Part 1:
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).
Nancy Krieger; Kevin Smith, Deepa Naishadham, Cathy Hartman,
Elizabeth M. Barbeau: Experiences of discrimination: Validity and reliability of a self-report measure for population health research on racism and health. Social Science & Medicine 61 (2005) 1576–1596.
2.What was the definition of the construct?
A self-report questionnaire instrument that measures past exposure to racial discrimination. The “Experiences of Discrimination (EOD)” instrument is based on a previous tool developed by Krieger and used in the CARDIA study.
3.How did the authors provide evidence on the validity of the measure? Could you think of additional approaches to validating the measure?
In addition to employing the EOD measure, the authors also employed another instrument that measures discrimination; the Major and Everyday discrimination measure (developed by Williams, 1997) as well as multiple single-item questions. Furthermore, the authors looked at the association of the EOD instrument with two health outcomes, psychological distress and smoking, that have been previously shown to be correlated with self-reported experiences of discrimination. The authors also collected information of experiences of discrimination from “key informants”. 75% of these key informants had known the study participant for greater than 5 years. The authors then looked at the concordance of study participant and key informants’ reports of experienced discrimination. I believe the authors had enough measures to validate this tool, including using single-item and other multiple-item tools.
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?
The authors reported scale reliability with Cronbach’s alpha (0.74) and by test re-test reliability correlations for the EOD items between the main study and the validation study (0.70). I wonder if the re-test reliability could be questioned as slightly less reliable because participants will have had time to think about prior experiences of discrimination once the topic is brought up during the first time EOD is given. This could increase recall of these negative experiences and change the re-test results.
5.Describe the implications of a lack of measurement validity or reliability for future research applications.
Without measuring validity or reliability, self-report measures such as the EOD can lead to mis-representation of results. Questionnaires are notoriously difficult to use as measurements due to biases introduced to participants (recall bias, need to please staff by answering what they think researchers want to know, misunderstanding of questions, etc.). This could result in null results which may lead to less interventions or policy changes.
Part 2:
1.Find a paper describing a health disparity (please give the full citation or upload the paper)
Neeta Thakur M.D., M.P.H., Melissa Martin M.D., Elizabeth Castellanos B.S., Sam S. Oh Ph.D., M.P.H., Lindsey A. Roth M.A., Celeste Eng B.S., Emerita Brigino-Buenaventura M.D., Adam Davis M.A., Kelley Meade M.D., Michael A. LeNoir M.D., Harold J. Farber M.D., M.S.P.H., Shannon Thyne M.D., Saunak Sen Ph.D., Kirsten Bibbins-Domingo Ph.D., M.D., Luisa N. Borrell D.D.S., Ph.D. & Esteban G. Burchard M.D., M.P.H. (2014) Socioeconomic status and asthma control in African American youth in SAGE II, Journal of Asthma, 51:7, 720-728
2.Summarize the construct and measurement of the dimension of disparity (e.g., race, SES) and the outcome measured (e.g., self-rated health).
SES was assessed using a composite index score that varied from 3-9 and was composed of 3 variables: maternal education, annual household income, and insurance type. These measures have been validated as stable measures of SES, current access to resources, and access to health care services, respectively. The outcome measured was asthma control. This is a composite score validated by the National Heart, Lung, and Blood Institute (NHLBI) that is based on questionnaire data responses of asthma symptoms, recent rescue medication use, nighttime awakenings and limitations of activity, in addition to lung function measures.
3.What is the evidence for the validity and reliability of the measures?
Both the SES and the asthma control composite scores have been previously validated in other studies and the asthma control composite score is used as a standard to measure control.
4.What is the reference category used for the disparity measure? Why does this reference category make sense (or not) for this research question?
There is no particular reference category for SES in this specific study. The SES score is reported to change by a certain odds ratio for each unit decrease (to lower SES) in the index. This makes sense for this research question because the authors were trying to determine how each unit decrease in SES is associated with a higher odds ratio of poor asthma control.
5.How is the disparity quantified? 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.
The disparity is quantified as a composite score scaled 3 to 9. The score itself is a relative measure that is based on absolute variables (maternal education, annual income, and insurance type). I would prefer the measure to be relative in this case as we are trying to determine how SES changes the odds of a health outcome (asthma control). Using an absolute measure for the SES index score may make less sense than using a relative measure that can compare each SES index score to the others.