'Humility, Concern, Respect': A Qualitative Study Exploring Parent Perspectives on a Pediatrician's Role in Addressing Racism.

OBJECTIVE: To explore racially minoritized families' perceptions on how, and if, physicians should address children's racial identity and concepts of racism within clinical settings. STUDY DESIGN: Parents of racially minoritized children, ages 5 through 18, were interviewed to explore experiences with racial identity formation, discrimination, and the extent to which they wanted pediatricians to address these topics. Children were included at the discretion of their parents. Interviews were transcribed, coded, and analyzed through a critical race theory lens based in constructivist grounded theory. RESULTS: Parents encouraged their children to embrace their racial identities but also wanted to shield them from negative experiences of racism to preserve identity safety. Parents felt pediatricians should address racial issues in a manner specific to their child's situation. Thoughtful inclusion of race-related questions, whether in discussion or on questionnaires, is essential to prevent tension in a therapeutic relationship. There was no consensus on the use of preclinical screening. Instead, families highlighted the importance of embracing humility, trust, and respect. CONCLUSIONS: Participant families have preferences for approaches to address the effects of racism on their children's health. Pediatricians should understand the importance of identity safety and approach their discussions with cultural humility, which includes self-reflection, empathy, active listening, and flexible negotiation. Above all, pediatricians need to create a safe environment for appropriate discussion of these issues.

Direct and indirect associations of experience of racial discrimination, dietary patterns and obesity in adults from southern Brazil.

OBJECTIVE: To analyse the direct and indirect associations of experience of racial discrimination on dietary patterns (DP), obesity and abdominal obesity. DESIGN: This is a cross-sectional population-based study. The main exposure was self-reported experiences of racial discrimination (Experiences of Discrimination scale). The mediator variables were the DP: healthy, Brazilian traditional, sugar and carbohydrates, and fast food. The outcomes were obesity (BMI ≥ 30 kg/m2) and abdominal obesity (waist circumference ≥ 88 cm for women; ≥ 102 cm for men). Structural equation modelling was applied. SETTING: Porto Alegre, Brazil. PARTICIPANTS: Totally, 400 adults aged between 20 and 70 years were participated. RESULTS: The mean age of participants was 47·2 years (sd = 13·9), and 75 % were women. Experiencing racial discrimination had a positive direct effect on obesity (healthy DP: ß = 0·153, P < 0·05; Brazilian DP: ß = 0·156, P < 0·05; sugar and carbohydrates DP: ß = 0·156, P < 0·05; and fast-food DP: ß = 0·153, P < 0·05) and abdominal obesity (healthy DP: ß = 0·206, P < 0·01; Brazilian DP: ß = 0·210, P < 0·01; sugar and carbohydrates DP: ß = 0·204, P < 0·01; and fast-food DP: ß = 0·204, P < 0·01). The experience of racial discrimination did not have a direct effect on DP, nor did it exert an indirect effect on obesity and abdominal obesity through any DP. CONCLUSIONS: A higher experience of racial discrimination is associated with obesity and abdominal obesity, independent of diet.

Racial discrimination predicts the increase in body weight and BMI in Black individuals from ELSA-Brasil cohort / Discriminação racial prediz o aumento do peso corporal e do IMC em indivíduos pretos da coorte ELSA-Brasil

Abstract We investigated whether racial discrimination accelerates the weight and Body Mass Index (BMI) gain in Blacks and Browns participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) in four years of follow-up. We compared body weight and BMI between the 1st (2008-2010) and 2nd visit (2012-2014) of 5,983 Blacks and Browns participants. Exposure to racial discrimination and covariates (age, sex, education, and research center) were obtained at the 1st visit. Linear mixed effects models stratified by race/skin color were used. Report of racial discrimination was more frequent among Blacks (32.1%) than Browns (6.3%). During the follow-up period, Blacks and Browns gained an average of 1.4kg and 1.2kg, respectively. This increase was greater among those who reported discrimination when compared to those who did not, both in Blacks (2.1kg vs.1.0kg, p < 0.001) and Browns (1.9kg vs. 1.1kg, p < 0.05). The results of the interaction between racial discrimination and time showed that Blacks, but not Browns, who reported racial discrimination had greater weight and BMI gains between visits. Our results suggest that reducing racial discrimination would contribute to prevent and/or control obesity increase in the country.

