Advance Health Equity Research Articles

Zooming in to Advance Health Equity for Heart Failure—Disaggregating Race, Ethnicity, and Social Data

Zooming in to Advance Health Equity for Heart Failure—Disaggregating Race, Ethnicity, and Social Data

Community-led transformation principles: Transforming public health learning systems by centering authentic collaboration with community-based organizations.

In the face of evolving public health challenges, including emerging diseases, pervasive health disparities, and escalating environmental threats, the integration of learning health system (LHS) principles emerges as a vital strategy for enhancing the adaptability and efficacy of public health initiatives. Traditional approaches within these systems often overlook the potential to deeply involve community-based organizations (CBO) that are led and staffed by the communities they serve as equal and essential partners in the public health discourse. This commentary proposes a suite of nine community-led transformation (CLT) principles aimed at reimagining LHS frameworks to authentically incorporate CBOs at their core. Drawing on the experiences from initiatives supporting Afghan refugees, we illustrate the application of these principles through two detailed case studies. These examples demonstrate the CLT principles in action and spotlight the enhanced cultural competency, effectiveness, and equitable power distribution that arise from such partnerships. Centering small to mid-sized CBOs including ethnic-led and/or faith based within LHS structures enables the system to access invaluable cultural insights, strengthen community bonds, and empower those communities to spearhead their transformative journey toward sustainable health, equity, and well-being improvements. The CLT principles herald a shift toward a more inclusive and co-led public health paradigm by offering a blueprint for stakeholders eager to forge strong, trust-based coalitions and cocreate initiatives with community leaders including Black, Indigenous, and People of Color (BIPOC) leaders from ethnic-led and/or faith-based CBOs. By embracing these principles, public health systems can evolve into truly inclusive, responsive, and sustainable entities poised to advance health equity for all community members.

Roles of Randomized Controlled Trials in Establishing Evidence-Based Gender-Affirming Care and Advancing Health Equity.

This article reviews the design of a recently published randomized controlled trial (RCT) on immediate vs delayed access to gender-affirming hormones for transgender and gender-diverse (TGD) people and outlines key learning points that clinicians should know about how RCTs can and cannot contribute to advancing health equity for TGD people.

A Quality Improvement Study on Colonoscopy Wait Times in Underinsured Patients Following the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic limited access to colonoscopy. To advance colorectal cancer health equity, we conducted a quality improvement study on colonoscopy wait times in 2019-2023 for underinsured (Medicaid, uninsured) compared with insured patients at an academic medical center providing colonoscopy for surrounding Federally Qualified Health Centers. Retrospective chart reviews were performed on adult outpatient colonoscopies in the preintervention period (2019-2021). In 2022, an institutional grant funded bilingual patient navigation to reduce colonoscopy wait times. Postintervention data were collected prospectively from May 2022 to May 2023 in 2 phases. Multivariable regression analyses were conducted for colonoscopy wait times as a primary outcome. Analysis of 3,403 screening/surveillance and 1,896 diagnostic colonoscopies revealed significantly longer colonoscopy wait times for underinsured compared with insured patients after 2019. For screening/surveillance colonoscopies, wait time differences between underinsured and insured patients in the second postintervention phase were reduced by 34.21 days (95% confidence interval [CI]: 11.07-57.35) compared with the postpandemic period and by 56.36 days (95% CI: 34.16-78.55) compared with the first postintervention phase. For diagnostic colonoscopies, wait time differences in the second postintervention phase were reduced by 27.57 days (95% CI: 9.96-45.19) compared with the postpandemic period and by 20.40 days (95% CI: 1.02-39.77) compared with the first postintervention phase. Colonoscopy wait times were significantly longer for underinsured compared with insured patients following the COVID-19 pandemic. This disparity was partially ameliorated by patient navigation. Monitoring outpatient colonoscopy wait times in underinsured patients is important for advancing health equity.

