The role of socioeconomic status (SES) in explaining racial/ethnic disparities in diabetes remains unclear. We investigated disparities in self-reported diabetes complications, and the role of macro (e.g., income, education) and micro (e.g., ‘owning a home’ or ‘having a checking account’) SES indicators in explaining these differences. The sample included individuals with a diagnosis of diabetes (N=795) who were on average 55 years old, and 55.6% non-Hispanic White, 25.0% African American, and 19.4% Hispanic. Approximately 8% reported nephropathy, 35% reported retinopathy, and 16% reported cardiovascular disease. There were significant disparities in the rates of complications among non-Hispanic White, African American and Hispanic participants, with Hispanics having the highest rates of nephropathy, retinopathy, and cardiovascular disease. Macro SES indicators (e.g., income) mediated racial differences (i.e., non-Hispanic Whites vs. African Americans) in self-reported retinopathy, a combination of macro and more micro SES indicators (e.g., education, income, and ‘owning a home’ or ‘having a checking account’) mediated racial/ethnic differences (i.e., non-Hispanic Whites vs. Hispanics) in self-reported cardiovascular disease, and only micro SES indicators (e.g., ‘owning a home’ or ‘having a checking account’) mediated differences between lower income SES racial/ethnic minority groups (i.e., African Americans vs. Hispanics) in self-reported retinopathy and cardiovascular disease. Findings underscore that indicators of SES must be sensitive to the outcome of interest and the racial/ethnic groups being compared.
Minority Health; Disparities; Diabetes Complications; Socioeconomic Status
To examine the association between physician race/ethnicity, workplace discrimination, and physician job turnover.
Cross-sectional, national survey conducted in 2006–2007 of practicing physicians [n = 529] randomly identified via the American Medical Association Masterfile and The National Medical Association membership roster. We assessed the relationships between career racial/ethnic discrimination at work and several career-related dependent variables, including 2 measures of physician turnover, career satisfaction, and contemplation of career change. We used standard frequency analyses, odds ratios and χ2 statistics, and multivariate logistic regression modeling to evaluate these associations.
Physicians who self-identified as nonmajority were significantly more likely to have left at least 1 job because of workplace discrimination (black, 29%; Asian, 24%; other race, 21%; Hispanic/Latino, 20%; white, 9%). In multivariate models, having experienced racial/ethnic discrimination at work was associated with high job turnover [adjusted odes ratio, 2.7; 95% CI, 1.4–4.9]. Among physicians who experienced work-place discrimination, only 45% of physicians were satisfied with their careers (vs 88% among those who had not experienced workplace discrimination, p value < .01], and 40% were con-templating a career change (vs 10% among those who had not experienced workplace discrimination, p value < .001).
Workplace discrimination is associated with physician job turnover, career dissatisfaction, and contemplation of career change. These findings underscore the importance of monitoring for workplace discrimination and responding when opportunities for intervention and retention still exist.
health care careers; hospital/office administration; race/ethnicity
Researchers have traditionally combined aging women (aged ≥50 years) when reporting their mammography use. This may inadvertently mask important cohort effects in mammography use, which are likely to result from distinct personal life experiences and generational differences. Using the Health and Retirement Study samples of 1998, 2000, and 2004, we examined cohort differences in mammography use between African American women born before 1946 (non–baby boomers) and those born in 1946 to 1953 (baby boomers). Between 1998 and 2004, screening rates for non–baby boomers declined, while those for baby boomers remained relatively steady. Hierarchical linear modeling (HLM) analyses suggest that while screening rates decreased with age (OR, 0.957; 95% CI, 0.947–0.968) cohort effects may have partially reversed the age effect, with non–baby boomers having an increased likelihood of receiving a mammogram compared to baby boomers (OR, 1.697; 95% CI, 1.278–2.254). Because African American women are diagnosed at later stages of breast cancer, documentation of cohort differences in mammography use among older African American women is important as health care professionals design intervention programs that are maximally effective for women from different cohorts. This is particularly critical as more African American women in the baby boomer cohort become part of the aging population.
