Health Equity最新文献

{"title":"The Necessity of Diversity, Equity and Inclusion Training for Obstetrics and Gynecology: A Department-Wide Needs Assessment of an Academic Obstetrics and Gynecology Department.","authors":"Ayana G R DeGaia, Shilpa Darivemula, Omar M Young","doi":"10.1177/24731242251374427","DOIUrl":"10.1177/24731242251374427","url":null,"abstract":"<p><strong>Introduction: </strong>The persistent disparities in the field of obstetrics and gynecology (OBGYN) have become increasingly visible in the public eye, while at the same time public discourse regarding the appropriateness and efficacy of diversity, equity and inclusion (DEI) education has become increasingly politically polarized.</p><p><strong>Background: </strong>While it has long been accepted that DEI training is an essential component of curricula offered in academic OBGYN departments, there remains a great deal of uncertainty regarding the best practices for developing and provisioning such training.</p><p><strong>Methods: </strong>In this article, the authors outline lessons learned from the process of developing an evidence-based department-wide needs assessment in order to evaluate the knowledge, attitudes, and behavior of members of a large academic OBGYN department, including an evaluation of the impact of prior DEI educational programming.</p><p><strong>Results: </strong>Of the 113 clinicians, nurses and administrative staff, the majority desired more DEI training and endorsed significant barriers to accessing it. There were also significant opportunities for improvement of health equity knowledge and clinical practice.</p><p><strong>Discussion: </strong>Although DEI training has been lauded for addressing health inequities, the findings of this needs assessment highlight existing gaps between desired and actual outcomes. It is essential that academic departments design, implement, and evaluate DEI strategies that are inclusive of the entire medical team, offer iterative and ongoing training opportunities, provide support for minoritized groups within the department, and involve a variety of stakeholders to improve our ability to provide equitable reproductive health care for all.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"442-449"},"PeriodicalIF":2.5,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions, Beliefs, and Knowledge of Oral and Familial Cancer in an Indigenous Community of Chile: A Mixed Quantitative-Qualitative Study.","authors":"Cynthia Cantarutti, Gerardo Yévenes, Águeda Muñoz-Del-Carpio-Toia, Daniela Adorno-Farias, Ricardo Fernández-Ramires, Alan Roger Santos-Silva, Jean Nunes Dos Santos, Ignacio Molina-Ávila, Francisco J Bravo, Wilfredo Alejandro González-Arriagada","doi":"10.1177/24731242251372703","DOIUrl":"10.1177/24731242251372703","url":null,"abstract":"<p><strong>Background: </strong>Oral cancer is one of the 10 most common cancers globally and represents a public health problem. Cultural practices and access to care are recognized as determinants of oral diseases, including cancer. Understanding the perceptions of indigenous communities is crucial for developing culturally appropriate interventions. This study aims to evaluate the perceptions, beliefs, and knowledge about oral and familial cancer within a specific indigenous community (Quechua and Aymara) in Chile using a mixed-methods approach.</p><p><strong>Methods: </strong>This exploratory study was conducted in two phases: an oral cavity clinical examination and a qualitative phase, consisting of semi-structured interviews with a subset of participants from the clinical examination. A total of 77 volunteers with no prior history of oral cancer underwent an oral cavity clinical examination, and 53% reported a familial history of cancer. The interview was conducted with 18 participants.</p><p><strong>Results: </strong>No significant differences were found in the clinical oral health status between the indigenous and nonindigenous populations. However, a lack of knowledge of oral cancer was noted in the indigenous community. A higher proportion of participants from the indigenous population reported a family history of cancer.</p><p><strong>Conclusion: </strong>The community demonstrated limited knowledge about oral cancer. Therefore, it is necessary to implement culturally and linguistically appropriate strategies for oral health promotion and oral cancer prevention to address the specific needs of these communities.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"433-441"},"PeriodicalIF":2.5,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Racial Disparities in Hypertension Control Using a Multicomponent, Equity-Centered Approach.","authors":"Susan Mwikali Kioko, Christina Council, Cecilia Tomori","doi":"10.1177/24731242251371424","DOIUrl":"10.1177/24731242251371424","url":null,"abstract":"<p><strong>Introduction: </strong>Black Americans have the highest prevalence of hypertension among all racial or ethnic groups in the United States. They are 40% more likely to have uncontrolled blood pressure (BP) and are five times more likely to die from hypertension compared with non-Hispanic Whites. Experiences of discrimination in health care, clinician and institutional bias, and socioeconomic and environmental inequities driven by structural racism contribute to uncontrolled hypertension in this population. Multilevel, multicomponent interventions have effectively improved BP control among Black Americans but remain inadequately implemented in the clinical setting. An integrated nursing/public health quality improvement study was designed to address this gap between evidence and integration into clinical practice.