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Lancet (London, England) Jul 2016In this paper we examine the social and legal conditions in which many transgender people (often called trans people) live, and the medical perspectives that frame the... (Review)
Review
In this paper we examine the social and legal conditions in which many transgender people (often called trans people) live, and the medical perspectives that frame the provision of health care for transgender people across much of the world. Modern research shows much higher numbers of transgender people than were apparent in earlier clinic-based studies, as well as biological factors associated with gender incongruence. We examine research showing that many transgender people live on the margins of society, facing stigma, discrimination, exclusion, violence, and poor health. They often experience difficulties accessing appropriate health care, whether specific to their gender needs or more general in nature. Some governments are taking steps to address human rights issues and provide better legal protection for transgender people, but this action is by no means universal. The mental illness perspective that currently frames health-care provision for transgender people across much of the world is under scrutiny. The WHO diagnostic manual may soon abandon its current classification of transgender people as mentally disordered. Debate exists as to whether there should be a diagnosis of any sort for transgender children below the age of puberty.
Topics: Gender Dysphoria; Gender Identity; Health Services Accessibility; Health Status; Human Rights; Humans; Minority Health; Social Stigma; Transgender Persons
PubMed: 27323925
DOI: 10.1016/S0140-6736(16)00683-8 -
Current Opinion in Endocrinology,... Apr 2016Transgender persons suffer significant health disparities and may require medical intervention as part of their care. The purpose of this manuscript is to briefly review... (Review)
Review
PURPOSE OF REVIEW
Transgender persons suffer significant health disparities and may require medical intervention as part of their care. The purpose of this manuscript is to briefly review the literature characterizing barriers to healthcare for transgender individuals and to propose research priorities to understand mechanisms of those barriers and interventions to overcome them.
RECENT FINDINGS
Current research emphasizes sexual minorities' self-report of barriers, rather than using direct methods. The biggest barrier to healthcare reported by transgender individuals is lack of access because of lack of providers who are sufficiently knowledgeable on the topic. Other barriers include: financial barriers, discrimination, lack of cultural competence by providers, health systems barriers, and socioeconomic barriers.
SUMMARY
National research priorities should include rigorous determination of the capacity of the US healthcare system to provide adequate care for transgender individuals. Studies should determine knowledge and biases of the medical workforce across the spectrum of medical training with regard to transgender medical care; adequacy of sufficient providers for the care required, larger social structural barriers, and status of a framework to pay for appropriate care. As well, studies should propose and validate potential solutions to address identified gaps.
Topics: Delivery of Health Care; Female; Health Priorities; Health Services Needs and Demand; Health Status Disparities; Healthcare Disparities; Humans; Male; Minority Groups; Minority Health; Needs Assessment; Sex Reassignment Procedures; Transgender Persons; Transsexualism
PubMed: 26910276
DOI: 10.1097/MED.0000000000000227 -
Current Opinion in Psychology Jun 2023The minority stress model has been influential in guiding research on sexual and gender minority health and well-being in psychology and related social and health... (Review)
Review
The minority stress model has been influential in guiding research on sexual and gender minority health and well-being in psychology and related social and health sciences. Minority stress has theoretical roots in psychology, sociology, public health, and social welfare. Meyer provided the first integrative articulation of minority stress in 2003 as an explanatory theory aimed at understanding the social, psychological, and structural factors accounting for mental health inequalities facing sexual minority populations. This article reviews developments in minority stress theory over the past two decades, focusing on critiques, applications, and reflections on its continued relevance in the context of rapidly changing social and policy contexts.
Topics: Humans; Sexual and Gender Minorities; Gender Identity; Mental Health; Minority Groups
PubMed: 37270877
DOI: 10.1016/j.copsyc.2023.101579 -
Patient Education and Counseling Dec 2018Patient-clinician communication (PCC) may generate or reduce healthcare disparities. This paper is based on the 2017 International Conference on Communication in... (Review)
Review
OBJECTIVE
Patient-clinician communication (PCC) may generate or reduce healthcare disparities. This paper is based on the 2017 International Conference on Communication in Healthcare keynote address and reviews PCC literature as a research area for the National Institute on Minority Health and Health Disparities (NIMHD).
METHODS
A narrative review of selected evidence on disparities in PCC experienced by race and ethnic minorities, associations between PCC and poor health outcomes, and patient and clinician factors related to PCC.
RESULTS
Factors associated with poor quality PCC on the patient level include being a member of racial/ethnic minority, having limited English proficiency, and low health and digital literacy; on the clinician level, being less culturally competent, lacking communication skills to facilitate shared decision-making, and holding unconscious biases. Recommendations include offering patient- and/or clinician-targeted interventions to guard against unconscious biases and improve PCC, screening patients for health literacy and English proficiency, integrating PCC in performance processes, and leveraging health information technologies to address unconscious biases.
CONCLUSION
EffectivePCC is a pathway to decrease health disparities and promote health equity.
PRACTICE IMPLICATIONS
Standardized collection of social determinants of health in the Electronic Health Record is an importantfirst step in promoting more effective PCC.
Topics: Adult; Communication; Cultural Competency; Culturally Competent Care; Female; Health Literacy; Health Status Disparities; Humans; Male; Middle Aged; Minority Health; Patient Participation; Physician-Patient Relations
PubMed: 30146407
DOI: 10.1016/j.pec.2018.08.021 -
Annals of Epidemiology May 2019Racial/ethnic disparities in severe maternal morbidity (SMM) are substantial, but little is known about whether these disparities are changing over time or the role of...
PURPOSE
Racial/ethnic disparities in severe maternal morbidity (SMM) are substantial, but little is known about whether these disparities are changing over time or the role of maternal and obstetric factors.
