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).
The Thomas article does a great job highlighting how health disparities research has progressed over the past 20+ years. My current work falls inside the 3rd generation work, focusing on interventions to reduce health and health care disparities. I have benefited from prior work in the 1st and 2nd generation work to set the foundation to identify health and health care disparities (1st generation) and connect health outcomes to the social determinants of health (2nd generation). It is widely accepted that there are disparities in health and health care access and delivery, with not all patients/persons having the same ability to access the same quality of care, and certain populations are more marginalized than others (1st generation). It is also now widely accepted that social determinants of health impact health outcomes, with things like unequal access to healthy food, supermarkets, sidewalks and safe parks being related to obesity and diabetes (2nd generation). As Thomas et al point out, there is now growing interest in evaluating interventions to address health and health care disparities (3rd generation), which is where my research lies, but they also eloquently point out how this work is not sufficient to reduce disparities. A big take away for me from their 4th generation model is patient/community engagement—which is the part of research that is often missing. In many projects/programs, even those that engage community groups and patient advocates, the actual patient voice can be overlooked—true of a project I did in residency looking at the impact of the PCMH model on health care disparities. where we interviewed clinicians, practice transformation groups, patient advocacy groups, policy makers, grant organizations, researchers, and payors, but not patients themselves. The 4th generation model also focuses on advocacy and action, another piece of research that can also be difficulty to achieve—turning findings and recommendations into actual change. I strive to be self-reflective and have cultural confidence—knowing that I have many opportunities and privileges in society and must always consider implicit bias in all my work, and question how I frame and think about my research, and how it may impact other cultures differently—never able to truly understand racial complexities—which is where collaboration with the patients and communities within which I work is so important. I have much growth to do with my own research and look forward to striving toward the 4th generation model of health disparities research.
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 Walton 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. (Note: Next week we will discuss policy-level interventions designed to directly impact social determinants).
Being interested in delivery of social services within the health care setting, I am highly interested in research focused on the evaluation of health care-based interventions to address social determinants of health. One project I am currently involved with is evaluating the Accountable Health Communities 10-item screening tool in terms of patient acceptability, concurrent validity and evaluating patient reported social needs vs. desire for assistance from their health care system. In this multi-site study, we hope to gain a better understanding of how patients feel about being asked personal social and economic questions in their health care clinic, and what patient-level demographics may impact patient acceptability and desire for assistance from the health care system. Through qualitative interviews, we will be able to further unpack perspectives on basic needs screening in health care systems, which will help inform not only how we talk to patients about their social and economic needs in clinic, but also how we can best move forward to actual delivery of assistance with basic needs. Informed by this work, my hope is to then take the research to the next level, using what we learn about best screening practices to design an intervention to evaluate how assistance with health-related social needs in clinic can impact health care outcomes. For our clinical trials class, I am designing a phase II RCT in which adult patients with hypertension who screen positive for a health-related social need by the AHC screening tool will be randomized to a face-to-face meeting with a new clinic case manager for referrals, direct assistance and follow-up of referrals (intervention arm) vs. usual care (control arm; provider dependent addressing of social needs). Patients will be followed-up q2months and their BP control will be tracked to better understand the long-term health implications for linking patients with community resources on hypertension control.