HIV infection has a devastating impact on individual and public health, and affects populations disproportionately. Treatment with antiretroviral therapy (ART) saves lives, but long-term adherence to ART is critical to its success. We performed an observational cohort study to determine the influence of race, sex and other sociodemographic factors on early ART discontinuations among HIV-infected persons.
TennCare-enrolled adults of black or white non-Hispanic race beginning ART with either a non-nucleoside reverse transcriptase inhibitor (NNRTI) or protease inhibitor (PI) between 1996–2003 (N=3,654) were assessed for early discontinuation. A subgroup of discontinuations was validated using the primary medical record.
Blacks were more likely than whites to discontinue NNRTIs (37 vs. 28%; P=0.003) and PIs (36 vs. 25%; P≤0.001). In multivariable models adjusting for race, sex, age, early HIV-related medical encounter, urban residence and TennCare enrollment category, black race, female sex and younger age were independent predictors of discontinuation among those starting PIs. Among persons starting NNRTIs, black race, younger age and a disability-based enrollment category predicted early drug discontinuation, but female sex did not.
Our results suggest that sociodemographic factors were associated with early NNRTI and PI discontinuation in this population, and some factors were ART class specific.
HIV/AIDS; treatment; health insurance
Individuals at greater risk for cardiovascular disease (CVD) display poorer cognitive functioning across various cognitive domains. This finding is particularly prevalent among older adults; however, few studies examine these relationships among younger adults or among African Americans.
The objective was to examine the relationships among 2 cardiovascular risk factors, elevated blood pressure and elevated triglycerides, and verbal learning in a community-based sample of African Americans.
Measurements of blood pressure and triglycerides were obtained in 121 African-American adults and compared to performance on 3 domains of the California Verbal Learning Test-II (CVLT-II).
Blood pressure was not related to CVLT-II performance. Triglyceride levels were inversely related to CVLT-II performance. Higher triglyceride levels were associated with poorer immediate, short delay and long delay recall.
Consistent with studies involving older participants, the current investigation shows that in a nonelderly sample of African Americans, triglyceride levels may be related to cognitive functioning. Because early detection and intervention of vascular-related cognitive impairment may have a salutary effect, future studies should include younger adults to highlight the impact of cardiovascular risk on cognition.
cognitive functioning; African Americans; cardiovascular
Understanding genetic factors that contribute to racial differences in cancer outcomes may reduce racial disparities in cancer morbidity and mortality. Achieving this goal will be limited by low rates of African American participation in cancer genetics research (CGR).
We conducted a qualitative study with African American adults (n=91) to understand attitudes about participating in CGR and to identify factors that are considered when making a decision about participating in this type of research.
Participants would consider the potential benefits to themselves, family members, and their community when making a decision to participate in CGR. However, concerns about exploitation, distrust of researchers, and investigators’ motives were also important to participation decisions. Individuals would also consider who has access to their personal information and what would happen to these data. Side effects, logistical issues, and the potential to gain knowledge about health issues were also described as important factors in decision-making.
African Americans may consider a number of ethical, legal, and social issues when making a decision to participate in CGR. These issues should be addressed as part of recruitment efforts.
African American; Participation; Cancer Genetics Research; Barriers and Facilitators
To review the success of barbershops as vehicles for health promotion and outline the Black Barbershop Health Outreach Program (BBHOP), a rapidly growing, replicable model for health promotion through barbershops.
BBHOP was established by clinicians in order to enhance community level awareness of and empowerment for cardiometabolic disorders such as diabetes and cardiovascular disease. At coordinated events utilizing existing infrastructures as well as culturally and gender-specific health promotion, BBHOP volunteers screen for diabetes and hypertension and reinforce lifestyle recommendations for the prevention of cardiometabolic disorders from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Patrons with abnormal findings are referred to participating physicians or health care facilities. We performed a selective review of the literature in order to place this model for health promotion in the context of previous efforts in barbershops. BBHOP is among several successful programs that have sought to promote health in barbershops.
