Health Equity最新文献

{"title":"From Detroit to Kansas City: Adapting the WE CARE Model to Improve Maternal and Infant Health.","authors":"Jenifer E Allsworth, Jannette Berkley-Patton, Bong Nguyen, Traci N Johnson, Anahi R Primgaard, Ayla T Nguyen, Gracyn J Pietrusinski, Khushi Patel, Martina T Caldwell, Stefanie R Ellison","doi":"10.1177/24731242261455680","DOIUrl":"10.1177/24731242261455680","url":null,"abstract":"<p><strong>Background: </strong>The United States lags peer nations in infant mortality, with persistent racial and geographic inequities. In Missouri, Black infants experience mortality rates more than double those of White infants. Addressing these disparities requires community-driven interventions beginning before conception and extending beyond routine perinatal care.</p><p><strong>Objectives: </strong>We describe the development and feasibility of Women & Person-Empowered Community Access for Reproductive Equity (WE CARE)-Jackson County (JC), a reproductive justice-informed intervention adapted from the Detroit WE CARE model to address reproductive health and infant mortality disparities.</p><p><strong>Design/setting: </strong>WE CARE-JC used a two-phase, mixed-methods design. Phase 1 included listening sessions with advocacy groups and reproductive-age women, and a community survey (<i>N</i> = 537) to identify needs, barriers, and engagement strategies. Phase 2 piloted the intervention in a safety-net hospital's emergency department. Intervention components included the \"One Key Question,\" MyPath decision-support tool, community health worker-led counseling, and follow-up care navigation.</p><p><strong>Results: </strong>Listening sessions identified trusted providers as preferred sources of family planning guidance, while stigma, limited provider access, and knowledge gaps were key barriers. Survey data showed social (13% housing, 22% food, and 35% transportation insecurity) and medical (51% comorbid condition) vulnerability. In the pilot, 45 women were enrolled (85% of those approached), of whom 58% scheduled follow-up care and 10 (39%) attended appointments. Feedback from eight attendees showed high acceptability of the MyPath tool, counseling, and navigation support.</p><p><strong>Implications for health equity: </strong>WE CARE-JC demonstrated feasibility and acceptability of a reproductive justice-informed, community-engaged model to reduce barriers and improve equitable access to reproductive health care. This model provides a scalable framework for addressing upstream drivers of infant mortality inequities.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"10 ","pages":"24731242261455680"},"PeriodicalIF":2.3,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13428108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148654731","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":"Rethinking Weight-Centric Models: Advancing Weight-Inclusive Care for Black Women.","authors":"Ashley Sneed, Rayonna Booth, Rachel E Mason, JaNelle M Ricks","doi":"10.1177/24731242261466925","DOIUrl":"10.1177/24731242261466925","url":null,"abstract":"<p><p>Weight-inclusive interventions offer a promising alternative to traditional weight-centric approaches that focus primarily on weight loss. Black women, who are disproportionately classified as having obesity based on body mass index (BMI) criteria, often face limited success and added stigma from weight-focused models, which overlook the complex biological, social, and structural factors affecting health, as well as intersecting oppressions like racism, sexism, and weight bias. This article examines how cultural norms, body image, and systemic barriers shape health behaviors among Black women and argues for weight-inclusive care, which prioritizes health-promoting behaviors and overall well-being rather than weight loss and better aligns with their values and lived experiences, including autonomy. Evidence from weight-inclusive interventions demonstrates improvements in psychological well-being, body appreciation, and health behaviors, though research in racially diverse populations remains limited. Culturally responsive, weight-inclusive approaches tailored to Black women are essential for supporting sustainable, meaningful health outcomes while fostering positive body image and self-perception.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"10 ","pages":"24731242261466925"},"PeriodicalIF":2.3,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13420979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632099","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":"Reimagining Perinatal Mental Health Care Models: A Community-Engaged Approach to Develop a Partner-Inclusive, In-Home Intervention.","authors":"Janelle S Peifer, Erin L P Bradley, Rachel Vanderkruik","doi":"10.1177/24731242261468989","DOIUrl":"10.1177/24731242261468989","url":null,"abstract":"<p><strong>Introduction: </strong>Perinatal mood and anxiety disorders (PMADs) are among the most common complications of pregnancy. Yet, identification, access, and intervention lag behind need, particularly for those from historically marginalized backgrounds. Although couples-based, cognitive behavioral approaches show promise, few interventions integrate community-engaged, partner-inclusive, and in-home approaches that bolster accessibility.