Advancement of Health Disparities Research: State of Nursing Science

1
Advancement of Health Disparities Research
State of Nursing Science

• Bobbie Berkowitz, PhD, RN, FAAN
• Professor and Chair
• University of Washington
• School of Nursing

2
Objectives

• Describe a model center for health disparities
  research
• Provide a conceptual framework for advancing
  health disparities research
• Discuss the contribution of nursing to research
  in health disparities

3
Health Disparities

• Differences in the incidence, prevalence,
  mortality, and burden of disease and other
  adverse health conditions that exist among
  specific population groups in the US.
• NIH Work Group on Health Disparities

4
Racial Ethnic Healthcare Disparities

• Racial and ethnic differences in the quality of
  healthcare that are not due to access-related
  factors or clinical needs, preferences, and
  appropriateness of the intervention.
• Institute of Medicine (2003)
  Unequal Treatment
• Confronting Racial and Ethnic
  Disparities in
• Healthcare.

5
Center for the Advancement of Health Disparities
Research

• P20 Center funded by the National Institute of
  Nursing Research (10/02-6/07)
• Collaborative partnership between the University
  of Hawaii at Manoa School of Nursing and Dental
  Hygiene and the University of Washington School
  of Nursing

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Center Mission

• The Center will develop scholarship relevant to
  understanding health disparities, catalyze
  research on health disparities, and develop
  future scholars to extend knowledge regarding
  health disparities.

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Center Goals

• Eliminate barriers to care within and across
  populations through an understanding of the
  prejudices and preconceptions that blind society
  to the diverse needs of its people.
• Unearth cultural, institutional, political,
  linguistic, and economic roadblocks to care and
  bring to those who can benefit from and those who
  can act on such insights.
• Enhance communication between the Center and
  those populations it ultimately exists to serve.

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Conceptual Framework

• Provides a roadmap for the Center for the
  Advancement of Health Disparities Research.
• Describes the issues and variables of interest
  for health disparities research.

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Issues Related to Health Disparities

• Nursing PartnershipCenter for the Advancement
  of Health Disparities Research
• Mission Statement
• Collaboration Across Academic Institutions
• Nurse Researchers Focused on Health Disparities
• Innovation in Health Disparities Research

• VARIABLES OF INTEREST
• Research development (design, methods
  instruments)
• Evidence-based nursing interventions
• Community-based initiatives

Elimination of Health Disparities
Research Trends in Disparities, Best
Approaches

• VARIABLES OF INTEREST
• Socioeconomic factors
• Environment factors
• Genetic factors
• Biological factors
• Behavioral factors
• Racial ethnic discrimination
• Gender discrimination

Determinants of Health Related to Health
Disparities

• VARIABLES OF INTEREST
• Chronic Disease
• Mental Health
• Cultural competency ethnic considerations of
  families, groups, communities (minority health)

Effects on Population Health Resulting from
Health Disparities

• VARIABLES OF INTEREST
• Service delivery Diversity of the workforce and
  access to care
• Symptom management
• Health promotion
• Laboratory analysis of biological indicators of
  health disparities

Health Care Needs Costs Resulting from Health
Disparities

• VARIABLES OF INTEREST
• Health status indicators
• Data sensitive to health disparities
• Quality indicators for health disparities

Policy and System Supports for the Elimination of
Health Disparities
To utilize this framework, please call the
Center for the Advancement of Health Disparities
Research at 206-616-6360 or email Laura Mason
at ljmason_at_u.washington.edu.
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Research Trends in Disparities and Best Approaches

• Research development (design, methods,
  instruments)
• Evidence-based nursing interventions
• Community-based initiatives

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Determinants of Health

• Socioeconomic factors
• Environmental factors
• Genetic factors
• Biological factors
• Behavioral factors
• Racial and ethnic discrimination
• Gender discrimination

12
Effects on Population Health

• Chronic disease
• Mental health
• Cultural competency and ethnic considerations of
  families, groups, communities

13
Health Care Needs and Costs Resulting from Health
Disparities

• Service delivery (diversity of the workforce
  access to care)
• Symptom management
• Health promotion
• Laboratory analysis of biological indicators of
  health disparities