Combining a grassroots organization approach to establishing a broad-based network of volunteers and partner agencies with substantial marketing expertise and media literacy, the BBHOP has screened more than 7000 African American men in nearly 300 barbershops from more than 20 cities across 6 states.
The BBHOP is an effective method for community level health promotion and referral for cardio-metabolic diseases, especially for AA men, one of the nation’s most vulnerable populations.
research; African Americans; men’s health
The purpose of this cross-sectional study was to assess the 2009 prevalence of chlamydial (CT) and gonococcal (GC) infection in two populations in a mid-western city in the United States: patients at a public sexually transmitted disease (STD) clinic, and individuals seeking HIV counseling and testing services at an AIDS community organization. We characterized STD prevalence in a random sample of 592 STD clinic patients and a convenience sample of 471 individuals agreeing to STD testing through outreach efforts at the community organization. The STD clinic population was 59% male, 60% black, with 3.1 mean sex partners in the last year. The community organization population was 72% male, 19% black, with a mean of 4.3 partners in the last year. The prevalence of CT and GC combined was consistently higher in STD clinic patients than at the community organization (18% vs. 4%). CT prevalence was higher than GC prevalence in both populations (CT: 3% and 13% at the STD clinic and community organization, respectively, vs. GC: 1% and 7%, respectively). Factors significantly associated with increased odds of GC/CT at the STD clinic include unmarried status, younger age, at least six partners in the last year, and unprotected sex in the last year. At the community organization, the only factor significantly associated with increased odds of GC/CT was lower educational attainment. Our findings confirm that STD prevalence differs widely by population group. Given these differences, local approaches to STD control should also be carefully targeted to specific subgroups.
chlamydia; gonorrhea; STD clinic; NAAT
Although blacks are at higher risk for obstructive sleep apnea (OSA), they are not as likely as their white counterparts to receive OSA evaluation and treatment. This study assessed knowledge, beliefs, and attitudes towards OSA evaluation and treatment among blacks residing in Brooklyn, New York.
Five focus groups involving 39 black men and women (aged ≥18 years) were conducted at the State University of New York (SUNY) Downstate Medical Center in Brooklyn to ascertain barriers preventing or delaying OSA evaluation and treatment.
Misconceptions about sleep apnea were a common theme that emerged from participants’ responses. Obstructive sleep apnea was often viewed as a type of insomnia, an age-related phenomenon, and as being caused by certain bedtime activities. The major theme that emerged about barriers to OSA evaluation was unfamiliarity with the study environment. Barriers were categorized as: problems sleeping in a strange and unfamiliar environment, unfamiliarity with the study protocol, and fear of being watched while sleeping. Barriers to continuous positive airway pressure (CPAP) treatment adoption were related to the confining nature of the device, discomfort wearing a mask while they slept, and concerns about their partner’s perceptions of treatment.
Results of this study suggest potential avenues for interventions to increase adherence to recommended evaluation and treatment of OSA. Potential strategies include reducing misconceptions about OSA, increasing awareness of OSA in vulnerable communities, familiarizing patients and their partners with laboratory procedures used to diagnose and treat OSA. We propose that these strategies should be used to inform the development of culturally and linguistically tailored sleep apnea interventions to increase awareness of OSA among blacks who are at risk for OSA and associated comorbidities.
