Appalachia is characterized as being a place of health inequalities, including substandard health care access. Health disparities in access to health care persist in the region, and many Tennessee residents are unable to afford premiums, if they can afford insurance at all. Uninsured individuals rely on community based free clinics, which serve as health care safety nets and allowing people to obtain limited health care. This ethnographic investigation, involving semi-structured interviews and participant-observation of the Blackberry Spruce Free Clinic, provides insight into the continued need of health care safety net resources. This research provides a patient’s perspective on the barriers to care for the uninsured, the difficulties in managing chronic illnesses and other medical needs when relying on charity care, and the problems of clinic management in its role as a temporary solution for the uninsured population.

Since 2021, some state legislators have passed laws that limit what public institutions can teach about discrimination. The number of these laws, also called gag orders, is increasing despite a national outcry against racism, homophobia and transphobia, and other forms of discrimination. Many nursing and other professional healthcare organizations have recognized and published statements decrying racism in healthcare and calling for an increased focus on health disparities and advancing health equity. Similarly, national research institutions and private grant funders are funding health disparities research. Nursing and other faculty in higher education, however, are being gagged by laws and executive orders which prevent them from teaching and conducting research about historic and contemporary health disparities. This commentary seeks to highlight the immediate and long-term impact of academic gag orders and to encourage action in opposition of such legislation. Supported by professional codes of ethics and discipline-specific education, we present concrete activities readers can use to address gag order legislation and in doing so, protect patient and community health outcomes.

Introduction: The purpose of this study is to examine how nursing home (NH) characteristics, specifically racial composition of nursing homes residents, influences the use of physical restraints. As the population ages and becomes more diverse, it is essential to mitigate/eliminate racial/ethnic disparities in quality care. Methods: This is cross-sectional study using a 2010 national data set from Brown University Center for Gerontology and Healthcare Research. This study employs Donabedian's Structure-Process-Outcome (SPO) conceptual framework. Statistical analysis includes univariate, bivariate, and a logistic regression model. It is hypothesized that nursing homes with higher proportions of black residents, more Medicaid residents, and for-profit ownership status will be associated with higher prevalence of physical restraint use. Results: Findings show that nursing homes with high proportions of blacks have a lower likelihood of high physical restraint use. Nursing homes with a higher proportion of Medicaid-reliant residents have a higher likelihood of restraint use, as does for-profit nursing homes. Discussion: The findings indicate that there are no racial/ethnic disparities present in the use of physical restraints in nursing homes. There is indication of socio-economic disparities, since nursing homes with higher Medicaid-reliant residents are associated with greater restraint. There are policy implications associated with these findings, including raising Medicaid per diem or implementing a quality performance payment incentive. Further research will be needed to determine ways to reduce racial/ethnic disparities in nursing homes. This research, adds to the nursing home literature focused on socio-economic disparities.

Latinx, or Hispanic/Latino, minoritized groups experience a broad spectrum of mental health challenges, disparities, and risks at a disproportionate rate compared to both their non-White counterparts and compared to other minorized groups in the U.S. (SAMHSA, 2015). They also experience a number of cultural and individual strengths associated with their values, practices, and resiliencies (Leyva et al, 2022; Gennetian et al, 2021; Calzada et al, 2020). However, given the substantial percentage of Latinxs who live in the United States (18.7%), the mental health needs of this minoritized group are not sufficiently addressed in social science literature, as a number of systemic factors limit the inclusion of Latinxs in participant pools (Roberts et al, 2020; DeJesus et al, 2019). Across 13 high-impact journals and three clinical disciplines, a mere 2.5% of all scholarship published focused on Latinxs. Through qualitative content-analysis of key topics, methodology, funding sources, and sample characteristics across 20 years of literature (n = 7, 061), this paper seeks to highlight both the strengths and weaknesses of Latinx representation in the current literature with the hope to better prepare policy makers, program interventionists, and clinical practitioners to competently serve this marginalized population.

