1. Choose a paper describing the development or validation of a measure of relevance in health disparities research (please give the full citation and/or upload the paper if that's possible).
Natalie R. Holt, Terrence Z. Huit, Grant P. Shulman, Jane L. Meza, Jolene D. Smyth, Nathan Woodruff, Richard Mocarski, Jae A. Puckett, Debra A. Hope, Trans Collaborations Clinical Check-In (TC3): Initial Validation of a Clinical Measure for Transgender and Gender Diverse Adults Receiving Psychological Services, Behavior Therapy. Volume 50, Issue 6, 2019, Pages 1136-1149, ISSN 0005-7894, https://ucsf.idm.oclc.org/login?url=https://doi.org/10.1016/j.beth.2019.04.001.
2. What was the definition of the construct?
Transgender and gender diverse people (TGD) are a group that faces large documented health disparities and marginalization in health care. Within the provision of psychological services, no measure exists to support measurement-based care using a brief self-report measure. Given the distinct needs of this group, this study developed and provided initial psychometric validation of a short, behavioral health progress monitoring self-report measure, the Trans Collaborations Clinical Check-in (TC3).
3. How did the authors provide evidence on the validity of the measure? Could you think of additional approaches to validating the measure?
The authors explain the validation process of the TC3 starting with an early development and qualitative feedback phase, onto an online validation study. The first version of the TC3 was developed by the third author in collaboration with a TGD client at university training clinic to meet the clinical need of an appropriate progress monitoring scale for that client. Three clinicians who worked with TGD clients participated in unstructured interviews about what topics should be covered in a progress monitoring measure for TGD. Based on these interviews, 16 items were created to assess distress about common areas addressed in therapy or that would be important to monitor. After utilizing the first version of the TC3 with several TGD clients in a university training clinic, they sought feedback on the utility and content of the TC3 as part of a larger study of health care services for gender minorities. Twenty-seven TGD adults and 10 mental health clinicians provided feedback on the TC3 in qualitative interviews. The feedback from community members and providers were integrated with comments from the Trans Collaborations Nebraska Local Community, National Advisory Board, and a panel of experts in TGD health, as well. The measure was then validated online through the participation of 215 TGD individuals.
4. How did the authors provide evidence on the reliability of the measure? Could you think of additional approaches to evaluating the reliability of the measure?
Because the study measure at the time was confined to a geographic location, authors were not able to test the reliability of the TC3 on heterogenous populations. Moving forward, the TC3 should be further validated with a large, diverse sample of TGD individuals to further understand the potential effects of race/ethnicity on TC3 scores, as comparisons between White and non-White participants. It is also important that the TC3 be administered along different age groups. Finally, it should be administered repeatedly through different points in time to monitor changes.
5. Describe the implications of a lack of measurement validity or reliability for future research applications.
Lack of measurement reliability can jeopardize the application of the TC3 in populations that are ethnically diverse, potentially furthering the disparity of non-white transgender individuals who are seeking psychological care.
Part 2:
1. Find a paper describing a health disparity (please give the full citation or, even better, upload the paper so everyone else can look at it too)
Befus, D.R., Irby, M.B., Coeytaux, R.R. et al. A Critical Exploration of Migraine as a Health Disparity: the Imperative of an Equity-Oriented, Intersectional Approach. Curr Pain Headache Rep 22, 79 (2018). https://doi-org.ucsf.idm.oclc.org/10.1007/s11916-018-0731-3
2. Summarize the construct and measurement of the dimension of disparity (e.g., racial inequalities?, SES inequalities?) and the outcome measured (e.g., self-rated health).
The study aims to determine if health disparities impact the timing of initial and follow-up care, as well as overall survival of pediatric patients after a brain tumor diagnosis. It is understood that racial and ethnic disparities in adult healthcare exist but are less defined in the pediatric population. Therefore, the construct is not clearly defined but outcome measures including follow-up information such as total number and percentage of missed follow-up appointments and number of days that had passed between initial symptom onset and the patient’s first neurosurgical consult/appointment.
3. What is the evidence for the validity and reliability of the measures?
The authors conducted a retrospective study of pediatric patients previously diagnosed with, and initially treated for, a primary CNS tumor between 2005 and 2012 at Monroe Carell Jr. Children’s Hospital at Vanderbilt. The validity and reliability of the measures isn’t discussed, presumably because their sample is region dependent and small.
4. What is the reference category used for the disparity measure (ie, who is the comparison group)? Why does this reference category make sense (or not) for this research question?
Overall, of the 198 pediatric brain tumor patients included in the analysis, there were no patients of a race other than White or African American. Although not explicitly stated, I believe that the reference category are White pediatric patients. Ultimately, this comparison group does make sense.
5. How is the disparity quantified or measured? Is this an absolute or relative measure or are both provided? Describe which type of measure you would prefer for this research area, or, if both, why.
Relative measures were provided. The median time from symptom onset to initial presentation was 30.0 days. A mean of 7.45% of all core visits were missed. When comparing African American and Caucasian patients, there was no significant difference in age at diagnosis, timing of initial symptoms, or tumor grade. African American patients missed significantly more core visits than Caucasian patients (p = 0.007). Using both measures would be very beneficial for this research area because it would provide the full picture of the issue.