focus group; sleep apnea; African Americans; knowledge, attitudes, and beliefs
Substantial changes in not only access to care, cost, and quality of care, but also health professions education are needed to ensure effective national healthcare reform. Since the actionable determinants of health such as personal beliefs and behaviors, socioeconomic factors, and the environment disproportionately affect the poor (and often racial/ethnic minorities), many have suggested that focusing efforts on this population will both directly and indirectly improve the overall health of the nation. Key to the success of such strategies are the ongoing efforts by historically black medical schools (HBMSs) as well as other minority serving medical and health professional schools, who produce a disproportionate percentage of the high-quality and diverse health professionals that are dedicated to maintaining the health of an increasingly diverse nation. Despite their public mission, HBMSs receive limited public support threatening their ability to not only meet the increasing minority health workforce needs but to even sustain their existing contributions. Substantial changes in health education policy and funding are needed to ensure HBMSs as well as other minority-serving medical and health professional schools can continue to produce the diverse, high-quality health professional workforce necessary to maintain the health of an increasingly diverse nation. We explore several model initiatives including focused partnerships with legislative and business leaders that are urgently needed to ensure the ability of HBMSs to maintain their legacy of providing compassionate, quality care to the communities in greatest need.
historically black colleges and universities; minority; health disparities
The objective of this pilot study was to determine the effect of a supervised short-term exercise trial on exercise adherence in a sample of African American males.
We observed exercise adherence rates among a group of African American men in response to an exercise intervention. Exercise adherence was determined by dividing the total number of actual sessions attended by the total number of possible sessions (12 sessions). A participant was classified as an adherer if they completed 9 out of 12 exercise sessions (75%).
Seventy-one percent of the study participants (12/17) completed at least 75% of the study sessions and therefore adhered to the study protocol. Among the adherers, 7 out of 12 (58%) had adherence rates of 100%. Five participants withdrew from the exercise group due to lack of time and lack of interest.
Exercise adherence rates among African-American men in this study were favorable during this supervised exercise intervention and were comparable to adherence rates observed in other supervised exercise interventions. Recommendations based on this pilot study are provided to reduce participant withdrawal and to inform future largescale studies.
exercise; adherence; African Americans; men's health
Clinical evidence supports the value of BRCA1/2 genetic counseling and testing (GC/T) for managing hereditary breast and ovarian cancer risk; however, BRCA1/2 GC/T is underutilized among Black women and reasons for low use remain elusive. We examined the potential influence of socio-cultural factors (medical mistrust, concerns about genetic discrimination) on GC/T engagement in a sample of 100 Black women at increased risk for carrying a BRCA1/2 mutation. Eligible participants fell into one of three groups: 1) healthy women with ≥ 1 first-degree relative (FDR) affected by breast and/or ovarian cancer, 2) women diagnosed with breast cancer at age ≤ 50, and 3) women diagnosed with breast and/or ovarian cancer at age ≥ 50 with either one FDR or two second degree relatives with breast and/or ovarian cancer. Participants were recruited from clinical and community settings and completed a semi-structured interview. Study variable relationships were examined using bivariate tests and multivariate regression analysis. Forty-three percent of participants were aware of GC/T services. Yet referral and receipt of GC/T services in this sample was low (28%). After accounting for sociodemographic factors, women with higher self-efficacy had greater GC/T engagement (B = 0.37, p < .001), while those with higher medical mistrust had lower GC/T engagement (B = −0.26, p <. 01). Interventions targeted towards increasing provider referrals may facilitate higher levels of engagement in GC/T services. Individual interventions that enhance women’s personal confidence in obtaining GC/T may also be useful in promoting GC/T engagement.
Medical Mistrust; Self-efficacy; BRCA 1/2; African American
Racial minorities have poorer cancer survival in the United States. The purpose of this study was to better understand patients’ barriers to cancer care, and to determine which patients have a greater need for assistance from a patient navigator.
Community health workers assisted newly-diagnosed breast and colorectal cancer patients during a randomized trial of patient navigation, and collected information about patients’ barriers. Barriers to care were characterized, and were compared between non-Hispanic white and minority patients. A multivariate model was constructed of factors associated with increased log Navigation Time, a measure of patients’ need for assistance.
