Narrowing Health Disparities Research Articles

Abstract A14: Digital health information access among Asian Americans

Abstract Background Access to health information is essential to patient-centered healthcare. Healthy People 2020 recommended three key strategies for improving health outcomes and narrowing health disparities. One of the key strategies is to provide equitable access to health information. Digital technology holds great promise in helping to reduce health disparities. In fact, recent studies indicate that the “digital divide” is narrowing between racial/ethnic minorities and the general population. The question remains, however, on whether or not all groups have equal access to digital health information. Asian Americans (AAs) are the fastest growing minority group in the U.S. More than 65% of AAs are foreign-born, and greater than 30% have limited English proficiency. Non-English speaking AAs were not specifically targeted in previous digital technology ownership and usage surveys. However, such information is important to ensure equal access to digital cancer control information and other health information. Objective The purpose of this study was to examine (1) the most common channels that AA immigrants use to obtain health information, and (2) factors predicting the ownership and usage of computers, as well as the use of the Internet to obtain health information. Methods This study used a cross-sectional design and quota sampling. Participants were recruited through seven community-based organizations and from six Asian subgroups (Cambodian, Chinese, Filipinos, Korean, Laotian, South Asians and Vietnamese) . Participants were asked where they usually received helpful health information. They were also asked whether they had a computer at home and knew how to use it, as well as whether they used the Internet to obtain health information. Surveys were conducted in participants' native language. Only data from participants who were foreign-born were used in the statistical analysis. Results 403 participants completed the survey and 395 (98%) were foreign-born. 49% had family income <$20,000/year, 36% had <9 years of education, 45% reported less than average English proficiency. 26% were less than 50 years old (mean age = 56). 27% in the U.S. less than 10 years (mean years = 20). Overall, 78% of participants had a computer at home and 65% knew how to use it. However, only 14% of participants who did not have a computer at home knew how to use a computer. The most common channels to obtain helpful health information were: doctor (61%), family (38%), friends (37%), newspaper (32%), Internet (30%), ethnic television (29%), and community events (25%). However, there were significant differences across AA subgroups. 29% participants whose family income <$20,000/year did not have a computer at home, compared to 5% of participants whose family income >$20,000/year (p <.0005). Nearly half of the participants (47%) whose family income <$20,000 did not know how to use a computer, compared to only 14% participants whose family income >$20,000/year (p < .0005). Participants who did not have a computer at home were less likely to use the Internet for health information (OR = 0.14, 95%CI: .06-.33, p <.0005), so did participants who did not know how to use a computer (OR=.14, 95%CI: .08-.27, p <.0005). Participants who had less than average English proficiency were less likely to use the Internet to obtain health information (OR=.36, 95%CI: .23-.29, p <.0005), so did participant who had less than 12 years of education (OR=24, 95%CI: .11-.54, p =.001). Conclusion Despite a narrowing racial/ethnic “digital divide”, disparities still exist, particularly among Asian immigrants with low social economic status, less years of education and limited English proficiency. New interventions are needed to target underserved AA subpopulations and help them to gain access to digital health information and develop information seeking skills. Citation Format: Helen Lam, Michael Quinn, Edwin Chandrasekar, Karen Kim. Digital health information access among Asian Americans. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A14.

A Concept Analysis of Cultural Nursing Competence.

The aim of this study was to conduct a concept analysis of cultural nursing competence. Cultural nursing competence was analyzed using Rodgers' evolutionary concept development method. A literature search using the keywords "cultural nursing competence", "intercultural nursing competence", "cultural nursing", "cultural health nursing", and "cultural competence" was conducted in PubMed, CINAHL, ERIC, and RISS on material published before 2015. Database and bibliographic searches yielded 35 records. Cultural nursing competence comprised cognitive, affective, and behavioral domains. The critical attributes of the concept were sensitivity, equality, and activity. The analysis identified the following dimensions: awareness, openness, and coherence. The consequences of cultural nursing competence were personal satisfaction and social justice. The definition contained competence on both an individual and social level. Cultural competency enhances quality of care by narrowing health disparities and increasing client satisfaction. The concept analysis of cultural nursing competence may offer an acceptable framework which can be used to develop psychometric tools of this concept and provide guidelines in nursing practice.