</p><p><strong>Methods: </strong>Using a one group pre/posttest design, we examined the effect of an innovative, evidence-based 12-week intervention on BP among Black Americans with uncontrolled hypertension aged 18 and older in the primary care setting. Intervention components included remote BP monitoring, weekly phone coaching with culturally congruent care, medication intensification, and a standardized hypertension protocol.</p><p><strong>Results: </strong>The average age of the participants (<i>n</i> = 35) was 64 years, and two thirds (<i>n</i> = 23) were female (66%). The mean difference in systolic BP from pre to postintervention decreased significantly (M = 23, standard deviation [SD] = 14.0), <i>t(34)</i> = -9.7, <i>p</i> < 0.001). A significant reduction in the mean difference in diastolic BP from pre to postintervention was also observed (M = 11, SD = 11.8), <i>t(34)</i> = -5.5, <i>p</i> < 0.001). At 12 weeks, 87% of participants had achieved BP control. The intervention also improved medication adherence and hypertension knowledge (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>A multicomponent, culturally congruent quality improvement intervention may effectively improve BP among Black Americans.</p><p><strong>Health equity implications: </strong>Scaled up implementation of equity-centered, culturally congruent approaches is needed to reduce racial disparities in hypertension control.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"416-424"},"PeriodicalIF":2.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persons Experiencing Housing Instability Perspectives on Medicaid Managed Care Organizations and Homeless Shelters.","authors":"Emily R Clear, Allison M Scott, Kelsie Kwok, Mark A Ribott, Teresa M Waters, Rachel Hogg-Graham","doi":"10.1177/24731242251371428","DOIUrl":"10.1177/24731242251371428","url":null,"abstract":"<p><strong>Background: </strong>Persons experiencing housing instability (PEHIs) are medically vulnerable and at increased risk for poor health outcomes, high clinical service utilization, and mortality. Unstable housing is just one of many social determinants of health or nonmedical factors influencing health outcomes.</p><p><strong>Methods: </strong>Focus groups were conducted on-site at two Kentucky homeless shelters to assess the structure and perceived effectiveness of Medicaid managed care organizations (MCOs) and community-based organizations (CBOs) partnerships. We share perspectives of homeless Medicaid enrollees who are living without housing on the interaction between Medicaid MCOs and homeless shelters addressing unmet social needs.</p><p><strong>Results: </strong>Three themes emerged from our qualitative analysis: (1) Benefits of and barriers to receiving various services through Medicaid, (2) Medicaid does not appear to interface well with community-based shelters, and (3) Medicaid enrollees living without housing perceive a lack of information from Medicaid. Concerns raised by participants included barriers to receiving services, strengthening resource and referral processes, and increasing communication with both CBOs and Medicaid enrollees. These concerns must be addressed to improve care and outcomes.</p><p><strong>Conclusions: </strong>PEHIs rely on homeless shelters to help them enroll and utilize Medicaid rather than relying on Medicaid to identify and utilize CBOs. There are opportunities for improvement in how MCOs interact with PEHI enrollees. PEHIs utilize Medicaid and navigate cross-sector relationships in different ways than other Medicaid enrollees.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"425-432"},"PeriodicalIF":2.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Holistic Ecosystem Model to Diversify the Physician Workforce and Enhance Health.","authors":"Erik J Porfeli, Sunny Nakae, Leila Amiri, Leila E Harrison, Will Ross","doi":"10.1177/24731242251371526","DOIUrl":"10.1177/24731242251371526","url":null,"abstract":"<p><strong>Importance: </strong>The U.S. medical education system attracts and trains the next generation of physicians to advance the health care needs of a growing and increasingly diverse nation. This system can be credited for supplying a physician workforce achieving remarkable growth and innovation, yielding one of the world's most technologically advanced health care systems on the planet. This system, unfortunately, also contributes to educational, workforce, and health disparities.