Patients’ (n=103) most commonly-identified barriers to care included a lack of social support, insurance/financial concerns, and problems communicating with healthcare providers. Barriers differed between non-minority and minority patients, and minority patients faced a greater number of barriers (p=0.0001). In univariate analysis, log Navigation Time was associated with race/ethnicity, education, income, employment, insurance type, health literacy, marital status, language, and comorbidity. A multivariate model (R2=0.43) for log Navigation Time was created using stepwise selection, and included the following factors: minority race/ethnicity (p=0.032), non-full-time employment (p=0.0004), unmarried status (p=0.085), university center (0.0005), and months in study (p<0.0001).
Newly-diagnosed cancer patients’ most common barriers to care include lack of social support, insurance/financial concerns, and problems with healthcare communications. In this sample of patients, a greater need for assistance was independently associated with minority race/ethnicity and unemployment. These data may help in the design and targeting of interventions to reduce cancer health disparities.
Healthcare disparities; Breast neoplasms; Colorectal neoplasms; Minority groups; Community health aides
To evaluate the applicability of an evidence-based video intervention to promote informed decision making for prostate cancer (CaP) screening among African-American men with different levels of health literacy.
Forty nine African-American men participated in interviewer-administered, pretest-posttest interviews between January and March 2008. Health literacy status was assessed with the Test of Functional Health Literacy in Adults (TOFHLA). Repeated measures analysis of covariance (ANCOVA), McNemar or binomial distributions were computed to assess pretest/posttest differences in knowledge. Descriptive statistics were produced to describe participants’ perceptions of the information presented in the video.
Results indicated that men with functional health literacy had higher mean levels of CaP screening knowledge at baseline than men with inadequate health literacy. The between group (F2,44 = 4.84; p = .013) and within group (F1,44 = 5.16; p = .028) test results from repeated measures ANCOVA indicated that preexisting group differences in CaP knowledge had lessened after intervention exposure. Nearly all men rated the information presented in the video as credible (98%), trustworthy (96%), interesting (100%), understandable (94%), and complete (96%).
Result from this exploratory study suggests that the video intervention is suitable for use with African-American men with different health literacy characteristics in two counties in the Greater Florida Panhandle Region. More research is recommended to evaluate the impact of the intervention on mens’ intentions to undergo screening and actual screening behavior.
Health literacy; prostate cancer education; African-American men
Posttraumatic stress disorder (PTSD) has previously been associated with increased risk for a variety of chronic medical conditions and it is often underdiagnosed in minority civilian populations. The current study examined the effects of resilience on the likelihood of having a diagnosis of PTSD in an inner-city sample of primary care patients (n = 767). We measured resilience with the Connor-Davidson Resilience Scale, trauma with the Childhood Trauma Questionnaire and Trauma Events Inventory, and assessed for PTSD with the modified PTSD symptom scale. Multiple logistic regression model with presence/absence of PTSD as the outcome yielded 3 significant factors: childhood abuse, nonchild abuse trauma, and resilience. One type of childhood abuse in moderate to severe range (OR, 2.01; p = .0001), 2 or more types of childhood abuse in moderate to severe range (OR, 4.00; p ≤ .0001), and 2 or more types of nonchildhood abuse trauma exposure (OR, 3.33; p ≤ .0001), were significantly associated with an increased likelihood of PTSD, while resilience was robustly and significantly associated with a decreased likelihood of PTSD (OR, 0.93; p ≤ .0001). By understanding the role of resilience in recovery from adverse experiences, improved treatment and interventional methods may be developed. Furthermore, these results suggest a role for assessing resilience in highly traumatized primary care populations as a way to better characterize risk for PTSD and direct screening/psychiatric referral efforts.
psychiatry; urban population
Interventions that improve clinicians’ awareness of racial disparities and improve their communication skills are considered promising strategies for reducing disparities in health care. We report clinicians’ views of an intervention involving cultural competency training and race-stratified performance reports designed to reduce racial disparities in diabetes outcomes.