14
Policy System Supports for the Elimination of
Health Disparities

• Health status indicators reflective of health
  disparities
• Data sensitive to health disparities
• Quality indicators for health disparities

15
Research Underway

• Pilot Studies, Year 1
• Use of Traditional Chinese Medicine and
  Treatments by Chinese-Americans with Type 2
  DiabetesChen-Yen Wang, Ph.D., MN, RN, UHM
  Associate Professor
• Promoting Equal Access to Long-Term Care Service
  Utilization Among Diverse Ethnic Groups in
  HawaiiCharon A. Pierson, PhD, RN, UHM Assistant
  Professor
• Korean American Parenting and Childrens Conduct
  Problem BehaviorsEunjung Kim, PhD, RN, ARNP, UW
  Assistant Professor

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Research Underway

• Pilot Studies, Year 2
• Community Mapping Tobacco Environment in Native
  Hawaiian CommunitiesJohn Casken, RN, MPH, PhD,
  UHM Assistant Professor
• Filipino American Grandparents Caring for
  Grandchildren Caregiving Role, Acculturation,
  and Perceived Health StatusMerle Kataoka-Yahiro,
  Dr.P.H.,UHM Assistant Professor
• Assessing Health Beliefs, Physical Activity and
  Physical Functioning of the Filipino
  ElderlyClementina D. Ceria, RN, Ph.D., UHM
  Assistant Professor

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Research Underway

• Pilot Studies, Year 2, continued
• Intergenerational Relations, Family Functioning
  and Mental Health in Filipino Immigrant Families
  A Pilot StudyMayumi A. Willgerodt, RN, Ph.D., UW
  Assistant Professor
• Cultural Acceptability of the Family Centered
  Program for Adolescents with Schizophrenia to
  Asian American FamiliesMichael G. Kennedy, ARNP,
  Ph.D., CS, UHM Assistant Professor
• Research Participation in Women with a Partner in
  Prison A Feasibility StudyCheryl Cooke, RN,
  Ph.D., UW Post Doctoral Fellow

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State of the Science

• Our mission in health disparities research
• Nursing contribution to the state of the science
• Future directions

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Mission

• Aggressively develop and implement a research
  agenda that contributes to evidence-based
  practice and policy models aimed at the
  elimination of health disparities.
• Community-based studies
• Intervention studies
• Methodological approaches that encourage
  community participation

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Nursing Contribution to the State of the Science

• Overview of studies between 1952-2000
• Sample of studies between 2000-2004

21
Nursing Research (1952-2000)

• Flaskerud, Lesser, Dixon, Anderson, Conde,
  Koniak-Griffin, et al (2002) Health Disparities
  Among Vulnerable Populations Evolution of
  Knowledge Over Five Decades in Nursing Research
  Publications. Nursing Research, 51(2).

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Nursing Research (2000-2004)

• Research Trends in Disparities
• Best Approaches
• Design, Methods, Instruments
• Riner, Cunningham Johnson (2004) Public Health
  Education and Practice Using Geographic
  Information System Technology. Public Health
  Nursing, 21(1).
• Killien, Bigby, Champion, Fernandez-Repollet,
  Jackson, Kagawa-Singer, et al (2000). Involving
  Minority and Underrepresented Women in Clinical
  Trials The National Centers of Excellence in
  Womens Health. Journal of Womens Health
  Gender-Based Medicine, 9(10).

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Nursing Research (2000-2004)

• Research Trends in Disparities
• Best Approaches
• Community-based Initiatives
• Lorig, Ritter Gonzalez (2003) Hispanic Chronic
  Disease Self-Management. Nursing Research, 52(6).
• Averill (2002) Voices From the Gila Health Care
  Issues for Rural Elders in South-Western New
  Mexico. Journal of Advanced Nursing, 40(6).

