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).
a. My research is not directly focused on studying health disparities in sarcoidosis, however the type of translational and basic science research I perform need to take into account health disparities in sarcoidosis. I also need to be careful not to perpetuate disparities based on the study design I employ (ensuring broad enrollment of diverse populations), the methods (how I capture self-identified race, socioeconomic measures, and clinically-meaningful outcomes), and the conclusions I make (e.g. attributing biologic mechanisms to the difference in disease outcomes based on race or gender). There is on-going research in Sarcoidosis that is documenting difference in incidence/prevalence as well as mortality differences based on race and gender, which is first generation research. There is limited research currently that is identifying the causal factors for this.
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.
a. Sarcoidosis outcomes could be improved in multiple ways that include increased detection of disease in at-risk populations (e.g. African Americans) and ensuring that sarcoidosis patients receive accurate treatment. Interventions such as those employed by the barbershop hypertension intervention could be employed to help screen patients. For example, public notifications that encourage African Americans to obtain chest X-rays if they have common symptoms (e.g. cough, fatigue, shortness of breath). These notifications could be targeted to local communities such as bus stops, grocery stores, or beauty/barbershops. Another intervention that focuses on improving adherence to medications in patients with sarcoidosis could employ community structures such as churches and unions to have education and monitoring of patients taking these medications. The goal would be educate patients as to why it’s important to treat the disease and ensure that patients’ understanding of side effects ensures that they do not prematurely stop treatments.
3. Please respond to one other classmate's responses to this assignment – post this response as a separate post in the forum.
a. Hi Alison, Your research is very interesting and important in addressing disparities in IPF and other forms of fibrosing ILD. Since ILD is so dependent on advanced clinical centers, access to these centers can be a large barrier to receiving care. Understanding how much direct geography and distance to these centers vs. other factors such as race and SES relate is really important. I like that you are pursuing doing pilot programs to offer care to rural patients in your K is a great idea.