Research Design and Methods
Semi-structured interviews were conducted with 12 physicians and 5 nurse practitioners who recently participated in a randomized intervention to reduce racial disparities in diabetes outcomes. Clinicians were asked open ended questions about their attitudes towards the intervention, the causes of disparities and potential solutions to them.
Thematic analysis of the interviews showed that most clinicians acknowledged the presence of racial disparities in diabetes control among their patients. They described a complex set of causes, including socioeconomic factors, but perceived only some causes to be within their power to change, such as switching patients to less expensive generic drugs. The performance reports and training were generally well received but some clinicians did not feel empowered to act on the information. All clinicians identified additional services that would help them address disparities, for example culturally tailored nutrition advice. Some clinicians challenged the premise of the intervention, focusing instead on socioeconomic factors as the primary cause of disparities, rather than patients’ race.
The cultural competency training and performance reports were well received by many but not all of the clinicians. Clinicians reported the intervention alone had not empowered them to address the complex, root causes of racial disparities in diabetes outcomes.
diabetes; disparities; clinician attitudes
We evaluated the effect of perceived discrimination, optimism, and their interaction on health care utilization among African American adults with sickle cell disease (SCD).
Measures of optimism and perceived discrimination were obtained in 49 African American SCD patients. Multiple regression analyses controlling for sex and age tested effects of optimism and perceived discrimination on the number of emergency department visits (ED) and number and duration of hospitalizations over the past year.
A perceived discrimination-optimism interaction was associated with number of emergency departments visits (b = .29, p = .052), number of hospitalizations (b = .36, p = .019), and duration of hospitalizations (b = .30, p = .045) such that those with high perceived discrimination/high optimism had the greatest health care utilization.
African American SCD patients with high perceived discrimination/high optimism had greater health care utilization than patients who reported either low perceived discrimination or low optimism. This study suggests that patient personality and coping styles should be considered when evaluating the effects of stress on SCD-related outcomes.
sickle cell anemia; discrimination; health care
African American women are faced with many challenges regarding their historical, cultural, and social structural position in the United States that may heighten their vulnerability for depression, one of the most prevalent disorders that can engender poor functionality. The purpose of this cross-sectional pilot study was to foster greater understanding about the occurrence and correlates of depressive symptoms among a diverse convenience sample of 63 African American women recruited from a comprehensive primary health care clinic (n = 23), a small private academic institution (n = 25), and an urban community setting (n = 15). Self-report data concerning selected psychological, sociocultural, and biological factors were collected. Descriptive statistics, Pearson product moment correlation, and analysis of variance were used to analyze data. Results indicated several similarities and differences among the 3 groups of women concerning levels of depressive symptoms and their correlates. Among the total sample, symptoms of depression were mild among 65% of the women. Depressive symptoms were significant and positively associated with negative and ruminative thinking (r = 0.79, p < .01), low self-esteem (r = 0.58, p < .01), stressful life events (r = 0.43, p < .05), low social support (r = 0.46, p < .01), depression stigma (r= 0.36, p < 01), and indication of chronic diseases (r = 0.34, p <.01). Depressive symptoms were significant and negatively associated with resiliency (r = −0.48, p < .01) and spiritual well-being [r = −.47, p < .01). This research adds to the empirical data concerning contributors to depressive symptoms for African American women.