Abstract P404: Using Target: BP™ Initiative Resources and Awards To Improve Evidence-Based Practice Adoption And Blood Pressure Control

Target: BP™ is a national initiative created by the American Heart Association and the American Medical Association in 2017 in response to the high prevalence of uncontrolled blood pressure (BP). Committed to advancing health equity, Target: BP supports health care organizations to improve blood pressure control by leveraging AHA guidelines and scientific statements and the AMA MAP ™ framework; assists health care organizations in their journeys to improve and sustain BP control with professional education and resources; and recognizes health care organizations annually with achievement awards. Target: BP recognizes organizations that commit to improvement, adopt evidence-based BP activities, and achieve BP control rates ≥70 percent, currently defined as SBP<140 and DBP<90 mmHg in CMS Controlling High Blood Pressure #236. Evidence-based BP activities include 1) calibrating BP measurement devices, 2) checking to see if devices are validated, 3) training and, 4) testing care team members in BP measurement every 6-12 months, 5) using a protocol to measure and confirm BP measurements, and 6) posting a positioning graphic (job aid) next to every place where BP is measured. Since adding evidence-based activity award criteria, self-attested achievement levels have improved from 2021 to 2023 for device calibration from 47.9% to 65.3%, for team training from 67.6% to 85.5%, for team testing from 67.0% to 86.2%, for measurement protocol use from 83.3% to 94.4%, and for job-aid posting from 54.8% to 69.6%. For each activity, Target: BP provides no-cost education and resources to help achieve the criteria. Overall participation has grown from 330 to 1806 organizations since 2017, now caring for 8.6 million patients with hypertension. In 2023, 866 organizations reported BP control rates ≥70 percent and 1489 reported the adoption of ≥4 of 6 evidence-based BP activities. Future expansion of the evidenced-based activity criteria will address treatment intensification, lifestyle risk factors, self-measured blood pressure monitoring, and equitable health outcomes. In a 2023 survey of participating organizations, 85.2% of 230 respondents reported “improving patient outcomes” as their primary reason for participating in Target: BP. Among respondents, 95.7% agree or strongly agree that expanded criteria will help to focus QI priorities. Award incentives appear to play a positive role in encouraging organizations to adopt evidence-based practices and improve blood pressure control.

The Impact of Social Determinants on Health Outcomes

This study examines how the social determinants of health (SDOH) significantly affect health outcomes, with a focus on the inequities they cause. The environmental, social, and economic contexts in which people live and work are all included in SDOH. These variables, which affect variations in health outcomes, include community settings, healthcare access, education, and socioeconomic position. This study looks at the direct effects of neighbourhood factors, education, employment, and poverty on health disparities, including both mental and physical health. It also emphasises the significance of legislative actions taken to lessen these disparities. The results highlight how critical it is to address SDOH to advance health equity and enhance general public health. Keywords Social determinants of health, health disparities, socioeconomic status, health equity, public health

Expanding community-based participatory action research practices to clubhouses through sustainable research activities.

There is growing utilization and acknowledgement of the benefits of community-based participatory action research (CBPAR) in advancing health practices and equity. However, the sustainability and full impact of CBPAR in health care settings faces many obstacles and limitations. The present article examines the synergies between CBPAR and Clubhouse programs, presents the demonstration and ongoing implementation of sustainable CBPAR practices at Fountain House in New York City, and offers lessons learned for other Clubhouses and similar programs seeking to integrate CBPAR. Alignment in practice and principles between CBPAR and Clubhouse programs are presented. The innovation and ongoing sustainable CBPAR practices in the Fountain House Clubhouse program are examined with a contribution of practice guidance for other Clubhouse and similar programs in further adopting and learning CBPAR into participatory health practices. Clubhouse psychosocial rehabilitation programs present structurally conducive settings for the success and sustainability of CBPAR activities and projects. The Fountain House examination and demonstration of integrating CBPAR sustainably into core Clubhouse programming presents opportunities for further integration, research, and practice guidance in uniquely leveraging features of the Clubhouse model to advance health equity and rehabilitative outcomes through CBPAR. The opportunity for incorporating structural CBPAR activities within Clubhouse programs can be informed by the experience, processes, and lessons applied in the Fountain House example. Further research into the rehabilitation, program, and equity benefits of Clubhouse and CBPAR integration could uniquely contribute to the advancement of sustainable participatory research practices across the mental health field generally. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Community design of the Brooklyn Health Equity Index

