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Medical Education Online Dec 2024This mixed-methods study quantified and characterized incidents of microaggressions experienced by Asian American medical students. The authors report on their impact... (Review)
Review
PURPOSE
This mixed-methods study quantified and characterized incidents of microaggressions experienced by Asian American medical students. The authors report on their impact and suggest improvements to create a more equitable and supportive learning environment.
METHOD
Quantitative and qualitative data were collected from 305 participants who self-identified as Asian American or Pacific Islander. An online, anonymous survey was sent to US medical students through the Asian Pacific American Medical Student Association (APAMSA). Questions explored incidence, characteristics of, and response to microaggressions. We conducted four focus groups to further characterize students' experiences. Data were organized and coded, and thematic analysis was used to identify core themes.
RESULTS
Racial microaggressions were prevalent among Asian American medical students. Nearly 70% ( = 213) of survey respondents reported experiencing at least one incident during their medical training to date. The most common perpetrators were patients ( = 151, 70.9%) and fellow medical students ( = 126, 59.2%), followed by professors ( = 90, 42.3%). The most prevalent themes included being perceived as a perpetual foreigner, the assumption of timidness, and ascription of the model minority myth. Students rarely reported the incident and usually did not respond immediately due to fear of retaliation, uncertainties about the experience or how to respond appropriately, and perception that they would bear the burden of advocacy alone. Experiences with microaggressions led to feelings of frustration and burnout and had a negative impact on mental health. Recommendations were made to improve the anonymous reporting systems in medical schools, and to increase diversity and inclusion in medical education and leadership.
CONCLUSIONS
Asian American medical students face high exposure to racial microaggressions during their medical education that adversely impact their mental health. Changes are needed in medical training to create a more equitable and inclusive learning environment.
Topics: Humans; Asian; Microaggression; Minority Groups; Students, Medical; Racism; Psychological Well-Being
PubMed: 38159282
DOI: 10.1080/10872981.2023.2299534 -
PloS One 2022To explore COVID-19 vaccination uptake, facilitators and barriers in ethnically-diverse pregnant women.
OBJECTIVE
To explore COVID-19 vaccination uptake, facilitators and barriers in ethnically-diverse pregnant women.
DESIGN AND SETTING
An anonymous quality improvement questionnaire survey exploring COVID-19 vaccination uptake, causes of vaccine hesitancy and trusted sources of information among pregnant women in two acute district general hospitals in England (Berkshire and Surrey) between 1.9.21 and 28.2.22.
POPULATION
441 pregnant women attending routine antenatal clinic appointments.
METHODS
Consented pregnant women completed the survey either electronically using a QR code or on paper. Descriptive data were summarised and free text responses were thematically analysed.
RESULTS
441 pregnant women, mean age 32 years (range 17-44), completed the survey. Twenty-six percent were from ethnic minority groups, and 31% had a co-morbid health condition. Most respondents (66.2%) had been vaccinated against COVID-19 with at least one dose (White British 71.9%, Asian 67.9%, White-other 63.6%, Black 33%). The most common reasons for not being vaccinated were concerns about effects on the unborn baby and future pregnancies, anxiety about possible adverse impact on the mother, not enough known about the vaccine, and lack of trust in vaccines. Comments included: "I'd rather not risk injecting the unknown into my body", and "I don't trust it." Although 23% used social media for information on COVID-19 vaccination, the most trusted sources were the patient's GP and midwife (43%) and official health-related websites such as NHS (39%).
CONCLUSIONS
A third of these pregnant women had not been vaccinated against COVID-19. Trusted health professionals like midwives and GPs could have a crucial role in increasing vaccination uptake.
Topics: Adolescent; Adult; COVID-19; COVID-19 Vaccines; Ethnicity; Female; Health Knowledge, Attitudes, Practice; Humans; Minority Groups; Pregnancy; Pregnant Women; Vaccination; Young Adult
PubMed: 35976810
DOI: 10.1371/journal.pone.0271834 -
Issues in Mental Health Nursing Jul 2012A systematic review of the literature was performed to answer the following questions (a) What factors contribute to the emotional responses of school-age children who... (Review)
Review
A systematic review of the literature was performed to answer the following questions (a) What factors contribute to the emotional responses of school-age children who have asthma? (b) What are the potential gaps in the literature regarding the emotional responses of school-age children (ages 6-12) who have asthma? (c) Are children with a lower socioeconomic status (SES) and those who are minorities represented in the literature proportionate to their prevalence? Two main focus areas regarding emotional responses were identified: (a) factors related to children who have asthma and (b) factors related to caregivers of children who have asthma. Internalizing disorders were reported consistently for children and caregivers of children who have asthma. Negative consequences of asthma for children included panic and asthma attacks, missed school days, and behavioral problems. Issues for caregivers included higher levels of anxiety and depressive symptoms, asthma management deficits, and lower caregiver warmth and involvement. Gaps in the literature included separated studies for children ages 6-12, a lack of a standardized method to define SES, studies that were of a more experimental nature, and a disparate number of studies of minority children and caregivers relative to their asthma prevalence.