depression; African Americans; women’s health; psychosocial
Patient navigation has been widely implemented by cancer care programs across the United States. While activities of navigators have been described elsewhere, little has been documented regarding specific strategies used or challenges experienced by navigators from their own perspectives. We describe the experience of an African American patient navigator who promoted breast cancer screening and facilitated diagnosis and treatment among inner-city mostly African American women in Newark, New Jersey. We conducted qualitative analysis of journal notes, log data, and in-depth interviews with the patient navigator. Strategies used by the patient navigator to develop trust and rapport included: (1) “meet patients where they are” (outreach is best performed in locations women frequent, such as hair salons); (2) being accessible (must be flexible and available by phone or in person to meet patient’s needs); and (3) “bring it down, sista” (must have “street credibility” in dress and language). Key challenges included experiencing threats to safety, setting boundaries, and facing and overcoming burnout. The patient navigator responded to these obstacles by creating new community linkages and resources and reaching out for emotional support from her mother and supervisor. Areas that need to be addressed further for future patient navigator programs include promoting safety in potentially dangerous neighborhoods and helping navigators set boundaries and avoid burnout. Further research into experiences of patient navigators in different settings is needed to build upon this preliminary data, and to consider character traits and attributes best suited for a patient navigator, as well as the support needed for this new health care worker.
breast cancer; minority health; urban population; health care
This study presents black-white breast cancer statistics, tumor histology and receptor status, and treatment patterns for all ages and by age groups (under 40, between ages 40 and 49, and age 50 and over).
The study used data from the National Cancer Institute (NCI) Surveillance, Epidemiology and End Results (SEER) program for the time period 1995–2004. Age-adjusted incidence, mortality, relative survival rates, tumor grade, histology and receptor status, and treatment patterns for invasive breast cancer were calculated for nine SEER cancer registries for 1995–2004.
Invasive breast cancer age-adjusted incidence for black women age <40 was significantly higher than those for white women (rate ratio=1.16, 95% confidence interval=1.10–1.23). Age-adjusted mortality rate for black women age <40 was twice that for white women. Compared to white women, black women were significantly more likely to be diagnosed with regional or distant disease, have lower relative five-year survival rate, and have higher likelihood of being diagnosed with tumors with poorer prognosis. Black women were less likely to receive breast cancer surgery as part of the treatment plan.
Race/ethnic disparities in invasive breast cancer epidemiology, prognostic indicators, and treatment patterns exist between black and white women. The study findings support the need for innovative research, especially on the multifaceted determinants of the differential epidemiology of breast cancer. Equally importantly, there is a need for evidence-guided equal delivery of quality care to eliminate breast cancer disparities among black women.
breast cancer; minority health; mortality; survival; receptor; tumor
To evaluate the knowledge, perceptions, and effectiveness of an human papillomavirus (HPV)/cervical cancer education/prevention program.
Approximately 50 middle and high school girls and their mothers participated in the 7-part educational series. Qualitative pre-evaluations and postevaluations were completed for every session, followed by culminating focus groups with mothers and daughters separately.
Common themes included lack of basic knowledge about HPV and its related cancers. Additionally, mothers and daughters expressed difficulty in communicating with one another about healthy relationships; however, during the focus groups, both mothers and daughters discussed how they had utilized effective communication tools to discuss sensitive topics and make informed decisions together.
Despite recent HPV prevention campaigns, more innovative strategies must be implemented to educate more mothers and daughters of HPV and its dangers. Additionally, in educating communities about HPV and associated cancers, more innovative strategies should be mobilized to trigger discussions regarding protective behaviors against HPV.
health disparities; cervical cancer; sexually transmitted diseases; qualitative research; children/ adolescents
Physician-patient communication can be described according to four prototypes of control – paternalism, mutuality, consumerism, or default. Patients with inadequate health literacy skills may be less active participants in their care and more likely to have paternalistic encounters.
Two independent coders analyzed 31 transcribed outpatient medical visits between physicians and African-American patients with diabetes according to the four prototypes of control. Differences in communication and the balance of power by level of patients’ health literacy were analyzed by quantitative and qualitative methods.
Fourteen patients (45%) had inadequate health literacy, and most of them (N=8, 57%) had paternalistic encounters. Among patients with marginal or adequate health literacy skills, only 4 (23%) had paternalistic visits (p=0.06), and encounters marked by mutuality were most common (N=9, 53%).
Patients with inadequate health literacy appear more likely to have paternalistic interactions with their physicians.
health literacy; physician-patient communication; diabetes