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).
Thomas et al. define 1st generation research as research focusing on detection, identification and documentation of disparities including identifying vulnerable populations. 2nd generation research determines causal relationships that underlie health disparities. 3rd generation research provides solutions for eliminating health disparities. 4th generation research is research that takes action to eliminate disparities using a public health critical race praxis. My specific area of research is in nonadherence among adolescents with chronic kidney disease and how nonadherence affects transplant access and outcomes. My current research proposal primarily works within the 1st generation model and will be primarily focused on how adherence interacts with racial/ethnic and socioeconomic disparities in transplantation. In the future, I would like to directly address these disparities using the 4th generation framework. This would involve a multilevel approach in which I would work with patients, parents/guardians, and providers to identify modifiable factors affecting adherence and transplant access and develop implementation strategies that are both feasible and reasonable to the groups who will be subjected to them.
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.
De-medicalizing interventions and monitoring and moving them into the community is a method that I have considered for further research in the field of adherence among adolescents with chronic kidney disease. It is well known that adolescents value input from their peers over that of their parents or health care providers. Transplant Hero is a currently available smartphone app that allows transplant patients to set medication reminders and assign a trusted person to also see these alarms and remind them to take their medications. A project I am considering for the future is working with adolescent patients to identify a trusted peer who agrees to download the Transplant Hero app and help remind the patient to take their medications.