METHODS
We examined disparities in SMM prevalence and trends using linked birth certificate and delivery discharge records from Californian births during 1997-2014 (n = 8,252,025).
RESULTS
The prevalence of SMM was highest in non-Hispanic (NH) Black women (1.63%), lowest in NH White women (0.84%), and increased from 1997 to 2014 by approximately 170% in each racial/ethnic group. The magnitude of SMM disparities remained consistent over time. Compared with NH White women, the adjusted risk of SMM was higher in women who identified as Hispanic (RR 1.14; 95% CI 1.12, 1.16), Asian/Pacific Islander (RR 1.23; 95% CI 1.20, 1.26), NH Black (RR 1.27; 95% CI 1.23, 1.31), and American Indian/Alaska Native (RR 1.29; 95% CI 1.15, 1.44), accounting for comorbidities, anemia, cesarean birth, and other maternal characteristics.
CONCLUSIONS
The prevalence of SMM varied considerably by race/ethnicity but increased at similarly high rates among all racial/ethnic groups. Comorbidities, cesarean birth, and other factors did not fully explain the disparities in SMM, which remained persistent over time.
Topics: Adult; Black or African American; Black People; California; Cohort Studies; Female; Healthcare Disparities; Humans; Maternal Health; Maternal Mortality; Minority Health; Pregnancy; Prevalence; White People; Young Adult
PubMed: 30928320
DOI: 10.1016/j.annepidem.2019.02.007 -
Frontiers in Public Health 2021
Topics: Adolescent; Emigrants and Immigrants; Healthcare Disparities; Humans; Mental Health; Minority Groups; Minority Health
PubMed: 34222192
DOI: 10.3389/fpubh.2021.704765 -
Journal of General Internal Medicine Aug 2012
Topics: Healthcare Disparities; Humans; Minority Groups; Minority Health; Treatment Outcome
PubMed: 22592356
DOI: 10.1007/s11606-012-2108-3 -
PloS One 2017Globally, life expectancy together with multimorbidity and chronic diseases are increasing. This leads to a growing demand for care and hence for healthcare personnel... (Review)
Review
INTRODUCTION
Globally, life expectancy together with multimorbidity and chronic diseases are increasing. This leads to a growing demand for care and hence for healthcare personnel and nurses. To meet this demand, healthcare workers from abroad are increasingly hired. The nurses' workplace in general is characterized by physically and psychologically demanding tasks, while that of migrant and minority nurses is additionally characterized by discriminatory practices. The present knowledge about the health of migrant and minority nurses and the terminology in this context are diverse. Thus, the purpose of this review is to systematically identify and synthesize international publications that explicitly focus on migrant nurses' health.
MATERIALS AND METHODS
A systematic review of relevant studies was undertaken using the databases Medline, PsycINFO, CINAHL and Web of Science. The screening process was conducted in several phases. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines while the methodological quality assessment of the included papers was performed with the Mixed Method Appraisal Tool (MMAT).
RESULTS
Out of 11,599 citations initially obtained, 14 empirical studies were included in the final synthesis. The methodological quality of the empirical studies and reviews was diverse. The majority of the studies were conducted in the US and the nurses under study migrated from countries like the Philippines, India, Europe, and Africa. Among migrant nurses of different origins, there are differences in their physiological responses to stress. Migrant nurses and native nurses differ in reporting work-related injuries.
DISCUSSION
Migrant and minority nurses are at high risk of work-related injuries and discrimination than native or majority nurses. However, mixed results were obtained, namely that the reported health of migrant nurses either improves over time or it decreases. This review revealed that discrimination is the leading cause of impaired health amongst migrant and minority nurses.
Topics: Health Status; Humans; Minority Groups; Minority Health; Nurses; Prejudice; Transients and Migrants; Workplace
PubMed: 28650981
DOI: 10.1371/journal.pone.0179183 -
Canadian Journal of Public Health =... Nov 2013
Topics: Canada; Communication Barriers; Health Services Accessibility; Health Services Research; Health Status Disparities; Humans; Language; Minority Health
PubMed: 24300317
DOI: 10.17269/cjph.104.4381 -
Social Science & Medicine (1982) Mar 2017Acculturation represents an important construct in the context of health disparities. Although several studies have reported relationships between various aspects of... (Review)
Review
Acculturation represents an important construct in the context of health disparities. Although several studies have reported relationships between various aspects of acculturation and health in minority populations, crucial inconsistencies remain. One likely reason for these inconsistencies may relate to limitations in the conceptualization and operationalization of acculturation, particularly in the context of health research. The acculturation construct underwent major conceptual and operational change when it was adapted from anthropology to psychology, and we argue another major shift is now required for use of this construct in health research. Issues include determining whether acculturation measures should focus on an individual's internal attitudes or overt behaviors; whether they should characterize cultural orientation status at a given point in time or change over time; whether measures should be culture-specific or more global in nature; how the issue of multiculturalism should be addressed; how measures can optimally incorporate multiple dimensions of acculturation; and whether proxy measures should be used. These issues are important in the context of health research because of their implications for determining the direct and indirect effects of cultural change on health-related biological and behavioral processes. We elaborate on and address each of these issues from a perspective that spans multiple disciplines across the biological and social sciences, and offer concrete recommendations with the ultimate goal of achieving a better understanding of the role of acculturation in minority health and health disparities.
Topics: Acculturation; Cultural Competency; Humans; Minority Groups; Racism; Research Design; Surveys and Questionnaires
PubMed: 28135691
DOI: 10.1016/j.socscimed.2017.01.029