Resumo Investigou-se se a discriminação racial acelera o ganho de peso corporal e o Índice de Massa Corporal (IMC) em pretos e pardos participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) em quatro anos de seguimento. Comparou-se o peso corporal e o IMC entre a 1ª (2008-2010) e a 2ª visita (2012-2014) de 5.983 participantes pretos e pardos. A exposição à discriminação racial e às covariáveis ​​(idade, sexo, escolaridade e centro de pesquisa) foram obtidas na 1ª visita. Foram utilizados modelos lineares de efeitos mistos estratificados por raça/cor da pele. O relato de discriminação racial foi mais frequente entre pretos (32,1%) do que em pardos (6,3%). Durante o período de acompanhamento, pretos e pardos ganharam uma média de 1,4kg e 1,2kg, respectivamente. Esse aumento foi maior entre os que relataram discriminação, quando comparados aos que não relataram, tanto em pretos (2,1 kg vs. 1,0 kg, p < 0,001) quanto em pardos (1,9kg vs. 1,1kg, p < 0,05). Após ajustes, os pretos, mas não os pardos, que relataram discriminação racial apresentaram maiores ganhos de peso e IMC entre as visitas. Nossos resultados sugerem que a redução da discriminação racial pode contribuir para prevenir e/ou controlar o aumento da obesidade no país.

Sense of coherence moderates the relationship between perceived racial discrimination and oral health-related quality of life in schoolchildren.

AIM: To evaluate the moderating effect of the sense of coherence (SOC) in the relationship between racial discrimination and oral health-related quality of life (OHRQoL) in schoolchildren. METHODS: This is a cross-sectional study nested in a cohort performed in southern Brazil. OHRQoL was assessed using the short version of the Child Perceptions Questionnaire 11-14 (CPQ11-14). The perception of racial discrimination was measured using a question contained in the Bullying Questionnaire by Olweus, and SOC through the shortened version of the 13-item Sense of Coherence Scale. Sociodemographic and dental caries following the International Caries Detection and Assessment System (ICDAS) characteristics were also collected. A simple slop test and Poisson regression analysis were performed to test the interaction effects of the predictors on OHRQoL. RESULTS: A total of 429 schoolchildren were included in this study. About 6.7% reported had perceived racial discrimination. The simple slope test indicated that the negative effects of racial discrimination on OHRQoL were significant under different SOC levels. Among schoolchildren who suffered racial discrimination, those who had higher SOC reported lower impact on OHRQoL when compared to those with low SOC. CONCLUSION: SOC can be considered a moderating variable in the relationship between racial discrimination and OHRQoL. CLINICAL SIGNIFICANCE: These findings highlight that psychosocial factors such as SOC could attenuate the impact of perceived discrimination on OHRQoL in adolescence.

Desigualdade racial no Brasil: desafios contemporâneos para o trabalho do professor de Educação Física / Racial inequality in Brazil: contemporary challenges for the work of Physical Education teacher / Desigualdad racial en Brasil: desafíos contemporâneos para el trabajo del professor de Educacion Fisica

O presente estudo configura-se como um artigo de revisão, cujo objetivo foi identificar o conhecimento dos professores de Educação Física sobre a Lei 10.639/2003 e como tratam situações de desigualdade racial a partir de sua prática pedagógica. Para tal, realizou-se uma busca no Portal de Periódicos da Capes, a partir dos descritores: desigualdade racial, discriminação racial, Educação Física, escola. Definiu-se como marco temporal os anos entre 2014 e 2019, para as publicações. A busca retornou com 64 artigos, dos quais foi feita a leitura dos títulos e resumos, destes foram selecionados quatro artigos. Como critérios de inclusão: estudos na área de Educação Física, sobre a temática desigualdade racial e discriminação racial, e estudos na educação básica. Como critérios de exclusão: estudos com professores de outros componentes curriculares; estudos que abordassem outras temáticas como gênero associadas; estudos em ambiente não-escolar. Concluiu-se que há fragilidades na formação inicial e continuada de professores de Educação Física, para que a temática seja abordada na Educação Física em situações de discriminação, mas também para que a Educação para as Relações Étnico-raciais seja adotada e incluída nos currículos escolares, além do desconhecimento dos professores sobre a Lei 10.639/03.