Abstract Health equity drives quality care. Few reliable metrics that capture patients’ perceptions of health equity exist. We report on the development of a patient-centered metric for health systems change in central Brooklyn, which stands out as an outlier in New York City with a disproportionate burden of poverty, disease, and death. A community-engaged, sequential, mixed-methods research design was used. Qualitative interviews were conducted with 80 community and health care stakeholders across central Brooklyn. Candidate items were derived from qualitative themes and examined for face, interpretive validity, and language. Interitem reliability and confirmatory factor analysis was assessed using data collected via text and automated discharge calls among 368 patients from a local hospital. Qualitative data analysis informed the content of 11 draft questions covering 3 broad domains: trust-building, provider appreciation of social determinants of health, and experiences of discrimination. Psychometric testing resulted in a Cronbach's alpha of 0.774 and led to deletion of 1 item, resulting in a 10-item Brooklyn Health Equity Index (BKHI). The 10-item BKHI is a novel, brief, and reliable measure that captures patients’ perceptions of inequities and offers a real-time measure for health systems and payors to monitor progress toward advancing health equity.

Communicating sexual health to the incarcerated population: information dissemination in a US sample of inmate handbooks

Incarcerated individuals frequently enter prison with a history of high-risk lifestyle behaviours likely to contribute to the transmission of infectious disease. Prisons offer a unique setting in which to advance health equity to an underserved population by disseminating information and education. Sexual health education has the potential to mitigate negative health consequences in the incarcerated population and improve sexual health practices upon community re-entry, benefiting both incarcerated individuals and communities. Limited empirical research examines sexual health information and education in US correctional facilities. Handbooks, given to all people upon incarceration, have the potential to provide vital information and education to promote safe sexual practice and prevent disease transmission. This work, guided by 22 critical sexual health education recommendations from the US Centers for Disease Control and Prevention, examines the presence (or absence) of recommended sexual health information and guidance in prison handbooks. Handbooks (n = 74) from 49 of 50 US states were qualitatively analysed with results revealing limited information, education or guidance about sexual health/safe sexual practice during incarceration or afterwards. Utilising handbooks for comprehensive sexual education could be a critical step towards reaching members of an already at-risk underserved population.

A catalyst for activation against racism: case study on effectiveness of workplace equity, inclusion and diversity conversations

PurposeThis case study delves into the evolving landscape of equity, inclusion and diversity (EID) initiatives within the health-care sector, with a specific focus on the “EverybodyIN” program implemented at the Mayo Clinic, a large academic Medical Center in the USA. Against the backdrop of growing awareness catalyzed by societal events, this case study aims to explore the multifaceted aspects of workplace conversations aimed at addressing racial disparities and fostering a more inclusive environment.Design/methodology/approachThe case study relies on the application of critical race theory and a social constructionist approach to investigate the impact of a subset of voluntary educational conversations that were centered on the Black/African-American experience, on staff members’ racial understanding and allyship within the health-care organization. Through thematic analysis of postevent surveys and participant sentiments, three overarching themes emerged: appreciation, education and validation.FindingsThrough thematic analysis of postevent surveys and participant sentiments, three overarching themes emerged: appreciation, education and validation. The findings underscore the pivotal role of leadership buy-in, evidence-based practices, health equity and an ongoing commitment to “the journey” in successful EID efforts. The results highlight the significance of integrating EID into health-care organizations as a continuous endeavor that aligns with organizational values and mission.Research limitations/implicationsThe findings underscore the pivotal role that theory and practice play through a newly described framework that includes leadership buy-in, evidence-based practices, health equity and an ongoing commitment to “the journey” for successful EID efforts.Practical implicationsThe results highlight the significance of integrating EID into health-care organizations as a continuous endeavor that aligns with organizational values and mission.Originality/valueBy fostering a safe and informed space for dialogue, organizations can empower staff to engage authentically and acquire cultural competence that may contribute to advancing health equity.