The aim of this literature search was to explore the prevalence of obstetric violence and identify nursing interventions that could potentially prevent the mistreatment of pregnant women in the United States healthcare system. Background: The topics of obstetric violence and healthcare disparities have been gaining awareness. Other countries have a larger body of research for obstetric violence compared to the U.S. Methods: CINAHL Plus with Full Text and MEDLINE databases were utilized. Global perspectives were considered in conjunction with the U.S. and specifically Florida. Healthcare disparities in obstetric care were identified, based on race, ethnicity, socioeconomic status, sexuality, disability, weight, and age. Results: There were seven studies related to obstetric violence in U.S. healthcare facilities, none in Florida. These studies found there was obstetric violence in U.S. healthcare facilities, however, it was inconclusive to the degree and rate of mistreatment as well as the effectiveness of any stated prevention strategies. The quality of the reporting limited the generalizability and rate of mistreatment. Discussion: Nursing interventions to obstetric violence were readiness to learn, shared decision-making, empathy, and self-reflection. Nurses can implement these interventions to improve the quality of patient care and prevent violence within the healthcare setting.

The primary focus of the current study was to identify health disparities between sexual minority subgroups by examining differences of health indicators in lesbians, gay men, and bisexual individuals, and compare these to their heterosexual counterparts. Data was drawn from the National Health and Nutrition Examination Survey (NHANES), and variables examined in sexual minorities were related to health care access and utilization, risky health behaviors, and overall disease prevalence and outcomes. Findings suggest there are still some current health disparities in terms of insurance coverage, access to medical care, substance use, and prevalence of certain health conditions. However, a trend analysis conducted to examine three NHANES panels, suggests a mild improvement in some of these areas. Further findings, discussion, limitations of the study, current implications, and future directions are addressed.

Mistrust of the healthcare system is increased among the Black population compared to other race/ethnicity groups. Medical mistrust can lead to intensified health inequities and negative health outcomes among this population. Currently, there is limited research that explores ways to address medical mistrust, especially among the Black population. This study investigated medical mistrust to find ways to improve the quality of life amongst the Black population. Twenty-one participants in this study completed a Group Based Medical Mistrust Survey and five of those participants participated in a semi-structured interview. Descriptive and correlation analyses were conducted. The GBMMS was separated into three subscales: Factor 1) Suspicion, Factor 2) Group disparities in healthcare, and Factor 3) lack of support from healthcare providers. The mean score for the GBMMS was 3.41 (SD=0.74). Significant correlations were found between Factor 1 and income (r=-.459, p=.048). Results from the in-depth interview indicated, five primary themes were extracted from the interviews including 1) Historical references to racism in the healthcare system, 2) Racial discrimination common in a doctor's office, 3) Assumptions made about health issues amongst Black patients, 4) Not seeking medical attention when needed, and 5) Utilization of primarily Black doctors. Overall, this study found that medical mistrust in the Black population is multifactorial and offers insight on how to improve relationships between the Black population and the healthcare system.

Health disparities are differences in disease prevalence, mortality rates, and adverse health outcomes across social demographics. The prevalence of health disparities stems from sociopolitical inequities that contribute to the ongoing marginalization of different communities, the majority of which occur along racial and ethnic lines in the United States. As moral wrongs in need of moral repair, health disparities can be addressed in one of six ways, articulated in the scholarship of Margaret Urban Walker: (1) holding wrongdoers responsible; (2) addressing the harms imposed on victims; (3) instating moral terms and standards into harmed communities to regain their trust in social mechanisms meant to protect them; (4) recreating trust among harmed communities rooted in new norms; (5) nourishing hope; and (6) bringing together victims and wrongdoers. This dissertation engages the aforementioned morally reparative steps to redress the moral wrong of health disparities in the United States through proposed policy, educational, and clinical interventions. This dissertation examines health disparities from four perspectives. First, it employs a sociohistorical lens to chart the history of health disparities in the United States and the complex social factors contributing to their prevalence. Second, it uses international rights rhetoric of the United Nations and its supporting committees to examine methods of accountability from the United States aimed at reducing disparities and inequities. Third, the dissertation applies the lens of Jacques Maritain’s ontologically informed personalism to reclaim personhood as a viable concept that attends to the sacrality of humanity and our status as social and political beings. Fourth, the dissertation applies the historical, rights, and personalist perspectives in a case study centering black birthing people as an exemplary demographic plagued by racially impacted health disparities and in need of moral repair. This dissertation uses the four-perspective approach to conclude with a morally reparative framework aimed at eliminating health disparities through constructive healthcare policy, practice, and educational measures affirming personhood, human dignity, universal human rights, and health for all people.