The present study is configured as a literature review, whose objective was to identify the knowledge of Physical Education teachers about Law 10.639/2003 and how they deal with situations of racial inequality, considering their pedagogical practice. To this aim, a search was carried out on Portal Capes based on the descriptors: racial inequality, racial discrimination, Physical Education, school. The years between 2014 and 2019 were defined as the time frame for publications. The search returned with 64 articles, from which the titles and abstracts were read, of which four articles were selected. As inclusion criteria: studies in the area of Physical Education, on the theme racial inequality and racial discrimination, and studies in basic education. As exclusion criteria: studies with teachers from other curricular components; studies that addressed other themes such as associated gender; studies in a non-school environment. It was concluded that there are weaknesses in the initial and continuing training of Physical Education teachers, so that the issue is addressed in Physical Education in situations of discrimination, but also so that Education for Ethnic-Racial Relations is adopted and included in school curricula, in addition to the teachers' lack of knowledge about Law 10.639/03.

El presente estudio se configura como un artículo de revisión, cuyo objetivo fue identificar el conocimiento de los profesores de Educación Física sobre la Ley 10.639/2003 y cómo ellos afrontan situaciones de desigualdad racial desde su práctica pedagógica. Para ello, se realizó una búsqueda en el Portal de Periódicos da Capes, a partir de los descriptores: desigualdad racial, discriminación racial, Educación Física, escuela. Se definió como marco temporal para las publicaciones los años comprendidos entre 2014 y 2019. La búsqueda arrojó 64 artículos, de los cuales se leyeron los títulos y resúmenes, de los cuales se seleccionaron cuatro artículos. Como criterios de inclusión: estudios en el área de Educación Física, sobre el tema desigualdad racial y discriminación racial, y estudios en educación básica. Como criterios de exclusión: estudios con docentes de otros componentes curriculares; estudios que abordaron otros temas como el género asociado; estudios en un ambiente no escolar. Se concluyó que existen debilidades en la formación inicial y continua de los profesores de Educación Física, para que el tema sea abordado en Educación Física en situaciones de discriminación, pero también para que la Educación para las Relaciones Étnico-Raciales sea adoptada e incluida en los currículos escolares, además del desconocimiento de los docentes sobre la Ley 10.639/03.

Perceived racism or racial discrimination and the risk of adverse obstetric outcomes: a systematic review

ABSTRACT BACKGROUND: Racial disparities are differences among distinct subgroups of the human species; biologically, there are no scientifically proven reasons for them to exist. OBJECTIVE: To assess the impact of racism or racial discrimination on obstetric outcomes. DESIGN AND SETTING: Systematic review conducted at a tertiary/academic hospital. METHODS: The Cochrane Library, SCOPUS/EMBASE, PubMed, Web of Science and ClinicalTrials.gov databases were searched from inception to June 2020. Studies presenting any type of racial discrimination, or any manifestation of racism that was perceived by women of any age in an obstetric scenario were included. Studies that only assessed racial disparities without including direct racism were excluded. The secondary outcomes evaluated included quality of antenatal care, intra and postpartum care, preterm birth and birthweight. The Risk of Bias In Non-randomized Studies - of Interventions (ROBINS-I) scale was used to assess the quality of evidence from non-randomized studies. RESULTS: A total of 508 records were retrieved and 29 were selected for qualitative synthesis. No meta-analysis could be performed due to the high heterogeneity across studies. Perceived racism was associated as a risk factor in 7/10 studies focusing on pregnancy and postpartum maternal outcomes, five studies on preterm birth, one study on small for gestational age and two studies on low birthweight. Overall, among the 29 studies, the risk of bias was classified as moderate. CONCLUSIONS: Perceived racism presented an association with poor obstetric outcomes. Anti-racist measures are needed in order to address the problems that are causing patients to perceive or experience racism. SYSTEMATIC REVIEW REGISTRATION: PROSPERO database, CRD42020194382

Estudo-piloto de validação do instrumento Cartoon Test no contexto brasileiro / Pilot study for the validation of the Cartoon Test for the Brazilian context / Estudio piloto de validación del instrumento Cartoon Test en el contexto brasileño