The Use of Video Conferencing for Persons with Chronic Conditions: A Systematic Review.

The purpose of this paper is to present a systematic review of studies that used Video Conferencing (VC) intervention for common chronic conditions. Chronic conditions account for the majority of poor health, disability, and death, and for a major portion of health-care expenditures in the United States. Innovative methods and interventions are needed to enhance care and management, improve access to care, improve patient outcomes, narrow health disparities and reduce health-care costs. Video Conferencing could be particularly relevant in improving health, care management, access and cost in the care of chronic illnesses. A comprehensive literature search process guided by the PRISMA statement led to the inclusion of 27 articles measuring video conferencing, at least one chronic illness, and patient outcomes for adults living in a community setting. While VC has been found to be feasible and effective, a low number of randomized controlled trials limit evidence. In addition, studies in this review were not designed to address the question of whether access to care in rural areas is improved through VC. Hence, more research is needed.

Introduction to the Second Special Section on Health Disparities

Here we present the second special section on health disparities in Annals of Behavioral Medicine. Papers in the first section, published in February 2012, examined potential explanations and risk factors for disparities, resilience factors that might narrow health disparities, and interventions to improve health outcomes in populations affected by health disparities. The articles spanned a range of health conditions and risk factors across the lifespan, focusing primarily on disparities among ethnic groups. In this second special section, the focus is just as broad, addressing topics such as potential explanations for disparities (discrimination, stress) in different health conditions (obesity, diabetes), among different racial/ethnic groups (Black/African Americans, Latinos, and Native Hawaiians and Pacific People). As a collection, the papers in this special section provide interesting insights on the determinants of health disparities, utilizing both betweenand within-group comparisons. Between-group comparisons allow the examination of the possibility of distinct psychosocial processes driving observed differences between groups. For example, the paper by Tomiyama et al. [1] shows how body mass index, one of the largest health disparities between Blacks and Whites, is moderated by stress. Between-group comparisons of majority to minority groups alone, however, have limitations to advancing our knowledge about health disparities [2, 3]. One criticism of traditional comparisons of minorities to majority samples is that Whites are often implicitly viewed as a standard from which the minority group is assumed to deviate if differences are found [4]. The paper by Earnshaw and colleagues [5] takes an alternative approach, comparing Black and Latina women to examine everyday discrimination as a source of health disparities. The study did not find a difference in perceived discrimination between the groups; instead, discrimination served as a central precipitating factor for the disparities in the two different ethnic groups. Another departure from between-group research is within-group examinations of health disparities. An example of this approach is provided by Sinclair et al. [6], in which the investigators worked with Native Hawaiians and Pacific Islanders to design and test a culturally tailored intervention that was shown to be successful in improving glycemic control among individuals with diabetes. Avoiding ethnic umbrellas is critical for designing research on health disparities that can be translated into practice [7]. Consistent with this notion, in the fourth paper in this special section, Molina and colleagues [8] examine how discrimination may influence self-rated health across subgroups of Latinos in the USA and demonstrate the importance of disaggregating these groups to fully appreciate how psychosocial factors intersect with health. Taken together, these papers provide a critical lens on how individual and social factors are interwoven to produce some of the key factors that drive disparities observed in the general K. E. Whitfield Department of Psychology and Neuroscience, Duke University, Durham, NC, USA

79 Racial/Ethnic Disparities in Center for Disease Control and Prevention (CDC) Pediatric Vaccination Schedule and Recommendation in United States

Background and aimChildren require age-specific vaccination in order to prevent against childhood morbidities and mortality. The CDC provides the guidelines for immunization schedule. This study aimed to assess the prevalence...

Where Health Disparities Begin: The Role Of Social And Economic Determinants—And Why Current Policies May Make Matters Worse

Health disparities by racial or ethnic group or by income or education are only partly explained by disparities in medical care. Inadequate education and living conditions-ranging from low income to the unhealthy characteristics of neighborhoods and communities-can harm health through complex pathways. Meaningful progress in narrowing health disparities is unlikely without addressing these root causes. Policies on education, child care, jobs, community and economic revitalization, housing, transportation, and land use bear on these root causes and have implications for health and medical spending. A shortsighted political focus on reducing spending in these areas could actually increase medical costs by magnifying disease burden and widening health disparities.

