Category Archives: Barriers to care: cultural, gender and racial
For the 25th anniversary of the Robert Wood Johnson Foundation’s Summer Medical and Dental Education Program (SMDEP), the Human Capital Blog is publishing scholar profiles, some reprinted from the program’s website. SMDEP is a six-week academic enrichment program that has created a pathway for more than 22,000 participants, opening the doors to life-changing opportunities. Following is a profile of Sam Willis, MD, a member of the 1995 class.
After completing medical school, Sam Willis decided his residency could wait. He wanted to see the world.
So he joined the Peace Corps and spent two years working as a health volunteer in Burkina Faso, one of Africa’s poorest countries. Living among the Burkinabé, in a mud-and-brick house with no running water, Willis learned the native language along with French. Every day, he hauled water back from a well so he could take a bath outdoors.
He talked to the villagers about sanitation, HIV/AIDS prevention, and ways to fight malnutrition. He helped set up a food bank to tide residents over during the summer dry seasons, when the rains stopped and they couldn’t plant crops.
When he came back to the United States, it was with a different worldview.
“Learning to speak another language opened up my mind to understanding how the world works,” says Willis, who today is an assistant professor at Baylor College of Medicine and practices family medicine in Houston, Texas, treating patients from disadvantaged communities.
Thema Bryant-Davis, PhD, is an associate professor of psychology at Pepperdine University and an associate editor of the journal Psychological Trauma. Bryant-Davis is a Robert Wood Johnson Foundation (RWJF) New Connections grantee who studies the intersection of trauma and culture.
The assault perpetrated by Ray Rice, which ended in him dragging his unconscious fiancé, Janay Palmer, off an elevator, has captured wide public attention. Unfortunately, most of the dialogue has focused on blaming and shaming Ms. Palmer and other victims of intimate partner violence for staying in abusive relationships. There has also been an attempt to build sympathy for the perpetrator by questioning whether Rice’s punishment, which went from suspension for two games to permanent dismissal from his team, was fair. The most important questions have received far less attention. Why do abusive partners like Ray Rice abuse their spouses? Why does the public support intimate partner abuse either directly with words and actions or indirectly with their silence? What are the consequences of intimate partner abuse? And how can we stop intimate partner violence?
Partner abuse is an action not caused by the victim’s behavior, substance use, mental illness, or biology (being male). People choose to abuse their partners emotionally, physically, sexually, verbally and financially to exact control over the person and because they believe they have the right to do so.
Alexander Tsai, MD, PhD, is an assistant professor of psychiatry at Harvard Medical School, a staff psychiatrist in the Massachusetts General Chester M. Pierce, MD Division of Global Psychiatry, and an honorary lecturer at the Mbarara University of Science and Technology in Uganda. He is an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2010-2012), and a member of the core faculty in the Health & Society Scholars program at Harvard University.
When Robin Williams ended his life last month, his suicide sparked a raft of online and print commentary about the dangers of depression and the need to inject more resources into our mental health care system. I strongly agree with these sentiments. After all, as a psychiatrist at the Massachusetts General Hospital, I regularly speak with patients who have been diagnosed with depression or who are actively thinking about ending their lives.
But what if suicide prevention isn’t just about better screening, diagnosis and treatment of depression? What if there were a better way to go about preventing suicides?
It is undeniable that people with mental illnesses such as depression and bipolar disorder are at greater risk for suicidal thinking or suicide attempts. But not everyone with depression commits suicide, and not everyone who has committed suicide suffered from depression. In fact, even though depression is a strong predictor of suicidal thinking, it does not necessarily predict suicide attempts among those who have been thinking about suicide. Instead, among people who are actively thinking about suicide, the mental illnesses that most strongly predict suicide attempts are those characterized by anxiety, agitation and poor impulse control.
This is part of the July 2014 issue of Sharing Nursing’s Knowledge.
Short Rest Between Nurses’ Shifts Linked with Fatigue
New research from Norway suggests that nurses with less than 11 hours between shifts could develop sleep problems and suffer fatigue on the job, with long-term implications for nurses’ health.