Topics: Absenteeism; Adaptation, Psychological; Asthma; Caregivers; Child; Child Behavior Disorders; Cost of Illness; Cross-Sectional Studies; Emotions; Female; Humans; Male; Minority Groups; Panic Disorder; Sick Role; Students
PubMed: 22757594
DOI: 10.3109/01612840.2012.682327 -
JAMA Oncology Feb 2023Prostate cancer (PCa) is marked by disparities in clinical outcomes by race, ethnicity, and age. Equitable enrollment in clinical trials is fundamental to promoting...
IMPORTANCE
Prostate cancer (PCa) is marked by disparities in clinical outcomes by race, ethnicity, and age. Equitable enrollment in clinical trials is fundamental to promoting health equity.
OBJECTIVE
To evaluate disparities in the inclusion of racial and ethnic minority groups and older adults across PCa clinical trials.
DATA SOURCES
MEDLINE, Embase, and ClinicalTrials.gov were searched to identify primary trial reports from each database's inception through February 2021. Global incidence in age subgroups and US population-based incidence in racial and ethnic subgroups were acquired from the Global Burden of Disease and Surveillance, Epidemiology, and End Results 21 incidence databases respectively.
STUDY SELECTION
All phase 2/3 randomized PCa clinical trials were eligible for age disparity analyses. Trials recruiting exclusively from the US were eligible for primary racial and ethnic disparity analyses.
DATA EXTRACTION AND SYNTHESIS
This study was reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Data were pooled using a random-effects model.
MAIN OUTCOMES AND MEASURES
Enrollment incidence ratios (EIRs), trial proportions (TPs) of participants 65 years or older or members of a racial and ethnic subgroup divided by global incidence in the corresponding age group, or US population-based incidence in the corresponding racial and ethnic subgroup, were calculated. Meta-regression was used to explore associations between trial characteristics and EIRs and trends in EIRs during the past 3 decades.
RESULTS
Of 9552 participants among trials reporting race, 954 (10.8%) were African American/Black, 80 (1.5%) were Asian/Pacific Islander, and 8518 (78.5) were White. Of 65 US trials, 45 (69.2%) reported race and only 9 (13.8%) reported data on all 5 US racial categories. Of 286 global trials, 75 (26.2%) reported the enrollment proportion of older adults. Outcomes by race and age were reported in 2 (3.1%) and 41 (15.0%) trials, respectively. Black (EIR, 0.70; 95% CI, 0.59-0.83) and Hispanic (EIR, 0.70; 95% CI, 0.59-0.83) patients were significantly underrepresented in US trials. There was no disparity in older adult representation (TP, 21 143 [71.1%]; EIR, 1.00; 95% CI, 0.95-1.05). The representation of Black patients was lower in larger trials (meta-regression coefficient, -0.06; 95% CI, -0.10 to -0.02; P = .002).
CONCLUSIONS AND RELEVANCE
The results of this meta-analysis suggest that Black and Hispanic men are underrepresented in trials compared with their share of PCa incidence. The representation of Black patients has consistently remained low during the past 2 decades.
Topics: Male; Humans; Aged; Ethnicity; Minority Groups; Ethnic and Racial Minorities; Hispanic or Latino; Prostatic Neoplasms
PubMed: 36416812
DOI: 10.1001/jamaoncol.2022.5511 -
Development and Psychopathology Aug 2023Substance use increases throughout adolescence, and earlier substance use may increase risk for poorer health. However, limited research has examined whether stress...
Substance use increases throughout adolescence, and earlier substance use may increase risk for poorer health. However, limited research has examined whether stress responses relate to adolescent substance use, especially among adolescents from ethnic minority and high-adversity backgrounds. The present study assessed whether blunted emotional and cortisol responses to stress at age 14 related to substance use by ages 14 and 16, and whether associations varied by poverty status and sex. A sample of 277 Mexican-origin youth (53.19% female; 68.35% below the poverty line) completed a social-evaluative stress task, which was culturally adapted for this population, and provided saliva samples and rated their anger, sadness, and happiness throughout the task. They also reported whether they had ever used alcohol, marijuana, cigarettes, and vaping of nicotine at age 14 and again at age 16. Multilevel models suggested that blunted cortisol reactivity to stress was associated with alcohol use by age 14 and vaping nicotine by age 16 among youth above the poverty line. Also, blunted sadness and happiness reactivity to stress was associated with use of marijuana and alcohol among female adolescents. Blunted stress responses may be a risk factor for substance use among youth above the poverty line and female adolescents.
