1. State your health outcome of interest. (It could be the one you used for week #2 or another one.) Pick two key behaviors that are important factors leading to your health outcome. Explain the importance of these behaviors either for etiology, prevention, or intervention. (If none of the behaviors in the readings are important for your health outcome, suggest another behavior that is.)
My health outcome of interest is follow-up in emergency departments after self-managed abortion. Key behaviors influencing health outcomes include navigation of online education and support systems. In terms of education, ability to navigate self-sourced and/or online directions and precautions may influence the rate of ED follow-up. People that are unable to access and interpret online education may not understand what is considered a “safe” or “normal” experience during self-managed medication abortion and may be more likely to present to an emergency department when they do not need to. Unlike someone who has accessed care via telemedicine or in-person consultation for medication abortion, a person who is self-managing because of lack of access may be more likely to follow-up in an emergency department for reassurance from a provider.
2. Describe how you would study the role of one of the behaviors described for question #1 and your health outcome of interest. Incorporate a social factor (e.g. race/ethnicity, social exclusion, stress) in the study approach.
It is difficult to study those who self-manage their abortion as their experience is largely removed from the medical field. In order to better understand how people’s lack of having a medical support person might contribute to seeking emergency department care, I would perform a qualitative study of those who have self-managed their abortion and followed-up up in the emergency department for abortion or post-abortion care.
3. If key health behaviors (e.g. smoking, exercise, nutritious diet) are strongly influenced by neighborhood, income, and/or education, do we need to continue to study how these behaviors influence health outcomes? Why or why not?
We absolutely should continue to study how health behaviors influence health outcomes. Research aimed at understanding these influences can expand our understanding of people’s experiences and can guide development of appropriate interventions. Studying the relationship between behavior and outcome can also focus understanding of the cause of health behaviors - the paper by Freeman is an example of how research using critical race theory revealed how the factor of structural racism affects health behaviors and potentially health outcomes. Pampel et al. highlighted the importance of studying how SES influences health outcomes. Reviewing a diverse group of literature regarding mechanisms of SES’s influence on health behaviors, Pampel’s paper highlights less established influences for health outcomes. While they do not use this to suggest specific interventions, the paper does highlight the diversity of explanatory mechanisms and calls for better research in this field.
Freeman et al. Critical race theory as a tool for understanding poor engagement along the HIV care continuum among African American/Black and Hispanic persons living with HIV in the United States: a qualitative exploration. . International Journal for Equity in Health (2017) 16:54 DOI 10.1186/s12939-017-0549-3
Pampel, et al. Socioeconomic Disparities in Health Behaviors. Annu Rev Sociol. 2010 August ; 36: 349–370. doi:10.1146/annurev.soc.012809.102529.