</p><p><strong>Observations: </strong>The successes and challenges of the medical education and health care system align with broader economic, health, and educational patterns in the United States. An ecological model can be employed to unite a network of partners spanning four developmental stages to support a greater diversity of students for and from underrepresented communities to enter the physician workforce, enjoy the rewards granted by a career in medicine, and enact needed changes to eliminate health, economic, and educational disparities.</p><p><strong>Conclusions and relevance: </strong>Comprehensive and ecologically attuned pathways to the physician workforce could be especially beneficial to states and communities suffering from the looming high school enrollment cliff, outflows of residents to other states, challenges in recruiting and retaining physicians, and significant educational and health disparities. The ecosystem model spurs significant changes in how we think about the developmental pathways to the physician workforce and how we may mobilize resources to promote progress and ease transitions, especially for underrepresented students who face many fewer opportunities and many more challenges along their journey.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"405-411"},"PeriodicalIF":2.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healing Outside of a Doctor's Office: Advancing Reproductive Wellness Through Storytelling in the Dobbs Era.","authors":"Robyn B Adams, Stacie McCormick, Amber T A Reid, D'Andra Willis, Qiana Arnold, Helen Zimba, Tambra Morrison, Marsha Jones","doi":"10.1177/24731242251372699","DOIUrl":"10.1177/24731242251372699","url":null,"abstract":"<p><p>Amber Thurman, Candi Miller, Porsha Ngumezi, Josseli Barnica, and Neveah Crain highlight the tragic outcomes of restrictive abortion bans post-Dobbs v. Jackson Women's Health Organization. Their stories underscore the need to shift away from viewing medical institutions as the only sources of reproductive care. The Afiya Center's Livable Black Futures Collective advocates for community-based knowledge through a Reproductive Justice storytelling framework. By emphasizing the injustices faced by Black women and birthing people, these narratives aim to reclaim bodily autonomy, dismantle stigma, and foster resilience, ultimately serving as a powerful catalyst for collective healing and activism against systemic oppression.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"412-415"},"PeriodicalIF":2.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative Development of Research Engagement Manual: Strategies to Enhance Recruitment and Retention of Black Individuals in Clinical Trials for Substance Use Disorders.","authors":"Geoffrey Obel, DeWanda Harris-Trimiar, Joshua S Elmore, Taryn L Mayes, Adrienne Mays, Angela Casey-Willingham, Srividya Vasu, Steven Shoptaw, Madhukar H Trivedi","doi":"10.1177/24731242251362181","DOIUrl":"10.1177/24731242251362181","url":null,"abstract":"<p><strong>Background: </strong>The participation of Black individuals in clinical trials remains lower than that of other racial and ethnic groups. Substance abuse adds additional barriers to recruitment and retention. While significant attention has been devoted to identifying barriers to recruitment/retention, efforts have been largely unsuccessful in increasing the participation of Black individuals in clinical trials. This article details Phase 1 efforts to develop sustainable strategies to increase enrollment/recruitment of Black participants in clinical trials through an Innovative Development of Research Engagement Manual.</p><p><strong>Methods: </strong>Phase 1 involved a literature review and the establishment of an Expert Diversity Advisory Board, which identified barriers to Black individual participation in substance use disorder (SUD) research. Identified barriers included lack of awareness of research, mistrust, lack of comfort with research, lack of information, and time/resource constraints. Focus groups were conducted to assess the importance of the identified factors in 61 Black participants with SUD history.</p><p><strong>Results: </strong>Among the focus group participants, 37.7% indicated mistrust, 45.9% indicated a lack of knowledge, and 27.9% stated safety concerns as reasons for not engaging with researchers. They considered compensation, research benefits, study duration, privacy, safety, and side effects as vital information that informed their decisions on clinical trial participation. The focus groups identified financial incentives, potential treatment options, and potential for improved awareness about substance abuse treatment as factors that determine retention in a study.</p><p><strong>Conclusion: </strong>With barriers identified, future efforts will focus on qualitative assessments of focus group material and developing and evaluating the manual.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"387-396"},"PeriodicalIF":2.