O Cartoon Test é um instrumento que analisa a percepção de crianças e adolescentes acerca do significado de bullying por meio de cenas de interação entre pares no ambiente escolar. Este estudo qualitativo exploratório constitui a segunda etapa de validação do instrumento no Brasil, com os objetivos de verificar se os participantes compreendem as imagens e legendas dos cartoons e que palavras são utilizadas para descrever os comportamentos inadequados. Foram realizados oito grupos focais, com 52 alunos, com idades de oito e 14 anos, de duas cidades do Rio Grande do Sul. Os instrumentos utilizados foram: Questionário sociodemográfico, Folha de registro do pesquisador e Cartoon Test. Realizou-se análise de conteúdo para tratamento dos dados. Os resultados indicaram que o instrumento foi compreendido pelos participantes e o termo bullying foi o mais utilizado para descrever situações agressivas. Para as crianças, sugere-se a redução no número de cartoons, visando evitar a exaustão.(AU)

The Cartoon Test is an instrument that analyzes the perception of children and adolescents about the meaning of bullying through scenes of interaction between peers in the school environment. This qualitative exploratory study is the second phase of validation of the instrument in Brazil. The aim is to verify whether the participants understand both the images and captions of the cartoons and to record the words used to describe the inappropriate behaviors. Eight focus groups were carried out, with 52 students, aged between eight and 14 years, from two cities in Rio Grande do Sul. The instruments used were: sociodemographic questionnaire, record sheet and Cartoon Test. Content analysis was performed. The results showed that the instrument was understood by all the participants and bullying was the word most used to describe the aggressive situations. A reduction in the number of cartoons administered to children is suggested, in order to avoid exhaustion.(AU)

El Cartoon Test es un instrumento que analiza la percepción de niños y adolescentes a respeto del significado de bullying por medio de una escena de interacción entre pares en el ambiente escolar. Este estudio cualitativo exploratorio constituye la segunda etapa de validación del instrumento en Brasil, con el objetivo de verificar que los participantes comprenden las imágenes y leyendas de los cartoons y qué palabras son utilizadas para describir comportamientos inapropiados. Fueron realizados ocho grupos focales, con 52 alumnos, con edades entre ocho y 14 años, de dos ciudades de Rio Grande do Sul. Los instrumentos utilizados fueron: Cuestionario Sociodemográfico, Ficha de Registro del Investigador y Cartoon Test. Se llevo a cabo un análisis de contenido para procesar los datos. Los resultados indicaron que el instrumento fue comprendido por los participantes y el termo bullying fue lo más empleado para describir situaciones agresivas. Para los niños, se sugiere la reducción en el número de cartoons, para evitar el agotamiento.(AU)

Racial discrimination is associated with greater arterial stiffness and carotid intima-media thickness: the ELSA-Brasil study.

PURPOSE: The association between racial discrimination and subclinical cardiovascular markers remains under-examined. We aimed to investigate the association of race/skin color and racial discrimination with pulse wave velocity (PWV) and carotid intima-media thickness (c-IMT) in the Brazilian context. METHODS: We used data from 13,284 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline with information of PWV and 9850 for c-IMT. Self-reported race/skin color and perceived racial discrimination were the exposures. PWV and c-IMT were used continuously and categorizing according to cutoff that indicates increased cardiovascular risk. Linear and logistic regression models were used. RESULTS: Experience of racial discrimination was reported by 7% of total participants, but this prevalence was much higher among Blacks than Browns (PWV sample: 31,9% vs. 6,1%; c-IMT sample: 33,7% vs. 6,8%). After adjustments for age, sex, and research center, Blacks and Browns presented higher means of PWV and c-IMT and had greater chances of PWV>10 m/s and c-IMT≥75th percentile than Whites. The magnitude of all these associations were higher among Blacks and Browns with racial discrimination. In final models adjusted for education this pattern of association remained the same, although an attenuation in the magnitude of the association has been observed. CONCLUSIONS: Blacks and Browns presented worse profiles of subclinical cardiovascular markers compared to Whites and those exposed to racial discrimination seem to have an additional cardiovascular risk.

Asthmatic Symptoms in Children and Adolescents: the Role of Maternal Experiences of Racial Discrimination.