Topics: Humans; Adolescent; Female; Male; Ethnicity; Nicotine; Hydrocortisone; Minority Groups; Substance-Related Disorders; Stress, Psychological
PubMed: 35758286
DOI: 10.1017/S0954579422000244 -
Journal of General Internal Medicine Apr 2023Latinx (includes Hispanics and is the non-gendered term for Latino/Latina which is a person of Latin American origin or descent) constitutes the largest racial and... (Review)
Review
Latinx (includes Hispanics and is the non-gendered term for Latino/Latina which is a person of Latin American origin or descent) constitutes the largest racial and ethnic minority group in the United States (US). Many members of this group report limited English proficiency, experience discrimination, feel distrust in the healthcare setting, and face poorer health outcomes than non-Latinx Whites. As healthcare systems assess internal structures of care, understanding the experiences of Latinx patients may inform strategies to improve care. This narrative review describes studies that assessed the experiences of Latinx patients with limited English proficiency (LEP) in the inpatient and outpatient settings in the US. We searched PubMed for studies published between January 1, 1990, and March 2021. We reviewed all citations and available abstracts (n = 429). We classified study titles (n = 156) as warranting detailed consideration of the original article. Limited English proficiency is a well-documented challenge reported by Latinx patients seeking care in the outpatient setting, resulting in mistrust of healthcare organizations and clinicians. The effects of LEP overlap substantially with challenges related to patients' immigration status, cultural traditions, and socioeconomic needs. Use of professional interpretation rather than ad hoc interpretation improves trust and satisfaction. There is no consensus about the most effective mode of delivering professional interpretation (in person, telephonic, video conferencing), although rapid simultaneous telephone translation is a promising modality. Increasing awareness of the barriers to effective communication, improving skills in communicating through translators, and increasing the amount of time spent with patients may improve communication and trust more than structural changes like mode of translation or bedside rounding. Cultural fluency training, standardized language training for providers, and incentive pay for fluency are also deserving of further consideration.
Topics: Humans; United States; Ethnicity; Limited English Proficiency; Minority Groups; Delivery of Health Care; Communication; Communication Barriers
PubMed: 36720766
DOI: 10.1007/s11606-022-07995-3 -
Health Promotion International Apr 2023Culturally-responsive health promotion initiatives are important to the creation of health equity for Indigenous and minority populations and these initiatives are...
Culturally-responsive health promotion initiatives are important to the creation of health equity for Indigenous and minority populations and these initiatives are complex and time-intensive to establish. The knowledge and resources of cultural experts are often pivotal in programs, yet there is minimal research on effective collaborations. The KāHOLO Project demonstrated strong success in the management of uncontrolled hypertension in the high-risk Indigenous population through a 6-month program based on the Hawaiian cultural dance of hula. This program was developed utilizing a community-based participatory research approach and implemented by cultural experts. To better understand the effectiveness of the research endeavor and program, six experienced hula experts and educators who delivered the community-based program were interviewed. As skilled and trusted cultural experts they set a safe supportive learning environment that promoted health and cultural goals. They articulated it was important that the program maintained cultural priorities and integrity. Through the methodical establishment of mutual respect, cooperation on research protocols and requirements was achieved. The development of cultural experts as health allies offers important inroads to the inclusion of minority and Indigenous cultures in health programming.
Topics: Humans; Hawaii; Health Promotion; Indigenous Peoples; Minority Groups; Cultural Competency
PubMed: 37067166
DOI: 10.1093/heapro/daad022 -
Family Medicine Feb 2022Recruitment of underrepresented minorities (URM) in medicine has risen to the forefront as a strategy to address health inequities, but the experiences of URM residents...
BACKGROUND AND OBJECTIVES
Recruitment of underrepresented minorities (URM) in medicine has risen to the forefront as a strategy to address health inequities, but the experiences of URM residents within their own programs are poorly understood. We describe the development and implementation of a diversity, equity, and inclusion (DEI) climate survey at our residency program, the results of which have informed our DEI efforts.
METHODS
A resident-faculty work group collaboratively developed an 81-item questionnaire, informed by other institutional climate surveys. We administered the survey annually from 2018 through 2021 to all residents and faculty at our large academic family medicine residency program. The anonymous survey covered six key areas: general climate, climate for specific group, personal experience with discrimination and harassment, recruitment, burnout, and curriculum.
RESULTS
Average response rates were 84% and 50% for residents and faculty, respectively. Survey results show low satisfaction with resident and faculty diversity; higher rates of burnout for respondents who self-identify as URM, persons of color (POC), and/or LGBTQ; and racial and gender differences in experiences of workplace discrimination and sexual harassment.