BACKGROUND: Nearly all birthing people in the Dominican Republic (DR) deliver in a hospital, yet maternal and newborn mortality remain high. Respectful maternity care challenges have been reported but not systematically documented. This observational, mixed-methods study assessed birthing people’s and providers’ experiences at a public hospital in the DR, during the COVID-19 pandemic. METHODS: In May-July 2022, we surveyed postpartum people and providers to adapt the Person-Centered Maternity Care (PCMC) survey. In July-August 2022 we applied the contextually-modified PCMC survey with postpartum people and providers. Possible scores ranged from 0 (poor) to 93 (exceptional). We calculated mean scores and examined associations with socio-demographic factors. A concordance/discordance analysis examined postpartum people’s and providers’ responses. Content analysis of open-ended questions explored PCMC and opportunities for improvement. Results were stratified by nationality (Dominican or Haitian). RESULTS: Respondents felt the PCMC survey was appropriate for the context but recommended adding questions around contraception, maternal-newborn separation, differential treatment, and c-section decision-making. The mean PCMC score was 60.1 for postpartum people and 62.0 for providers. Being of Haitian origin, speaking Creole at home, being older, and living further from the facility were associated with lower scores (p<.001). Nearly 70% of providers reported birthing people were spoken to in understandable language/terms compared to 29.8% of birthing people. Most providers (91.7%) reported that consent was sought before procedures, compared to 58.1% of birthing people. Fewer Haitians, compared to Dominicans, reported favorably regarding friendly treatment (42% v 83%); ability to ask questions (34% v 66%); consent being sought before procedures (52% v 71%); and being spoken to in understandable language/terms (14% v 63%). Sixty-one percent of Haitians and 44% of Dominicans reported maternal-newborn separation for more than 6 hours. Qualitative responses revealed verbal abuse and the emotional toll of maternal-newborn separation, among other issues. Birthing people suggested improvements relating to family connectedness: companions, providers communicating with families, and keeping the mother-baby dyad together. Providers focused on infrastructure, equipment/supplies, training, and policy. CONCLUSION: As the first study to apply the PCMC survey in the DR, this study systematically documented challenges and opportunities to improve birth experiences from the perspectives of postpartum people and obstetric providers. Stakeholder-generated and evidence-based recommendations should be prioritized at Hospital Presidente Estrella Ureña. / 2025-01-04T00:00:00Z

This thesis seeks to investigate the 2014 Medicaid expansion’s effect on maternal mortality rates for New York and California. The CDC reported in 2019 that maternal mortality rates have been increasing. These findings are concerning for mothers and are a problem for developed nations like the United States with improved healthcare. Furthermore, women of color are disproportionately affected relative to white women. Previous research has indicated that healthcare expansions positively affect decreasing death rates among pregnant women. In this study, I investigate how increased access to healthcare through the 2014 Medicaid expansion under the Affordable Care Act affects maternal mortality for New York and California. I utilize the publicly available CDC Wonder Underlying Cause of Death 1999-2020 data to conduct my research for this analysis. For my analysis, I chose to observe the years 2006-2016. I plotted each state’s mortality rates by year to observe any visual trends or changes in reported data and then after ran regressions of each race on deaths. The results exhibited that women of color tend to experience higher maternal mortality ratios. When observing how deaths have changed post-expansion, the coefficients were not statically significant to a degree that would allow me to make confident conclusions that mortality rates had improved. This study contributes to the literature that women of color are more likely to suffer worse maternal health outcomes than white women. It brings to light the importance of attaining a solution to this issue.