How Perceived Structural Racism and Discrimination and Medical Mistrust in the Health System Influences Participation in HIV Health Services for Black Women Living in the United States South: A Qualitative, Descriptive Study

2020 ◽  
Vol 31 (5) ◽  
pp. 598-605 ◽  
Author(s):  
Schenita D. Randolph ◽  
Carol Golin ◽  
Hayley Welgus ◽  
Alexandra F. Lightfoot ◽  
Caressa J. Harding ◽  
...  
Author(s):  
Emmanuella N Asabor ◽  
Sten H Vermund

Abstract Tuberculosis incidence in the United States is declining, yet projections indicate that we will not eliminate tuberculosis in the 21st century. Incidence rates in regions serving the rural and urban poor, including recent immigrants, are well above the national average. People experiencing incarceration and homelessness represent additional key populations. Better engagement of marginalized populations will not succeed without first addressing the structural racism that fuels continued transmission. Examples include:(1)systematic underfunding of contact tracing in health departments serving regions where Black, Indigenous, and People of Color (BIPOC) live;(2) poor access to affordable care in state governments that refuse to expand insurance coverage to low-income workers through the Affordable Care Act;(3) disproportionate incarceration of BIPOC into crowded prisons with low tuberculosis screening rates; and(4) fear-mongering among immigrants that discourages them from accessing preventive health services. To eliminate tuberculosis, we must first eliminate racist policies that limit essential health services in vulnerable communities.


Author(s):  
Lauren F. Seibel ◽  
Robin Peth-Pierce ◽  
Kimberly E. Hoagwood

AbstractNearly four decades ago, Unclaimed Children documented the gaps in the United States between mental health programs and caregivers’ perspectives about those services for their children. This absence of attention to parent or caregiver perspectives, including their satisfaction with these services, was a key finding of the report, which detailed system failure in caring for youth with mental health needs. Since then, the focus on caregiver satisfaction with children’s mental health services has been largely overlooked in research, and when examined has been mostly included as an indicator of the feasibility of program implementation. In striking contrast, overall healthcare system reforms have highlighted the importance of improving consumer’s direct experience of care. However, caregiver satisfaction remains largely disconnected to these overall health system reforms, even as reforms focus increasingly on value-based, coordinated and integrated care. In this paper, we review literature from 2010 to 2020, revisit the measurement of caregiver satisfaction, identify how and when it is being measured, and delineate a research agenda to both realign it with health system improvements, refine its focus on expectancies and appropriateness, and root it more firmly in the principles of user experience (UX) and human-centered design (HCD).


1984 ◽  
Vol 39 (12) ◽  
pp. 1424-1434 ◽  
Author(s):  
David J. Knesper ◽  
John R. Wheeler ◽  
David J. Pagnucco

2021 ◽  
pp. 233264922098109
Author(s):  
Shannon K. Carter ◽  
Ashley Stone ◽  
Lain Graham ◽  
Jonathan M. Cox

Reducing race disparities in breastfeeding has become a health objective in the United States, spurring research aimed to identify causes and consequences of disparate rates. This study uses critical discourse analysis to assess how Black women are constructed in 80 quantitative health science research articles on breastfeeding disparities in the United States. Our analysis is grounded in critical race and intersectionality scholarship, which argues that researchers often incorrectly treat race and its intersections as causal mechanisms. Our findings reveal two distinct representations. Most commonly, race, gender, and their intersection are portrayed as essential characteristics of individuals. Black women are portrayed as a fixed category, possessing characteristics that inhibit breastfeeding; policy implications focus on modifying Black women’s characteristics to increase breastfeeding. Less commonly, Black women are portrayed as a diverse group who occupy a social position in society resulting from similar social and material conditions, seeking to identify factors that facilitate or inhibit breastfeeding. Policy implications emphasize mitigating structural barriers that disproportionately impact some Black women. We contribute to existing knowledge by demonstrating how dominant health science approaches provide evidence for health promotion campaigns that are unlikely to reduce health disparities and may do more harm than good to Black women. We also demonstrate the existence of a problematic knowledge set about Black women’s reproductive and infant feeding practices that is both ahistorical and decontextualized.


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