</p><p><strong>Methodology: </strong>This article presents the development and protocol for the New Family Wellness Project (NFWP). The six-session NFWP focuses on shared family values and communication supplemented with between-session provider check-ins, support groups, homework, and tailored case management. Twenty-two participants (8 couples; 6 mothers alone) provided quantitative and qualitative feedback on the NFWP feasibility and acceptability.</p><p><strong>Results: </strong>Participants reported very high engagement (M = 96/100) and identified the in-home and partner-inclusive format as vital. Qualitative feedback highlighted that the NFWP improved communication and enhanced reflection on family values and actionable steps to support effective co-parenting. Nearly half of the participants said they would <i>not</i> have participated without the in-home and couples-based format.</p><p><strong>Conclusions: </strong>Preliminary findings support the feasibility and acceptability of this community-engaged, cognitive behavioral therapy, couples-based intervention for PMADs. Future directions explore scalability on a larger scale to enhance equitable, perinatal mental health interventions for family systems.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"10 ","pages":"24731242261468989"},"PeriodicalIF":2.3,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632180","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":"Challenging Racism in Perinatal Care: How Doulas Advocate for Black Women.","authors":"Juan L Salinas, Thalia Diaz, Manisha Salinas","doi":"10.1177/24731242261466916","DOIUrl":"10.1177/24731242261466916","url":null,"abstract":"<p><strong>Introduction: </strong>Systemic racism continues to shape maternal health care in the United States, contributing to higher rates of adverse outcomes for Black women and other women of color. Doulas have emerged as important advocates, yet little is known about how doulas' own racial identities influence their work in challenging inequities.</p><p><strong>Methods: </strong>This qualitative study used a phenomenological approach to explore doulas' perspectives on racism in maternal health care. Ten doulas in Northeast Florida participated in in-depth interviews and focus groups between 2021 and 2022. Data were transcribed verbatim and analyzed thematically using established qualitative methods.</p><p><strong>Results: </strong>Four major themes were identified: (1) challenging differential racial treatment, (2) leveraging privilege, (3) anti-racist doula training, and (4) advocating for Black doula recruitment and engagement. White doulas described using their privilege to support clients of color, while Black doulas described navigating heightened scrutiny and exclusion. Across participants, there was consensus that current training inadequately prepares doulas to address racism and that greater racial diversity within the profession is essential.</p><p><strong>Discussion: </strong>Findings highlight how doulas both confront and adapt to systemic racism in maternal health care. Their accounts point to gaps in training and structural barriers to equitable practice, while also illustrating how advocacy can both protect clients and, at times, reproduce inequities through unequal access to power and privilege.</p><p><strong>Health equity implications: </strong>Addressing how race and privilege shape advocacy pathways, reforming training to include racial justice, expanding recruitment and support for Black doulas, and integrating doulas into perinatal care models are important strategies for advancing maternal health equity and advocating for Black racial justice in health.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"10 ","pages":"24731242261466916"},"PeriodicalIF":2.3,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13420973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632160","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":"Gender Diversity Among U.S. Allopathic Medical School Graduates, 2016-2023.","authors":"Elle Lett, Renée Brown, Asa Radix, Richard E Greene, Carl Streed","doi":"10.1177/24731242261466923","DOIUrl":"10.1177/24731242261466923","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to characterize demographic characteristics of transgender and nonbinary (trans) medical students and their training experiences.</p><p><strong>Methods: </strong>We conducted cross-sectional analyses of responses to the Association of American Medical Colleges Graduation Questionnaire (2016-2023) to characterize trans medical students using measures of race, ethnicity, age, and medical school region; assess overall satisfaction with medical training; and evaluate time to graduation, all compared to cisgender peers.</p><p><strong>Results: </strong>Among 121,291 respondents who completed gender identity items, 837 (0.7%) were trans. After adjustment, trans graduates were more likely to be unsatisfied with their education (adjusted odds ratio [aOR]: 2.64, 95% confidence interval [CI]: 2.08, 3.29, <i>p</i> < 0.001) and more likely to take greater than 4 years to complete medical school (aOR: 1.55, 95% CI: 1.32, 1.82, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>With higher odds of being unsatisfied with their education, additional research must identify and develop interventions to improve their training experience.