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Place Matters: Geographic Distribution of Abortion Fund Services.","authors":"Erin R Johnson, Monica R McLemore","doi":"10.1177/24731242251369612","DOIUrl":"10.1177/24731242251369612","url":null,"abstract":"<p><strong>Background: </strong>Where you live impacts your access to all forms of health care, but abortion in particular. In response to restrictions on abortion, communities have organized to support those seeking abortion care via abortion funds. This study documents the services provided by these organizations and examines how they have been shaped by local conditions.</p><p><strong>Methods: </strong>Data come from a content analysis of the websites of all abortion funds affiliated with the National Network of Abortion Funds and interviews with 22 abortion fund leaders. Content analysis data presented include data about abortion funds' catchment area and what services funds provide.</p><p><strong>Results: </strong>Types of support offered by abortion funds include procedure funding, practical support, emotional support, other sexual health services, and parenting support. Interviews with fund leaders show that these services are shaped by local policies, cultural and geographic specifics of their catchment area, local clinics, and ties to other organizations in funds' communities.</p><p><strong>Discussion: </strong>Abortion funds are a diverse group of organizations that provide a variety of services to help patients overcome barriers to abortion. The geographic patterning of their services suggest that funds are responding to local environments, with the greatest variety of services being offered by funds in the South.</p><p><strong>Health equity implications: </strong>Abortion funds' service offerings clearly respond to the barriers to abortion described in the literature, driven by the needs of their local communities. This is particularly relevant in a post-Dobbs environment, as patients in some parts of the country find abortion even farther out of their reach.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"397-404"},"PeriodicalIF":2.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Corrigendum to:</i> \"Trustworthiness, Not Trust: How Systemic Racism Impacts COVID-19 Vaccine Receipt\".","authors":"","doi":"10.1177/24731242251368359","DOIUrl":"10.1177/24731242251368359","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1089/heq.2022.0145.].</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"386"},"PeriodicalIF":2.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Bleeding: An Analysis of Presenting Symptoms Among Black Patients with Endometrial Cancer.","authors":"Maya E Gross, Mindy Pike, Julianna Alson, Patrice Williams, Mollie E Wood, Erica Marsh, Erin Carey, Til Stürmer, Ronit Katz, Whitney R Robinson, Kemi M Doll","doi":"10.1177/24731242251365480","DOIUrl":"10.1177/24731242251365480","url":null,"abstract":"<p><strong>Objectives: </strong>Black patients have the highest mortality rate from endometrial cancer (EC), and yet remain underrepresented in EC research. Thus, currently published symptom patterns may not be comprehensive for this population. The purpose of this study is to analyze symptomatology among Black patients with EC in the Guidelines for Ultrasound in the Detection of Early Endometrial Cancer study and to compare with those undergoing benign hysterectomy.</p><p><strong>Methods: </strong>This is a retrospective consecutive patient sample of Black individuals undergoing hysterectomy in an academic-affiliated 10-hospital health care system from 2014 to 2020. We collected clinical, sociodemographic, and diagnostic information for 24 months before hysterectomy, using merged structured and abstracted data from electronic health records. We used descriptive statistics to describe the sample and pertinent subgroups-patients with fibroids/enlarged uteri, without postmenopausal bleeding (PMB), and patients <50 years old. Symptom distribution between subgroups was analyzed using chi-square tests and Fisher exact tests.</p><p><strong>Results: </strong>The sample included 3,455 hysterectomy patients, 12% with EC (<i>n</i> = 404). Among EC patients, 77% had PMB and 7% had no bleeding history. EC patients were symptomatic beyond bleeding, with fibroids/enlarged uteri (70%), pelvic/abdominal pain (38%), anemia (30%), and more. Young patients (8% of all EC cases) had more pelvic/abdominal pain (61% vs. 36%, <i>p</i> = 0.017) and anemia requiring transfusion (33% vs. 6%, <i>p</i> < 0.001) compared with older patients. Subgroup symptom presentations overlapped between those with and without cancer, with few symptoms differing by >20%.</p><p><strong>Conclusions: </strong>PMB alone is rarely the only presenting symptom among Black patients with EC; symptoms overlap heavily with patients presenting with benign disease. Young patients, those with fibroids/enlarged uteri, and those without PMB represent subgroups with nuanced presentations, for whom EC should be considered.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"375-385"},"PeriodicalIF":2.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}