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).
My current projects are using national databases to understand if/what types of disparities exist between men and women with regards to their presentation, care, and outcomes related to peripheral arterial disease (PAD), specifically critical limb ischemia (CLI). This is 1st/2ndgeneration disparities research, aiming to answer the question “do disparities exist” and to a lesser degree “why do disparities exist”? My hope is that by answering these questions in my field, I can move on to conduct valuable 3rd/4thgeneration disparities research. For example one area of focus for me is disease severity at time of intervention, and my preliminary work shows that women undergoing operative interventions have more advanced disease than men. We are now looking into the why behind this, is it related to access to care, or perhaps lack of knowledge in patients and providers on how to identify and diagnose women with PAD (given the vast majority of PAD research is in men)? By answering these questions we can create data driven, targeted interventions towards improving timely diagnosis of PAD that will help mitigate the disparities in disease severity at time of intervention which will hopefully improve outcomes after interventions as well.
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.’’
To me, these interventions focus on providing necessary resources when and where vulnerable populations need them. Supposing our 2ndgeneration research finds that education and screening for PAD in women is truly the cause of the disparity we see in disease severity at time of intervention, it will be important to design interventions that address this. One potential option would be to include PAD screening questions as part of a regular women’s health visit after a certain age. Additionally, educational campaigns targeted at women (as have been done for mammograms, pap smears, etc) could be valuable in addressing this disparity.