Psychologist Elisabeth Flo, PhD, of the University of Bergen in Norway, led a team of researchers that analyzed survey data from more than 1,200 Norwegian nurses, focusing on questions about how much time nurses had between shifts, their level of fatigue at work and elsewhere, and whether they experienced anxiety or depression.
Analyzing the data, they found that nurses, on average, had 33 instances of “quick returns” in the previous year—that is, shifts that began 11 hours or less after another shift ended. Nurses with more quick returns were more likely to have pathological fatigue or suffer from difficulty sleeping and excessive sleepiness while awake—both common problems for night workers.
Lorenzo Lorenzo-Luaces graduated from the University of Puerto Rico–Rio Piedras, where he studied cross-cultural differences in suicidality. He is currently a graduate student in the University of Pennsylvania clinical psychology PhD program. Lorenzo-Luaces is an alumnus of Project L/EARN, a project of the Robert Wood Johnson Foundation, the Institute for Health, Health Care Policy and Aging Research, and Rutgers University.
The population of groups referred to as “minority” is growing at a faster rate in this country than Caucasians, with estimates suggesting that by 2060, 57 percent of the U.S. population will be non-White. This demographic shift could create a public health concern if racial/ethnic minorities remain underrepresented in mental health research. At present, these populations are less likely to receive mental health care than Whites. When they do receive care, it is usually of lesser quality.
Stereotypes among racial/ethnic minority communities regarding mental health are complex. Research suggests that they tend to have more negative beliefs about mental illnesses than White communities; for example, they are more likely to believe that mental illnesses occur due to factors outside of the individual’s control (e.g., spiritual or environmental reasons). However, despite generally holding more negative views about mental illnesses, research shows that racial/ethnic minorities tend to have less punitive attitudes about the mentally ill. Moreover, they tend to be more accepting about mental health treatments, although they express a clear preference for psychological services over medications.
Differences in access to care, rather than attitudes, likely explain the racial/ethnic gap in service use. Besides the obvious discrepancies in socioeconomic status (SES) between Caucasians and racial/ethnic minorities, the latter’s preference for psychological services may be one barrier to access. This is because, even among the insured, psychological services are more expensive in the short term and harder to access than psychotropic medications. There also are questions as to whether psychological interventions tested largely on White populations are effective for minorities.
Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:
In a Talking Points Memo opinion piece, Harold Amos Medical Faculty Development Program alumna Paloma Toledo, MD, MPH, writes that while the Affordable Care Act holds the promise of greatly increasing access to care, language and cultural barriers could still stand between Hispanic Americans and quality care. Toledo’s research into why greater numbers of Hispanic women decline epidurals during childbirth revealed that many made the choice due to unfounded worries that it would leave them with chronic back pain or paralysis, or that it would harm their babies. “As physicians, we should ensure that patients understand their pain management choices,” she writes.
More than one in three patients with bloodstream infections receives incorrect antibiotic therapy in community hospitals, according to research conducted by Deverick J. Anderson, MD, an RWJF Physician Faculty Scholars alumnus. Anderson says “it’s a challenge to identify bloodstream infections and treat them quickly and appropriately, but this study shows that there is room for improvement,” reports MedPage Today. Infection Control Today, FierceHealthcare, and HealthDay News also covered Anderson’s findings.
People’s health and wellness can be linked to their zip codes as much as to their genetic codes, according to an essay in Social Science and Medicine co-authored by Helena Hansen, MD, PhD. As a result, Hansen argues, physicians should be trained to understand and identify the social factors that can make their patients sick, HealthLeaders Media reports. Hansen is an RWJF Health & Society Scholars alumna.
Annik Sorhaindo, MSc, is a senior program researcher with the Population Council’s Reproductive Health Program in Mexico. A 1997 alumna of the Robert Wood Johnson Foundation-funded Project L/EARN initiative, she conducts research to provide evidence that helps inform government policy. This post reports on her work.
Fifty-five percent of all pregnancies in Mexico are unplanned.
That dramatic statistic, from a report by the Guttmacher Institute, can be mapped to the limited access women have to contraception.
“Many women can’t readily obtain contraceptive methods,” says Annik Sorhaindo. As part of a five-organization alliance working to improve reproductive health in the world’s 11th most populous country, the council directs research and analysis for the effort.