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Nursing Research (2000-2004)

• Determinants of Health
• Socioeconomic Factors
• Kneipp Drevdahl (2003) Problems with Parsimony
  in Research on Socioeconomic Determinants of
  Health. Advances in Nursing Science, 26(3)
• Environmental Factors
• Bent, K. (2003) Culturally Interpreting
  Environment as Determinant and Experience of
  Health. Journal of Transcultural Nursing, 14(4)

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Nursing Research (2000-2004)

• Effects on Population Health
• Chronic Disease
• Lewis (2002) Clinical Nurse Specialist Practice
  Addressing Populations with HIV/AIDS. Clinical
  Nurse Specialist, 16(6).
• Graham-Garcia, Raines, Andrews, Mensah (2001).
  Race, Ethnicity, and Geography Disparities in
  Heart Disease in Women of Color. Journal of
  Transcultural Nursing, 12(1).
• Appel, Harrell, Deng (2002) Racial and
  Socioeconomic Differences in Risk Factors for
  Cardiovascular Disease Among Southern Rural
  Women. Nursing Research, 51(3).

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Nursing Research (2000-2004)

• Effects on Population Health
• Cultural Competency Ethnic Considerations of
  Families, Groups, and Communities
• Kim-Godwin, Clarke, Barton (2001) A Model for
  the Delivery of Culturally Competent Community
  Care. Journal of Advanced Nursing, 35(6).
• Dreher MacNaughton (2002). Cultural Competence
  in Nursing Foundation or Fallacy? Nursing
  Outlook, 50(5).

27
Nursing Research (2000-2004)

• Health Care Needs and Costs
• Service Delivery
• Fongwa (2001) Exploring Quality of Care for
  African Americans. Journal of Nursing Care
  Quality, 15(2).

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Future Directions

• NINR NCMHD Research Center Partnerships
• National Alaska Native American Indian Nurses
  Association Recommendations
• Healthy People 2010
• Political Action
• Advancing the Science
• Institute of Medicine Unequal Treatment
  recommendations

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Advancing the Science

• Evidence-based Action
• Identify practical approaches for health care
  providers to reduce disparities
• Measure racial and ethnic disparities in
  populations served by providers, insurers, and
  payers so the rate of disparity will emerge as a
  key measure of quality
• Timely data on patterns of utilization to monitor
  quality
• Lavizzo-Mourey Knickman (2003)
  JAMA

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Advancing the Science

• Examine Variables of Interest within Public
  Health Models
• Focus on ecologic/multilevel determinants
• Integrate population-based models (determinants
  of health) with health services research models
  (behaviors of patients and providers, treatment
  quality, patient satisfaction, cost, access)
• Stewart Napoles-Springer
  (2003) Medical Care

31
Advancing the Science

• New Paradigms
• Explore assets that protect minority groups from
  developing specific diseases and reduce the
  incidence of health risk behaviors
• Doswell (2002) Research in Nursing
  Health
• Recognize societal factors as primary forces that
  contribute to the major health conditions
• Flaskerud Nyamathi (2002)
  Nursing Research

32
Advancing the Science

• Interdisciplinary Research Partnerships
• Community-based initiatives are dependent on
  partnerships with shared-decision making
• Collaboration in transferring research findings
  to practice
• Baker, White, Lichtveld (2001) Public
  Health Reports

33
Unequal Treatment IOM Findings

• Racial ethnic healthcare disparities exist,
  associated with worse outcome and are
  unacceptable
• Many sources, including health systems,
  providers, patients contribute
• Bias, stereotyping, prejudice clinical
  uncertainty by providers may contribute to racial
  and ethnic disparities in healthcare.

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Unequal Treatment IOM Recommendations

• Increase healthcare providers awareness of
  disparities
• Promote consistency and equity of care though the
  use of evidence-based guidelines
• Increase the proportion of underrepresented US
  racial and ethnic minorities among health
  professionals
• Collect and report data on health care access and
  utilization by patients race, ethnicity,
  socioeconomic status, and where possible, primary
  language.

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IOM Recommendations

• Include measures of racial and ethnic disparities
  in performance measurement.
• Conduct further research to identify sources of
  racial and ethnic disparities and assess
  promising intervention strategies.
• Conduct research on ethical issues and other
  barriers to eliminating disparities.

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Our Imperative

• Assure that nursing reflects the diversity of our
  society.
• Advocate for increased funding for research
  targeted at health disparities.
• Investigate political and policy barriers to
  eliminating health disparities
• Alteration of the HHS report National Healthcare
  Disparities Report
• US House of
  Representatives Committee on
• Government
  Reform (2004)