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).
Research interest: Maternal mortality
The research on contraceptive counseling is currently in the third and fourth generations. We know that there are vast disparities in maternal mortality in the United States (first generation), and we know that these disparities are multifactorial but are largely structural relating to racism (second generation, and generating more data on this could still be useful). There are some identified solutions to the problem (i.e., increased access to reproductive care), but more third generation research needs to be done to identify all of the different possible points of intervention for the mechanisms identified in the second-generation research. The development of the reproductive justice framework is what brought maternal mortality research into the fourth generation. Actions that would further fourth generation research include, but are not limited to, (1) increasing self-reflection and race consciousness, which may involve healthcare providers participating in the Undoing Racism Workshop series, or participating in implicit bias training that has an outcome measure beyond attendance at a workshop; (2) diversifying the healthcare provider and researcher work force; (3) amplifying voices of the under-represented and advocating for policy changes at the levels ranging from single institutions to federal institutions to close the health disparities and health care disparities gaps.
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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).
The barbershop study is an example of using established social fabrics to introduce health interventions that otherwise were inaccessible for many potential reasons, including distrust in medical practice. An example in maternity care that similarly takes advantage of social fabrics is group prenatal care. While members do not have established relationships prior to the program initiation, they develop social relationships over the course of their pregnancies. In group prenatal care, they learn much of pregnancy-related maternity care from each other rather than from a one-on-one encounter with a physician. This can be more engaging and empowering and address needs that patients themselves identify.