Recruiting and Retaining a Diverse Workforce in Nursing: From Evidence to Best Practices to Policy

Health policy makers, providers, clinicians, and social scientists are among those who have identified racial and ethnic diversification of the health care workforce as one strategy for solving the seemingly intractable problem of health disparities in the U.S. population. But evidence supporting the impact of such diversification on narrowing health disparities is lacking, thus making it unclear if the push for workforce diversification is empirically or politically driven. Moreover, data are largely derived from the study of physicians, making it difficult to generalize findings to nursing and other health professions. This article reviews the evidence that supports the impact of a diverse workforce on patient outcomes and delivery services. Assuming a positive social value in the absence of the data, the authors review the approaches that have been successful in diversifying the nursing workforce. The authors conclude with recommendations for research and policies, including best practices, for enhancing recruitment and retention of a diverse nursing workforce.

Progress Towards Narrowing Health Disparities: First Steps in Sorting Out Infant Mortality Trend Improvements Among American Indians and Alaska Natives (AI/ANs) in the Pacific Northwest, 1984–1997

Most AI/AN infant mortality rates (IMRs) remain higher than white rates. The Northwest Portland Area Indian Health Board (NPAIHB), serving 43 tribes, CDC and the Washington, Oregon, and Idaho health departments investigated AI/AN infant survival. NPAIHB completed linking computerized birth certificate and birth-death files. We used death and birth cohorts, StatXact and SAS to compare 3-state resident, single and multi-year IMRs, basing infant race on mother's race, regardless of Hispanic origin. We used CDC's National Infant Mortality Surveillance ICD-9 categories for cause-specific rates. From 1984 to 1997, about 2100-2800 AI/AN births occurred annually. From 1984 to 1990, AI/AN IMRs were 1.8-2.4 fold higher than white rates. Then aggregate-year IMRs significantly declined from 16.3 in 1984-1987 to 6.7 in 1994-1997 (P < 0.0001), approaching the 5.6 1994-1997 white rate. In 1998 the AI/AN IMR rate increased to 10.3. AI/AN SIDS and respiratory distress syndrome rates decreased significantly, respectively, from 8.1 in between 1984-1987 to 2.3 in 1994-1996 and from 1.8 in 1984-1987 to 0.3 in 1991-1993, then leveled off. Significant rate declines occurred among most demographic, risk behavior, birthweight, gestational-age, reproductive risk, birth spacing, and labor/delivery sub-groups. Among others, AI/AN residents in Idaho as well as those who received no prenatal care and who had 0-5 month birth spacing experienced no improvements. These uncommon rate declines imply multi-factorial improvements among Northwest AI/ANs. Community-level surveillance and interventions before conception through post-partum may further improve health. Collaborative efforts need to be maintained to continue to monitor changes in AI/AN infant health and maternal characteristics.

Building a Research Agenda for Community Health Centers and the Medically Underserved: Meeting Proceedings

Community, migrant, and homeless health centers (CHCs) are an integral component of the nation's safety net with a proven record of success in access, quality, and cost effectiveness. Still, as CHCs face rising numbers of vulnerable patients and shrinking resources, they must continue to improve quality of care to further narrow health disparities, as well as demonstrate their cost effectiveness and value to policymakers. CHCs, researchers, national partners, and others met in December 2005 to produce a consensus-driven research agenda that lays out research priorities for CHCs and the medically underserved. This article details the meeting process and resulting research agenda. The meeting focused on three domains that touch on community need: health information technology (HIT), quality improvement, and cost effectiveness and value. Community representatives helped to drive research priorities. CHCs must continually demonstrate their efficiency and effectiveness. Accordingly, the research agenda must be continually revisited through a collaborative process.

Deserving the Spotlight

Community health centers were designed to overcome barriers to healthcare and narrow health disparities faced by underserved communities. Given the increased attention health centers are now receiving over expansion efforts, questions over their quality of care and cost-effectiveness must be addressed. This article reviews the relevant literature and documents that health centers improve access for hard-to-reach and underserved populations, provide continuous and high-quality primary care, and reduce the use of costlier providers of care, such as emergency departments and hospitals. The health center model produces substantial benefits for patients, communities, insurers, and governments.