Emerging evidence suggests that vicarious racial experiences of discrimination may negatively influence child health. Few studies have focus on childhood asthma symptoms and potential moderators of such relationship. METHODS: We used two population-based cross-sectional studies from the Social Change Allergy and Asthma in Latin America project in Salvador, Brazil. A total of 1003 children and mothers interviewed in 2006 were included, of whom 873 were reached again in 2013. Vicarious racial discrimination was assessed in mothers by applying the Experiences of Discrimination scale. Data on wheeze and environmental exposures were collected with standardized questionnaires. Levels of allergen-specific IgE were measured to identify atopy. Generalized estimating equations were used to estimate the association between maternal discrimination and wheezing and asthma phenotypes. Interaction terms were evaluated to identify whether mothers' mental health and family social support modified such associations. RESULTS: Children whose mothers reported racial discrimination had greater odds of have asthma symptoms (OR 1.75; 95% CI 1.15-2.67) and non-atopic asthma (OR 1.92; 95% CI 1.09-3.40). When we considered effect modification by social support, we found a higher ORs when the level of social support was lower (OR 2.43; 95% IC 1.19-4.97) than when the level of social support was higher (OR 1.12; CI 0.64-1.96). CONCLUSION: Maternal discrimination was associated with asthma symptoms and with non-atopic phenotype among their children. Enjoying wider social support network appears to buffer the effect on asthmatic symptoms. Intervention on childhood asthma needs to incorporate strategies that target the family.

Association between race/color and incidence of hypertension in the ELSA-Brasil population: investigating the mediation of racial discrimination and socioeconomic position.

OBJECTIVE: To investigate the mediation effect of socioeconomic position and racial discrimination in the association between race/color and incidence of hypertension in 4-years follow up. METHODS: We included 8,370 participants of the Longitudinal Study of Adult Health (ELSA-Brasil). A latent variable was constructed to represent socioeconomic position (SEP). The perception of discrimination was measured through an adaptation of the Lifetime Major Events Scale; and hypertension was defined using standard criteria. We investigated Body Mass Index (BMI) due to its role in proximal risk for hypertension. To investigate the mediating role of SEP and racial discrimination, we used structural equation modeling. RESULTS: SEP had a direct and negative effect on HT incidence (HT incidence increased in worse SEP categories), while the effect of BMI on HT was direct and positive. We did not find significant direct effects of race/color and racial discrimination on HT. As for indirect effects, we observed associations between race/color and HT only through SEP mediation. CONCLUSION: According to our results, race/color is indirectly related to HT incidence, mediated by SEP. Racial discrimination was not a mediator in the relationship between race/color and HT in the follow-up period.

Discriminação racial e saúde: ações dos profissionais de saúde na assistência à mulher em processo de abortamento provocado / Racial discrimination and health: health professionals' actions in providing care women in the induced abortion process

Resumo Este artigo tem como objetivo avaliar as desigualdades raciais na assistência de profissionais de saúde ao abortamento provocado. Estudo de revisão sistemática, seguindo o modelo Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a partir das seguintes bases: Biblioteca Virtual em Saúde, Scientific Eletronic Library Online (SciELO), National Library of Medicine and National Institutes of Health (PubMed), Science Direct, Portal de Periódicos Capes, com os descritores: "racism OR social discrimination AND abortion, induced AND health personnel OR comprehensive health care OR delivery of health care OR human rights", escolhidos mediante consulta ao DeCS e Medical Subject Heading (MeSH). Seguindo os critérios de inclusão e exclusão, analisaram-se 18 artigos, publicados entre os anos de 2005 a 2020 na literatura nacional e internacional. A maioria dos estudos encontrou uma relação significativa entre discriminação racial e violência institucional, incluindo o acesso e qualidade da assistência de pacientes em abortamento provocado. A discriminação racial é um fator de risco significativo para resultados adversos no atendimento.

Abstract This paper aims to evaluate the racial inequalities in the care provided by health professionals concerning induced abortion. This systematic review study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) model, based on the following bases: Brazilian Virtual Health Library (BVS), Scientific Electronic Library Online (SciELO), National Library of Medicine, and National Institutes of Health (PubMed), Science Direct, Capes periodicals portal, with the descriptors: "racism OR social discrimination AND abortion, induced AND health personnel OR comprehensive health care OR delivery of health care OR human rights", selected via the DeCS and Medical Subject Heading (MeSH). Eighteen papers published between 2005 and 2020 in national and international literature were analyzed following the inclusion and exclusion criteria. Most studies found a significant relationship between racial discrimination and institutional violence, including access and quality of care for patients undergoing an induced abortion. Racial discrimination is a significant risk factor for adverse care outcomes.