Exploring health equity integration among health service and delivery systems in Nova Scotia: perspectives of health system partners

BackgroundAchieving health equity is important to improve population health; however, health equity is not typically well defined, integrated, or measured within health service and delivery systems. To improve population health, it is necessary to understand barriers and facilitators to health equity integration within health service and delivery systems. This study aimed to explore health equity integration among health systems workers and identify key barriers and facilitators to implementing health equity strategies within the health service and delivery system in Nova Scotia, ahead of the release of a Health Equity Framework, focused on addressing inequities within publicly funded institutions.MethodsPurposive sampling was used to recruit individuals working on health equity initiatives including those in high-level leadership positions within the Nova Scotia health system. Individual interviews and a joint interview session were conducted. Topics of discussion included current integration of health equity through existing strategies and perceptions within participant roles. The Consolidated Framework for Implementation Research (CFIR) was used to guide coding and analysis, with interviews transcribed and deductively analyzed in NVivo. Qualitative description was employed to describe study findings as barriers and facilitators to health equity integration.ResultsEleven individual interviews and one joint interview (n = 5 participants) were conducted, a total of 16 participants. Half (n = 8) of the participants were High-level Leaders (i.e., manager or higher) within the health system. We found that existing strategies within the health system were inadequate to address inequities, and variation in the use of indicators of health equity was indicative of a lack of health equity integration. Applying the CFIR allowed us to identify barriers to and facilitators of health equity integration, with the power of legislation to implement a Health Equity Framework, alongside the value of partnerships and engagement both being seen as key facilitators to support health equity integration. Barriers to health equity integration included inadequate resources devoted to health equity work, a lack of diversity among senior system leaders and concerns that existing efforts to integrate health equity were siloed.ConclusionOur findings suggest that health equity integration needs to be prioritized within the health service and delivery system within Nova Scotia and identifies possible strategies for implementation. Appropriate measures, resources and partnerships need to be put in place to support health equity integration following the introduction of the Health Equity Framework, which was viewed as a key driver for action. Greater diversity within health system leadership was also identified as an important strategy to support integration. Our findings have implications for other jurisdictions seeking to advance health equity across health service and delivery systems.

Parent and healthcare professional experiences of critical congenital heart disease in New Zealand to advance health equity

BackgroundHigher odds of survival have been reported in European infants compared to Indigenous Māori and Pasifika infants with critical congenital heart disease in New Zealand. We therefore aimed to understand how to mitigate this disparity by investigating the parent and healthcare professional experiences’ of critical congenital heart disease healthcare in New Zealand.MethodsA prospective qualitative study utilising semi-structured interviews was conducted on a cohort of purposefully sampled parents and health professionals with experience of critical congenital heart disease healthcare in New Zealand. Parents were recruited after a fetal critical congenital heart disease diagnosis and offered two interviews at least three months apart, whilst multidisciplinary fetal and cardiosurgical health professionals were interviewed once. Interviews were recorded and transcribed verbatim before coding, categorization and qualitative analysis.ResultsDuring 2022 and 2023, 45 people participated in 57 interviews (25 parents: 19 mothers, 6 fathers; Indigenous Māori, n = 5; Pasifika, n = 6; Asian, n = 4; European, n = 10; and 20 healthcare professionals: European n = 17). The three lessons learned from participants were: (1) Minoritized groups experience disparate healthcare quality; (2) healthcare systems are under-resourced to provide equitable support for the differential needs of grieving parents; and (3) healthcare systems could engage minoritized families more optimally in shared decision-making.ConclusionsAccording to the experiences of parents and healthcare professionals, persisting inequities in CCHD healthcare quality occur by ethnic group, with the New Zealand healthcare system privileging European families. The concepts from this study could be translated by healthcare leaders, policymakers, and professionals into evidence-based healthcare system improvements to enhance experiences for non-European families more broadly.

