- 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).
One of my research interests is the impact of speaking a limited-English proficiency on cardiovascular care. This topic fits into 1st generation research. The impact of speaking a primary language other than English has been studied in relation to medication adherence and control of chronic diseases (i.e. diabetes) but there is little research surrounding language and cardiovascular care i.e. the patterns of care and diagnostic testing that patients who present with chest pain receive in the emergency department. Previously, racial disparities in cardiovascular care have been documented with black patients being less like than white patients to receive cardiovascular testing and interventions. My hypothesis is that speaking a language other than English is likely to increase rates of diagnostic testing – as providers who feel they are unsure about their history taking due to language barriers may be more likely to order diagnostic testing. If a disparity in cardiovascular care utilization is found, second generation research parsing out the role of contextual factors such as presence of interpreters and confounding factors such as race/ethnicity, insurance status and hospital characteristics must be studied. Future 3rd generation work would be focused on clinical interventions using interpreter services or culturally competent/ language-tested questionaries’ to facilitated information transfer in the emergency department
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. What types of clinical interventions can you think of in your area of research that could similarly bridge levels of the socioecological model?
My research interest - the impact of speaking a limited-English proficiency on cardiovascular care - is a care-delivery topic, thus the resulting interventions would primarily be focused at the “ambulance” level rather than the fence or safety-net.
I do think that a source of over-testing is clinician uncertainty with the history they receive from patients and this uncertainty is magnified by language barriers i.e. when clinicians ask what type of chest pain a patient is experiencing – they may ask if they have chest pressure? A sharp pain? A burning pain? Does it feel like an elephant sitting on your chest? My own experience is that these subjective questions are more difficult than objective questions (i.e. do you have a rash), as these adjectives may have different meanings across diverse languages. I think that educational outreach at community / religious centers targeting limited-English proficiency patients around the concerning features of chest pain might have a beneficial impact. Similar to the common “symptoms of a stroke” flyers designed to educate patients on when to seek care – language-specific flyers might be able to assist patients and physicians in conveying chest pain features which require additional testing.