Category Archives: Barriers to care: cultural, gender and racial

Jul 11 2014

Recent Research About Nursing, July 2014

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.

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Jun 4 2014

The Effect of Cultural Stereotypes on Mental and Public Health

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.

Lorenzo Lorenzo-Luaces

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. 

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Mar 27 2014

RWJF Scholars in the News: Cultural barriers to care, medical conspiracies, parenting, and more.

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.

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Mar 26 2014

Where Evidence Meets Policy—and Politics

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.

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Mar 25 2014

Sharing Nursing’s Knowledge: The March 2014 Issue

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.

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Feb 5 2014

Be Heart Smart: Addressing the High Burden of Cardiovascular Disease Among African-American Women

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.

file Nadia Winston

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.

file Vanessa Jones Briscoe

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.

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Jan 31 2014

Resolve to Address Violence Against Women and Girls

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.

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Jan 30 2014

Human Capital News Roundup: HIV treatment for ex-offenders, ‘healthy’ fast food myths, and more.

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:

Making new medical device technology quickly available is important, but research suggests there is a risk associated with swift Food and Drug Administration approval of implantable heart devices. Aaron Kesselheim, MD, JD, MPH, recipient of an RWJF Investigator Award in Health Policy Research, told USA Today that the medical community should be wary of the expedited review process because it can compromise product safety and effectiveness. The Boston Globe also covered Kesselheim’s research.

Health Canal featured a study co-authored by RWJF Health & Society Scholars alumna Chyvette Williams, PhD, MPH, that examines gender differences in HIV treatment outcomes among recently released prisoners. Williams and colleagues found that women were considerably less likely than men to attain any of the three optimal HIV treatment outcomes six months after release from jail, and thus had significantly more negative health outcomes.

Despite media campaigns promoting healthy eating, customers at fast food restaurants such as Subway do not necessarily make better food choices, according to a Medical Daily article. Citing research from Lenard Lesser, MD, MSHS, an RWJF Clinical Scholar alumnus, the article states that people consume nearly as many calories, and as much sugar, carbohydrates, and sodium from Subway as they would at another fast food restaurant. Lesser’s research was also covered by WNCN. Read more about Lesser’s research.

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Jan 22 2014

Overcoming Health Disparities: Promoting Justice and Compassion

By Janet Chang, PhD, an alumna of the Robert Wood Johnson Foundation (RWJF) New Connections Program and an assistant professor of psychology at Trinity College in Hartford, Connecticut. Chang received a PhD from the University of California, Davis, and a BA from Swarthmore College. She studies sociocultural influences on social support, help seeking, and psychological functioning among diverse ethnic/racial groups. Her RWJF-funded research project (2009 – 2012) examined the relationship between social networks and mental health among Latinos and Asian Americans.

“Injustice anywhere is a threat to justice everywhere.”  
Dr. Martin Luther King, Jr. (Letter from Birmingham Jail, April 16, 1963)


Dr. Martin Luther King, Jr. is well known for his fight against racial injustice, but he also advocated for socioeconomic justice. In particular, Dr. King said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane” (Second National Convention of the Medical Committee for Human Rights, March 25, 1966). His profound words still resonate with us today.

While strides have been made in the past several decades, there continues to be inequality and unequal treatment. In 1978, the President’s commission reported ethnic/racial disparities in health services, and this is still a vexing societal problem in the United States. Compared to non-minorities, American Indians, Latino Americans, Asian Americans, African Americans, and other ethnic/racial minorities are significantly less likely to receive the care that they need and more likely to receive lower quality health care. Ultimately, these disparities compromise the quality of life of most Americans.

The factors that contribute to heath disparities are complex. As a social-cultural psychologist, I also believe that our tolerance for injustice stems in part from larger cultural forces that shape our psychological tendencies, which simplify our world and constrain our ability to take the perspective of others. In the United States, the cultural values that make our society distinctive, independent, and strong may also serve to limit our potential for greater growth—a healthier, happier, and more productive society. 

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Dec 19 2013

Human Capital News Roundup: Body mass index and kidney function, impact of health spending on life expectancy, and more.

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:

The Food & Drug Administration issued a proposed rule on December 16 that would require makers of antimicrobial and antibacterial soaps and body washes to demonstrate the safety and effectiveness of their products, the Examiner reports. Scientists have long been concerned that the common anti-bacterial ingredient triclosan may harm health. Allison Aiello, PhD, MS, concluded in a 2007 report that soaps containing triclosan “were no more effective than plain soap at preventing infectious illness symptoms and reducing bacterial levels on the hands.” Aiello is an RWJF Health & Society Scholars alumna. Read her post on the RWJF Human Capital Blog.

In the first study to estimate health spending efficiency by gender across industrialized nations, RWJF Health & Society Scholars program alumnus Arijit Nandi, PhD, and others discovered significant disparities within countries. The research team found that increased spending on health brought stronger gains in life expectancy for men than for women in nearly every nation, Newswise reports. The United States ranked 25th among the 27 countries studied when it came to reducing women’s deaths.

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