The power of Hispanic nurses in advancing health equity: The career of Henrietta Villaescusa

There is increased national attention to the impact nurses can and should have in advancing health equity. Nurses of color have made important contributions in nursing and other sectors to this end, but their efforts remain invisible. To amplify the contribution of Latino nurses in advancing health equity, we use oral histories and supplemental records to examine the career of Henrietta Villaescusa, RN, FAAN to illuminate her impact across government, health, and nursing sectors in advocating for the health of Latino communities. She was skilled in community activism, political savvy, developing and leading intersectoral networks to address and identify Hispanic health issues and strategies to address them. Her career serves as an exemplar to the importance of including and supporting diverse nurses in leading health equity efforts.

Assessing prenatal and early childhood social and environmental determinants of health in the HEALthy Brain and Child Development Study (HBCD)

The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social, and emotional development beginning prenatally and planned through early childhood. The charge of the HBCD Social and Environmental Determinants (SED) working group is to develop and implement a battery of assessments to broadly characterize the social and physical environment during the prenatal period and early life to characterize risk and resilience exposures that can impact child growth and development. The SED battery consists largely of measures that will be repeated across the course of the HBCD Study with appropriate modifications for the age of the child and include participant demographics, indicators of socioeconomic status, stress and economic hardship, bias and discrimination (e.g., racism), acculturation, neighborhood safety, child and maternal exposures to adversity, environmental toxicants, social support, and other protective factors. Special considerations were paid to reducing participant burden, promoting diversity, equity, and inclusion, and adopting trauma-informed practices for the collection of sensitive information such as domestic violence exposure and adverse childhood experiences. Overall, the SED battery will provide essential data to advance understanding of child development and approaches to advance health equity across infant and child development.

The Association Between Experienced Discrimination and Pain in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study.

The relationship between experienced discrimination and its effects on pain interference and management among racial disparities is not well explored. This research investigated these associations among Black and White U.S. adults. The analysis involved 9369 Black and White adults in the REasons for Geographic and Racial Differences in Stroke (REGARDS), assessing experiences of discrimination, pain interference (SF-12), and pain treatment, incorporating factors like demographics, comorbidities, and stress. Black participants experiencing moderate discrimination were found to have a 41% increased likelihood of pain interference (aOR 1.41, 95% CI 1.02-1.95), similaritythose facing high levels of discriminationalso showed a 41% increase (aOR 1.41, 95% CI 1.06-1.86) compared to those without such experiences. White individuals reporting moderate discrimination also faced a heightened risk, with a 21% greater chance of pain interference (aOR 1.21, 95% CI 1.01-1.45). Notably, the presence of moderate discrimination among Black participants correlated with a 12% reduced probability of receiving pain treatment (aOR 0.88, 95% CI 0.56-1.37). Furthermore, Black, and White individuals who reported discrimination when seeking employment had a 33% (aOR 0.67, 95% CI 0.45-0.98) and 32% (aOR 0.68, 95% CI 0.48-0.96) lower likelihood, respectively, of receiving treated pain. The study elucidates how discrimination exacerbates pain interference and restricts access to treatment, affecting Black and White individuals differently. These findings underscore an urgent need for strategies to counteract discrimination's negative effects on healthcare outcomes. Addressing these disparities is crucial for advancing health equity and improving the overall quality of care.

Perceptions of multi-cancer early detection tests among communities facing barriers to health care.

Marginalized racial and ethnic groups and rural and lower income communities experience significant cancer inequities. Blood-based multi-cancer early detection tests (MCEDs) provide a simple and less invasive method to screen for multiple cancers at a single access point and may be an important strategy to reduce cancer inequities. In this qualitative study, we explored barriers and facilitators to MCED adoption among communities facing health care access barriers in Alaska, California, and Oregon. We used reflexive thematic analysis to analyze general barriers to cancer screening, MCED-specific barriers, facilitators of MCED adoption, and MCED communication strategies. We found barriers and facilitators to MCED adoption across 4 levels of the social-ecological model: (1) individual, (2) interpersonal, (3) health care system, and (4) societal. These included adverse psychological impacts, positive perceptions of MCEDs, information and knowledge about cancer screening, the quality of the patient-provider relationship, a lack of health care system trustworthiness, logistical accessibility, patient supports, and financial accessibility. Optimal MCED communication strategies included information spread through the medical environment and the community. These findings underscore the importance of understanding and addressing the multilevel factors that may influence MCED adoption among communities facing health care access barriers to advance health equity.

