Journal of Health Care for the Poor and Underserved
About: Journal of Health Care for the Poor and Underserved is an academic journal. The journal publishes majorly in the area(s): Health care & Population. It has an ISSN identifier of 1049-2089. Over the lifetime, 2627 publication(s) have been published receiving 48060 citation(s).
Topics: Health care, Population, Health equity, Medicaid, Health policy
Papers published on a yearly basis
TL;DR: Cultural humility is proposed as a more suitable goal in multicultural medical education that incorporates a lifelong commitment to self-evaluation and self-critique and to developing mutually beneficial and nonpaternalistic clinical and advocacy partnerships with communities on behalf of individuals and defined populations.
Abstract: Researchers and program developers in medical education presently face the challenge of implementing and evaluating curricula that teach medical students and house staff how to effectively and respect- fully deliver health care to the increasingly diverse populations of the United States. Inherent in this challenge is clearly defining educational and training outcomes consistent with this imperative. The traditional notion of competence in clinical training as a detached mastery of a theoretically finite body of knowledge may not be appropriate for this area of physician education. Cultural humility is proposed as a more suitable goal in multicultural medical education. Cultural humility incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-physician dynamic, and to developing mutually beneficial and nonpaternalistic clinical and advocacy partner- ships with communities on behalf of individuals and defined populations.
TL;DR: It is suggested that mistrust remains an important barrier to research participation among African Americans and researchers should incorporate strategies to reduce mistrust and thereby increase participation amongAfrican Americans.
Abstract: This paper describes results of a qualitative study that explored barriers to research participation among African American adults A purposive sampling strategy was used to identify African American adults with and without previous research experience A total of 11 focus groups were conducted Groups ranged in size from 4-10 participants (N=70) Mistrust of the health care system emerged as a primary barrier to participation in medical research among participants in our study Mistrust stems from historical events including the Tuskegee syphilis study and is reinforced by health system issues and discriminatory events that continue to this day Mistrust was an important barrier expressed across all groups regardless of prior research participation or socioeconomic status This study illustrates the multifaceted nature of mistrust, and suggests that mistrust remains an important barrier to research participation Researchers should incorporate strategies to reduce mistrust and thereby increase participation among African Americans
TL;DR: Identifying protective factors underlying the epidemiological paradox, while improving access to care and the economic conditions among Hispanics, are important research and policy implications of this review.
Abstract: Evidence suggests that social and economic factors are important determinants of health. Yet, despite higher porverty rates, less education, and worse access to health care, health outcomes of many Hispanics living in the United States today are equal to, or better than, those of non-Hispanic whites. This paradox is described in the literature as the epidemiological paradox or Hispanic health paradox. In this paper, the authors selectively review data and research supporting the existence of the epidemiological paradox. They find substantial support for the existence of the epidemiological paradox, particularly among Mexican Americans. Census undercounts of Hispanics, misclassification of Hispanic deaths, and emigration of Hispanics do not fully account for the epidemiological paradox. Identifying protective factors underlying the epidemiological paradox, while improving access to care and the economic conditions among Hispanics, are important research and policy implications of this review.
TL;DR: Implicit and explicit attitudes about race using the Race Attitude Implicit Association Test for a large sample of test takers, including a sub-sample of medical doctors, showed an implicit preference for White Americans relative to Black Americans and women showed less implicit bias than men.
Abstract: Recent reports suggest that providers' implicit attitudes about race contribute to racial and ethnic health care disparities. However, little is known about physicians' implicit racial attitudes. This study measured implicit and explicit attitudes about race using the Race Attitude Implicit Association Test (IAT) for a large sample of test takers (N=404,277), including a sub-sample of medical doctors (MDs) (n=2,535). Medical doctors, like the entire sample, showed an implicit preference for White Americans relative to Black Americans. We examined these effects among White, African American, Hispanic, and Asian MDs and by physician gender. Strength of implicit bias exceeded self-report among all test takers except African American MDs. African American MDs, on average, did not show an implicit preference for either Blacks or Whites, and women showed less implicit bias than men. Future research should explore whether, and under what conditions, MDs' implicit attitudes about race affect the quality of medical care.
TL;DR: Medical and social service providers and policy makers may improve the quality of care for abused Latina and Asian immigrant women by understanding and addressing barriers to patient-provider communication and help seeking.
Abstract: This study identifies social, political, and cultural barriers to help seeking from health care organizations faced by abused Latina and Asian immigrant women. Qualitative data were collected through four semistructured ethnic-specific focus group interviews with 28 abused Latina and Asian immigrant women. Participants who had suffered intimate partner abuse were recruited through urban community-based organizations in San Francisco, California. Sociopolitical barriers to help seeking and patient-provider communication included social isolation, language barriers, and, for some, discrimination and fears of deportation. Sociocultural barriers included dedication to the children and family unity, shame related to the abuse, and the cultural stigma of divorce. Abused Latina and Asian immigrant women face significant social, cultural, and political barriers to patient-provider communication and help seeking. Medical and social service providers and policy makers may improve the quality of care for these women by understanding and addressing these barriers.
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