Colorism and Health Disparities in Home Countries: The Case of Puerto Rico.

This study reveals the association of skin color with health disparities in Puerto Rico, a US territory that is home to the second largest Latino population in the US. Aware of the inadequacy of standard OMB ethno-racial categories in capturing racial differences among Latinos, we incorporated skin color scales into the Puerto Rico BRFSS. We apply both logistic regressions and propensity score matching techniques. We found that colorism plays a significant role in health outcomes of dark-skinned Puerto Ricans in Puerto Rico and that skin color is a better health predictor than the OMB ethno-racial categories. Our results indicate that Puerto Ricans of the lightest skin tone have better general health than Puerto Ricans who self-described as being of the darkest skin tones. Findings underscore the importance of considering how racial discrimination manifested through colorism affects the health of Latino populations in the US and its territories.

"O escuro das cores, na pele afrodescendente, herdeira das dores": dimensões do racismo no contexto de assistência ao parto / "The dark of colors, in the afro-descendant skin, heir of pain": dimensions of racism in the context of childbirth care

Resumo Partindo de uma pesquisa mais ampla sobre as vivências de mulheres negras na assistência ao período gestacional e parto, este artigo aborda alguns aspectos do racismo na rotina de atenção à mulher negra durante este ciclo. Trata-se de uma pesquisa empírica de abordagem qualitativa com mulheres e mães que se autodeclaram negras e antirracistas. Nas narrativas, os pontos apresentados envolviam, na sua maioria, estereótipos associados ao corpo negro construídos sob um imaginário social racista. Nas relações interpessoais, discursos permeados por estereótipos racistas desumanizam a mulher negra, gerando barreiras na sua saúde reprodutiva.

Abstract Starting from a broader research on the experiences of black women in assisting the gestational period and childbirth, this article addresses some aspects of racism in the routine of care for black women during this cycle. This is an empirical research with a qualitative approach with women and mothers who declare themselves black and anti-racist. In the narratives, the points presented involved, for the most part, stereotypes associated with the black body constructed under a racist social imaginary. In interpersonal relationships, speeches permeated by racist stereotypes dehumanize black women, creating barriers in their reproductive health.

Validação de conteúdo do instrumento Percepção sobre Discriminação Racial Interpessoal nos Serviços de Saúde (Driss) / Content validity of the scale Perceptions on Interpersonal Racial Discrimination in Brazilian Healthcare Facilities (Driss)

Resumo Com o objetivo de elaborar e validar o conteúdo do instrumento de medida das Percepções sobre Discriminação Racial Interpessoal nos Serviços de Saúde Brasileiros (Driss), foi conduzido um estudo do tipo metodológico com base na Teoria Clássica dos Testes. O pool de itens inicial, com 49 itens, foi elaborado a partir dos resultados de uma revisão abrangente de literatura, um estudo qualitativo prévio e recomendações de um grupo de pesquisa sobre desigualdades étnico-raciais. Para a validação de conteúdo, um comitê de especialistas foi formado. Critérios qualitativos e quantitativos foram empregados para garantir rigor metodológico. Após a avaliação da versão 1 do Driss pelo comitê de especialistas, houve exclusão de 28 itens, além do desmembramento e/ou modificação de outros dez. A partir disso, elaborou-se a versão 2, submetida a pré-teste, que mostrou a necessidade de se incluírem questões introdutórias para melhor entendimento por parte da população-alvo quanto aos objetivos do estudo. Posteriormente, elaborou-se a versão 3, com conteúdo que busca valorizar as percepções e sentimentos experimentados pelos indivíduos que sofreram discriminação racial nos serviços de saúde. A validade de conteúdo da versão 3 foi verificada, por meio da Razão de Validade de Conteúdo, sendo considerada satisfatória e pronta para a verificação da validade de constructo.