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"10 ","pages":"24731242261466923"},"PeriodicalIF":2.3,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13420394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632036","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":"Perspectives from Black Midwifery Leaders on Scaling Culturally Affirming and Community-Centered Models of Care.","authors":"Noelene K Jeffers, Sylvie T Wilson, Yordanos Tesfai","doi":"10.1177/24731242261462709","DOIUrl":"10.1177/24731242261462709","url":null,"abstract":"<p><strong>Introduction: </strong>Black midwifery practice leaders are reimagining perinatal care for Black women and birthing people by designing and implementing innovative culturally affirming community models of care. They possess a unique lens on the factors that sustain and threaten their innovative work. The aim of this study was to explore Black midwives' perspectives on the components of these models of care, their leadership experiences, and facilitators and barriers of scaling these models for maximal impact for Black women and birthing people throughout the United States.</p><p><strong>Methods: </strong>We purposively identified and conducted in-depth semi-structured interviews with Black midwifery leaders (i.e., founders, directors, owners of Black-led community-centered midwifery practices). We interviewed nine participants including certified nurse-midwives (<i>n</i> = 7) and direct entry midwives (<i>n</i> = 2) between September 2023 and July 2024.</p><p><strong>Results: </strong>We identified four themes: (1) Reclaiming a legacy of care and safety: the incorporation of ancestral traditions and culturally holistic practices to create responsive models of care; (2) Scaling up: the urgent need for more Black midwives and culturally safe educational and professional development pathways; (3) Scaling out: the necessary policy and infrastructure reforms, particularly reimbursement reform and regulatory integration; and (4) Scaling deep: the importance of transformative cultural norms and solidarity-based relationships.</p><p><strong>Conclusion: </strong>Black midwives lay out a vision of how their reimagining can be scaled nationally. Their suggestions span broader structural changes relevant to all midwives, while also identifying potential solutions specific to the needs of Black midwives, who face both racism and hostility toward the practice of midwifery.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"10 ","pages":"24731242261462709"},"PeriodicalIF":2.3,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632121","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":"Models of Birth Doula Access in Hospital Settings: Insights from the ACURE4Moms Study in North Carolina.","authors":"Stephanie S Sperry, Marcella H Boynton, Angela A Tatum, Maya Jackson, Cindy McMillan, April Miller, Rhonda K Lanning, Lewis Lipscomb, Jennifer H Tang, Rachel Peragallo Urrutia","doi":"10.1177/24731242261455178","DOIUrl":"10.1177/24731242261455178","url":null,"abstract":"<p><strong>Introduction: </strong>Continuous doula support during labor and delivery in the hospital setting is associated with improved maternal and newborn outcomes, such as reduced labor duration and higher infant Apgar scores. ACURE4Moms, a 4-arm cluster randomized controlled trial of 39 prenatal clinic groups across North Carolina, is evaluating whether community-based doula support can reduce low birthweight. This short report outlines hospital doula policy insights gleaned from implementation of the doula support intervention.</p><p><strong>Objectives: </strong>Identify the most common models for doula support in the hospital setting and discuss their potential impact on patient access to doula support.</p><p><strong>Methods: </strong>We worked with study clinics and their health systems to obtain their hospital doula policies so that we could prepare study doulas to support patients at the participating hospitals. We conducted thematic analysis to categorize the policies by their various approaches.</p><p><strong>Key observations: </strong>Four commonly observed approaches to hospital access policies for doulas were identified among study sites: (1) the Visitor Model, (2) the Credentialing Model, (3) the Vendor Compliance Model, and (4) the Hospital Workforce Model. We noted that the wide variability in policies and their enforcement and restrictiveness could create confusion and unnecessary barriers for doulas who support patients in labor.</p><p><strong>Conclusion: </strong>There is a need for equitable, standardized, and clearly communicated hospital doula policies to ensure that more patients, especially those from underserved populations, can access the benefits of continuous doula support in hospital-based births.