Impact of Park Redesign and Renovation on Children's Quality of Life.

Despite increasing interest in the role of parks on children's health, there has been little empirical research on the impact of park interventions. We used a quasi-experimental pre-post study design with matched controls to evaluate the effects of park redesign and renovation on children's quality of life (QoL) in underserved neighborhoods in New York City, with predominantly Hispanic and Black populations. Utilizing longitudinal data from the Physical Activity and Redesigned Community Spaces (PARCS) Study, we examined the parent-reported QoL of 201 children aged 3-11 years living within a 0.3-mile radius of 13 renovated parks compared to 197 children living near 11 control parks before and after the park intervention. QoL was measured using a modified version of the KINDL questionnaire, a health-related QoL scale that assessed children's physical and emotional well-being, self-esteem, and well-being in home, peer, and school functioning. Linear mixed regression model was used to examine the difference in difference (DID) between the intervention vs. control group for QoL. We found a significant differential improvement in the physical well-being subscale of KINDL in the intervention vs. control group (DID = 6.35, 95% Confidence Interval [CI] = 0.85-11,85, p = 0.024). The effect was particularly strong among girls (DID = 7.88, p = 0.023) and children of the lowest socio-economic background (p < 0.05). No significant DID was found in other KINDL domains. Our study indicated a beneficial impact of improving park quality on the physical well-being of children residing in underserved neighborhoods. These findings lend support for investments in neighborhood parks to advance health equity.

The Mississippi Healthy Aging Data Report: Tools to Advance Health Equity

The Mississippi Healthy Aging Data Report: Tools to Advance Health Equity

An antiracism framework for educating nursing professionals

BackgroundA conceptual, methodological, and theoretical framework is needed in Nursing Education to center racism, in the curriculum, as a root cause of health inequity. MethodsCritical race theory is the underpinning for a historical analysis of racism and a critique of scientific racism, whiteness, and white supremacy ideologies that perpetuate harmful and lethal outcomes for racialized individuals and communities. ResultsThis framework conceptualizes learning, unlearning, relearning, and reflective practice as the fundamental process needed to transformative nursing education and advance health equity. DiscussionMethodological application is given for 1) unlearning harmful white supremacy ideology 2) learning that racism as it is embedded in every sector of American life and racial inequities are inherent in the health care system 3) relearning the importance of counternarratives and building structural competency and 4) engaging in reflective practice to challenge deficit paradigms assigned to racialized people and their communities.

Advancing Health Equity: A Collaborative Framework to Address HIV Disparities in Georgia and Louisiana through Data, Education, and Policy Initiatives

Abstract: The United States grapples with over 30,000 new HIV infections annually, a challenge exacerbated by delayed diagnosis and treatment. HIV stigma hinders data collection and contributes to health disparities. High-quality data and a community-driven approach are critical to reducing these disparities. The collaborative effort of the Satcher Health Leadership Institute at Morehouse School of Medicine, and the Center for Minority Health and Health Disparities Research and Education at Xavier University of Louisiana, addresses systemic barriers perpetuating the HIV epidemic in Georgia and Louisiana. We influence policy, implement an HIV education curriculum, map resources, and display data via the Health Equity Tracker. Stigma surrounding HIV/AIDS impedes disclosure, creates data gaps, and affects care quality and access. Addressing these data gaps, influencing policy, and implementing education are crucial steps to improving outcomes for Black people living with HIV/AIDS. This framework aligns with the federal Ending the HIV Epidemic program's goals, advancing health equity for vulnerable populations.