“My work focuses on answering research questions: Which occurrences in daily life impact women’s decisions about contraception? What are the impediments to preventing teen pregnancy? What are the challenges to using contraception post-abortion?”
Sorhaindo is quick to note that the council stays above the political fray. “We do the research and interpret the results, and the advocacy organizations address the politics,” she says.
Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of the Foundation’s nursing programs, and the latest news, research, and trends relating to academic progression, leadership, and other essential nursing issues. Following are some of the stories in the March issue.
Nurses Need Residency Programs Too, Experts Say
Health care experts, including the Institute of Medicine in its report on the future of nursing, tout nurse residency programs as a solution to high turnover among new graduate nurses. Now, more hospitals are finding that these programs reduce turnover, improve quality, and save money. Success stories include Seton Healthcare Family in Austin, Texas, which launched a residency program to help recent nursing school graduates transition into clinical practice. Now, three out of four new graduate nurses make it to the two-year point, and five or six new nurse graduates apply for each vacant position.
Iowa Nurses Build Affordable, Online Nurse Residency Program
Some smaller health care facilities, especially in rural areas, cannot afford to launch nurse residency programs to help new nurses transition into clinical practice. A nursing task force in Iowa has developed an innovative solution: an online nurse residency program that all health care facilities in the state—and potentially across the country—can use for a modest fee. The task force was organized by the Iowa Action Coalition and supported by an RWJF State Implementation Program grant.
Nadia Winston, MSPH, is a graduate student at the University of Illinois at Chicago, School of Nursing, pursuing dual nurse practitioner studies in family practice and occupational health. She has a master of science in public health degree from Meharry Medical College and is a former scholar with the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College. This post is part of the “Health Care in 2014” series.
Cardiovascular disease is the number one killer of African American women. It has become imperative for the nation to take back the reins of its health status and educate the public about this threat. The statistics are alarming. Black women are twice as likely to suffer from cardiovascular disease as women of other ethnicities. And according to the American Heart Association, cardiovascular disease kills nearly 50,000 African-American women annually. The reason for this disparity can be attributed to a lack of health knowledge, being overweight or obese, and lack of physical activity. Early intervention and action has been identified as the key to reducing this population’s risk of mortality from cardiovascular disease and related diagnoses.
Addressing and raising awareness of the health risks associated with cardiovascular diseases for African American women has been quite challenging. Recognizing this issue, Vanessa Jones Briscoe, PhD, MSN, then a Health Policy Associate at the Center for Health Policy at Meharry Medical College, developed and implemented a culturally appropriate health education program to educate minority populations about unhealthy lifestyles. It is called the “Be Heart Smart” program.
Abigail L. Reese, CNM, MSN, is a fellow with the Robert Wood Johnson Foundation Nursing and Health Policy Collaborative at the University of New Mexico. She received her undergraduate degree from Princeton University and her master of science in nursing at the Yale School of Nursing. She has worked at a birth center on the U.S./Mexico border, and coordinated a federal women’s health grant in Vermont. This post is part of the “Health Care in 2014” series.
My resolution for the U.S. health care system in 2014 is to make strides in addressing one of the greatest health disparities affecting women and girls in this society and the world over: the experience of interpersonal and sexual violence. The Centers for Disease Control and Prevention (CDC) tells us that, in this country, one out of every five women has experienced rape or attempted rape. One in four has experienced “severe physical violence” at the hands of an intimate partner. Furthermore, the evidence tells us that victimization and its consequences begin early. Nearly half of all women who experience rape are assaulted before the age of 18, and 35 percent will be re-victimized during their lifetime.
Those of us who provide health care services to women are first-hand witnesses to the health-related consequences of interpersonal and sexual violence. These women are at greater risk for a range of potentially devastating health problems including: debilitating depression and anxiety, substance use disorders, sexually transmitted infections, unwanted pregnancies, and giving birth to preterm or low birth weight infants. They have higher reported rates of frequent headaches, chronic pain (including chronic pelvic pain), diabetes, asthma, and irritable bowel syndrome, among other conditions. Therefore, many of the symptoms and conditions that bring women into our care are related to their experiences of violence.