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"10 ","pages":"24731242261455178"},"PeriodicalIF":2.3,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13420425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632055","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":"Community Care in Action: Scaling Doula Support Through a Health Department-Community Partnership.","authors":"Monique Baumont, Sara Gelb, Isabel DoCampo, Gabriela Ammann, Monique Jaques, Nataly Jasso Morales, Mary-Powel Thomas","doi":"10.1177/24731242261462522","DOIUrl":"10.1177/24731242261462522","url":null,"abstract":"<p><strong>Introduction: </strong>Doula support is increasingly recognized as a promising strategy to address racial inequities in maternal health. The New York City Health Department launched the Citywide Doula Initiative (CDI) in March 2022 to expand access to free, community-based doula support in disinvested neighborhoods.</p><p><strong>Methods: </strong>To evaluate the program's first year of implementation, we conducted semi-structured interviews with 44 clients, doulas, doula-organization staff, and Health Department staff between November 2022 and April 2023. We coded interview notes using template analysis (a thematic analysis approach) and grouped barriers and facilitators according to the Practical Robust Implementation and Sustainability Model.</p><p><strong>Results: </strong>Facilitators included high perceived value of the CDI, a shared commitment to community, open communication, and policymaker support for doula work. Barriers included insufficient time for planning, cumbersome bureaucratic processes, and cultural and capacity differences between the Health Department and community partners. Additional factors, such as-variation in hospital treatment of doulas, doula-organization capacity, doula skills and experiences, and client needs and circumstances-had mixed effects on program implementation.</p><p><strong>Discussion: </strong>Findings indicate that community-based doula models, which have been shown to improve birth outcomes in disinvested communities, can be successfully scaled in an urban setting. Programs seeking to expand access to doula support should prioritize time for planning, allocate sufficient resources for administrative support, and work to establish efficient and responsive payment and contracting processes. Having mission-driven staff at all levels of the program and prioritizing relationships with community-based organizations and doulas are vital for success.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"10 ","pages":"24731242261462522"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632095","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":"Applying Holistic Care Research Principles to Black Maternal Health.","authors":"Ayanna Robinson, Sang Hee Won, Danielle Rivers, Angela Aina","doi":"10.1177/24731242261444628","DOIUrl":"10.1177/24731242261444628","url":null,"abstract":"<p><p>The maternal health crisis in the United States, particularly affecting Black women, is due to disparities in health care access, socioeconomic inequalities, and systemic racism. The Black Mamas Matter Alliance, Inc. (BMMA) leads efforts to improve Black maternal health using frameworks like reproductive justice and Black Feminism. To integrate reproductive justice frameworks within research, BMMA's Research Working Group created six holistic care research principles for conducting research by, with, and for Black Mamas. This article describes the application of these principles across BMMA's research projects, which can ensure that research activities and findings are responsive to the needs of Black birthing people.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"10 ","pages":"24731242261444628"},"PeriodicalIF":2.3,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13420432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632172","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":"Expanding Perinatal Care Beyond Obstetrics: The National Veterans Affairs Maternity Care Coordinator Program.","authors":"Joan Combellick, Amanda Johnson, Sophia Hill-Smith, Jamison Dorsey, Elizabeth W Patton","doi":"10.1177/24731242261455183","DOIUrl":"10.1177/24731242261455183","url":null,"abstract":"<p><p>Pregnant and postpartum individuals in the United States experience high rates of adverse pregnancy outcomes, despite multiple obstetric initiatives to address this public health crisis. Perinatal care that meaningfully addresses long-term factors that impact pregnancy outcomes, such as chronic mental and physical conditions, adverse social and environmental factors, structural racism, birth-related morbidity and trauma, and transitions to parenting, must go beyond obstetric care sites to include health care providers who deliver care across the lifespan. Veteran's Health Administration (VHA), the nation's largest integrated health care system, has reimagined the integration of individualized pregnancy-related care coordination within a health care system that does not directly provide obstetric care. The VHA Maternity Care Coordinator Program provides a feasible, effective, and replicable model that is relevant to other integrated health care systems.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"10 ","pages":"24731242261455183"},"PeriodicalIF":2.3,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632042","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}