased on this study’s results, communication strategies to empower both midwives and ethnic minority clients with depression can be developed in a collaborative approach.     

Perceived facilitating and limiting factors for healthcare professionals to adopting a patient decision aid for breast cancer aftercare: A cross-sectional study

ObjectiveEffective healthcare innovations are often not adopted and implemented. An implementation strategy based on facilitators and barriers for use as perceived by healthcare professionals could increase adoption rates. This study therefore aimed to identify the most relevant facilitators and barriers for use of an innovative breast cancer aftercare decision aid (PtDA) in healthcare practice.MethodsFacilitators and barriers (related to the PtDA, adopter and healthcare organisation) were assessed among breast cancer aftercare health professionals (n = 81), using the MIDI questionnaire. For each category, a backward regression analysis was performed (dependent = intention to adopt). All significant factors were then added to a final regression analysis to identify to most relevant determinants of PtDA adoption.ResultsExpecting higher compatibility with daily practice and clinical guidelines, more positive outcomes of use, higher perceived relevance for the patient and increased self-efficacy were significantly associated with a higher intention to adopt. Self-efficacy and perceived patient relevance remained significant in the final model.ConclusionsLow perceived self-efficacy and patient relevance are the most important barriers for health professions to adopt a breast cancer aftercare PtDA.Practice implicationsTo target self-efficacy and perceived patient relevance, the implementation strategy could apply health professional peer champions.     

Barriers to the use of genetic testing: A study of racial and ethnic disparities

PurposeRacial and ethnic disparities in health are evident among a range of diseases and health care services. New genetic technologies are likely to increase these disparities as access to expensive genetic tests further widens the gap.MethodsOur analysis used data from a national representative sample collected in 2000. The total sample size for our analysis was 1724 men and women (consisting of 946 non-Hispanic whites, 392 Latinos, and 386 blacks) aged 18 to 91 years. Ordered logistic regression and binary logistic regression analysis were applied to investigate differences by race/ethnicity.ResultsResults showed significant differences by racial/ethnic groups in knowledge and concerns about the potential misuse of genetic testing. A significant difference was also found between the types of health insurance coverage by race/ethnicity as well as significantly higher levels of mistrust in a physician and the medical system.ConclusionOur findings raise concern about several barriers among minorities and calls for a development of educational and communication strategies that facilitate in narrowing the gap between racial and ethnic groups.