CONCLUSIONS
Instituting an annual internal climate survey at our residency has provided invaluable information regarding the perspectives and experiences of our residents and faculty that has informed our DEI initiatives. We envision that our survey will inform continual improvement and serve as a model for similar introspection leading to meaningful action at other programs.
Topics: Humans; Internship and Residency; Minority Groups; Sexual Harassment; Surveys and Questionnaires; Temperature
PubMed: 35143685
DOI: 10.22454/FamMed.2022.344019 -
BMC Public Health Mar 2022In older adults, including those with a migrant background, ill health is associated with less internet use. However, it is not known what are the specific...
BACKGROUND
In older adults, including those with a migrant background, ill health is associated with less internet use. However, it is not known what are the specific self-perceived barriers to internet use among older migrants with different health conditions. The aim of this study was to investigate the associations between different health conditions and self-perceived barriers to internet use among older migrants.
METHODS
We used the Care, Health and Ageing of Russian-speaking Minority in Finland (CHARM) study, which is a nationally representative survey of community-dwelling Russian-speaking adults aged ≥50 years living in Finland (N=1082, 57% men, mean age 63.2 years, standard deviation 8.4 years, response rate 36%). Postal survey data were collected in 2019. Health indicators were self-rated health (SRH), depressive symptoms, cognitive functioning, and doctor-diagnosed conditions. Linear regression analyses were used to investigate the associations between health indicators and a summary scale consisting of the following barriers of internet use: (1) internet use is too complicated and hard to learn; (2) having concerns about safety issues; (3) internet use is too expensive; (4) physical limitations hinder the internet use; (5) memory problems hinder the internet use. In addition, the two most commonly reported barriers (the first two) were examined separately using logistic regression analyses. The analyses were adjusted for age, sex, education, marital status, local language proficiency, and income support, and the health conditions, and were performed with weights accounting for the survey design and non-response.
RESULTS
After adjustments, spine/back problems (b=0.13; p=0.049), depressive symptoms (b=0.40; p=0.007), and problems in learning new things (b=0.60; p<0.0005) were associated with higher level of overall barriers to internet use. In addition, a number of health conditions were associated with individual barriers, albeit some health conditions appeared protective.
CONCLUSIONS
In general, older migrants with declining health experience more barriers to internet use than their counterparts with better health. To provide better access to healthcare for older adults, including older migrants, rapidly changing devices, software and apps need to be modified and adapted for those with specific health-related needs.
Topics: Aged; Aging; Female; Humans; Internet; Internet Use; Male; Middle Aged; Minority Groups; Surveys and Questionnaires; Transients and Migrants
PubMed: 35321678
DOI: 10.1186/s12889-022-12874-x -
Cancer Causes & Control : CCC Sep 2022The purpose of this study was to evaluate patient, oncologist and nurse perspectives on side effects and patient reported outcomes (PROs) with the question of how to...
Patient, provider, and nurse preferences of patient reported outcomes (PRO) and side effect management during cancer treatment of underrepresented racial and ethnic minority groups, rural and economically disadvantaged patients: a mixed methods study.
PURPOSE
The purpose of this study was to evaluate patient, oncologist and nurse perspectives on side effects and patient reported outcomes (PROs) with the question of how to optimize side effect management and PRO tools in this unique population.
METHODS
This pilot study utilized a mixed method explanatory design. Patients receiving intravenous (IV) chemotherapy from June to August 2020 were surveyed about side effect burden and PRO system preferences. Providers and nurses (PN) completed complementary surveys. Semi-structured phone interviews were conducted among a subset of each group.
RESULTS
Of 90 patient surveys collected; 51.1% minority, 35.6% rural, and 40.0% income < $30,000, 48% felt side effect management was a significant issue. All patients reported access to a communication device but 12.2% did not own a cell phone; 68% smart phone, 20% cell phone, 22% landline, 53% computer, and 39% tablet. Patients preferred a response to reported side effects within 0-3 h (73%) while only 29% of the 55 PN surveyed did (p < 0.0001). Interviews reinforced that side effect burden was a significant issue, the varied communication devices, and a PRO system could improve side effect management.
CONCLUSION
In a non-White, rural and low-income patient population, 87.8% of patients reported owning a cell phone. Although all agreed side effect management was a prominent issue, expectations between patients and PN differed substantially. Qualitative data echoed the above and providing concrete suggestions to inform development of a PRO program and side effect mitigation strategies among a diverse patient population.
Topics: Ethnic and Racial Minorities; Ethnicity; Humans; Minority Groups; Neoplasms; Patient Reported Outcome Measures; Pilot Projects
PubMed: 35829828
DOI: 10.1007/s10552-022-01605-7