1. After reading the article by Thomas et al., comment on where your research, or your research interests, fit into the generational framework for health disparities research. If your work is 1rst or 2nd generation, comment on how your work could lead in the future to 3rd or 4th generation work. If your work is 3rd or 4th generation, comment on what 1rst and 2nd generation work was necessary as a foundation for your current work (or current interests).
Currently I am formulating a research project with my mentor to investigate cervical cancer screening in patients >65 years of age. Currently US Guidelines from major organizations recommend cessation of screening at 65 if patient’s have had normal screening exams. Little information is known about screening after 65 years of age. In our analysis we will be trying to isolate screening practices and outcomes for this population of patients. I plan to pay specific attention to racial and ethnic minorities in this research as well, to specifically see if there is an observable difference in screening and outcomes. I believe this work would classify as first generational research as part of looks to identify if there are any racial/ethnic disparities in cervical cancer screening and outcomes in patients of color >65 years of age, and if they are different from those of white patients. I believe that this could lead to 3rd or 4th generational work that could A) inform future screening practices in women >65 years of age, and b) isolate if there is a difference between patients of color and how to screen/or not screen and limit poor outcomes with this population as well
2. The barbershop hypertension intervention, while essentially a clinical services intervention operating at either the fence or safety-net level as described by Jones, has some engagement with the social determinants of health. Interventions like that described in the Gottleib article are designed to mitigate the impact of social determinants. How could you apply one of these two types of interventions to your area of research? Propose one or two interventions that engage with social determinants on some level.
I enjoyed reading both of the studies and how they interface with health disparities. I think both are excellent interventions and particularly enjoyed reading how they were set up with eyes towards reducing disparities.
One intervention that I think would work to engage with social determinants of health regarding cervical cancer screening and treatment could revolve around procedures for positive pap testing. Colposcopies considered next step for positive pap testing, and are considered procedures and are given extended procedure time slots. Many Family Medicine Physicians can perform this service in their clinic or they can be referred to an OB/GYN for colposcopies. I cannot speak to OB/GYN clinics, but in my experience most Primary Care Practices only offer these extended procedure time slots during normal business hours (and sometimes on only specific days of the week). Thus, even when clinics offer extended evening hours or Saturday morning clinics, they may not be able to offer the procedure services that patients may need and unable to access during normal business hours because of employment, child care, etc. I think a clinical service intervention would be to thus offer these procedure time slots during extended hours/Saturday clinics. I anticipate some difficulty could be in the support staff of the clinic during these extended hours, thus this would have to be addressed as well to make this intervention feasible.
While this intervention would not mitigate the impact of social determinants, I think it would do a decent job of trying to engage with the social determinates of health in an effort to improve cervical cancer screening and treatment.
3. Please respond to one other classmate's responses to this assignment – post this response as a separate post in the forum.
RESPONSE TO JACK TAYLOR:
Hey Jack,
Thank you so much for sharing your work! I think the idea of combination of the CareEcosystem and your application could be a wonderful avenue for intervention. By communicating the decline the care navigator could be better informed about what potential services the patient would need. I another aspect that could be added to this intervention would be specific services that go beyond just resources for cognitive decline, but also resources for patients experiencing certain social determinants of health that may make care for these patients and their caregivers extra difficult.