Abstract Aiming to elaborate and assess the content validity of the new scale Perceptions on Interpersonal Racial Discrimination in Brazilian Healthcare Facilities (Driss), we conducted a methodological study based on the Classical Test Theory. Initially, we had a pool of 49 items based on a comprehensive literature review, previous qualitative study, and recommendations from a research group on ethnic-racial inequalities. To assess content validity, an experts committee was formed. Qualitative and quantitative criteria were used to ensure methodological rigor. After the evaluation of the Driss version 1 by the experts committee, 28 items were excluded; 10 others were fragmented and/or modified. Thus, Driss version 2 was developed and subjected to pre-test, which showed a need to include introductory questions to make it better understood by the target population regarding the objectives of the study. Subsequently, we elaborated Driss version 3, whose content aims to value perceptions and feelings experienced by individuals who suffered racial discrimination at healthcare facilities. The content validity of version 3 was assessed by the Content Validity Ratio, being considered satisfactory and ready for later construct validity valuation.

Percepção de Preconceito num Quilombo Urbano do Sul do Brasil / Perception of Discrimination in an Urban Quilombo in the South Region of Brazil / Percepción de Discriminación en un Quilombo Urbano en el Sur de Brasil

O negro, e por consequência as populações quilombolas, em uma sociedade racista e preconceituosa, participa de um processo de (re)construção identitária que passa, necessariamente, por questões culturais, históricas, de território e de parentesco. Nesse sentido, o objetivo deste estudo foi conhecer a percepção de moradores de um quilombo sobre o preconceito racial vivenciado por eles. Para isso, realizou-se uma pesquisa qualitativa, descritiva e exploratória, tendo como participantes seis residentes em posições de liderança num quilombo urbano: duas adolescentes, dois adultos e duas idosas. Foram feitas entrevistas com perguntas semiestruturadas, abordando história de vida e percepção sobre discriminação racial. Os dados foram gravados e filmados, para, posteriormente, serem transcritos. Para a análise, utilizou-se a Análise de Conteúdo Temática. Os principais resultados apontaram diferenças significativas entre a percepção de adolescentes, por um lado, e adultos e idosos, por outro. Os adultos e as idosas indicaram não se sentirem discriminados por serem negros e moradores de quilombo, ao contrário das adolescentes, que referiram sofrer bullying por esses motivos na escola e em ambientes públicos como shoppings e comércios em geral. As idosas relataram sentir-se discriminadas em função da idade, mas nunca pela sua negritude ou pelo local onde moram. Entende-se que esta percepção tão diferente entre jovens, adultos e idosos deva-se, principalmente, ao nível de escolaridade mais elevado das adolescentes e, consequentemente, à sua maior capacidade reflexiva. Esta lhes permite perceber por si mesmas aquilo que não lhes foi dito no grupo familiar e que lhes foi ocultado nos debates escolares....(AU)

Black people in a racist and discriminating society, specifically the quilombola population, undergo an identity (re)construction process which certainly includes cultural, historical, territorial and kinship issues. This study verified the perception of quilombo dwellers regarding the racial discrimination they go through. A qualitative, descriptive, exploratory research was conducted with six residents in leadership positions in an urban quilombo: two teenage girls, two adults in their fourties and two older women. They answered a semistructured interview about their life stories and their perception of racial discrimination. The data were recorded, filmed, and later transcripted. Afterwards, they were analyzed according to Thematic Content Analysis. The main results pointed out significant differences in the way teenagers perceive racial discrimination compared to adults and older adults. These claimed not having been through situations in which they were discriminated because of their color or for living in a quilombo. On the other hand, the teenagers reported having gone through bullying at school and public places, like malls and retail places in general. The older women said they felt discriminated because of their age, but never because of their color or the place where they live. It is assumed that these big differences in perception are mainly due to the higher educational level of teenagers and, consequently, to their higher reflection ability. This ability enables them to perceive for themselves facts and realities that their familiar group never mentioned and that debates at school have always hidden from them....(AU)

El negro, en consecuencia, la población quilombola, en una sociedad racista e intolerante participa en un proceso de (re)construcción identitaria que pasa, necesariamente, por cuestiones culturales, históricas, territoriales y de parentesco. El objetivo de este estudio fueconocer la percepción de los moradores de un quilombo sobre la discriminación racial vivida por ellos. Para eso, se realizó una investigación cualitativa, descriptiva y exploratoria, en la cual participaron seis residentes en posición de liderazgo en un quilombo urbano: dos adolescentes, dos adultos y dos ancianas. Se realizaron entrevistas con preguntas semiestructuradas,abordando la historia de vida y percepción sobre discriminación racial. Los datos fueron grabados y filmados, y posteriormente fueron transcritos. Para el análisis, se utilizó el análisis de contenido temático. Los principales resultados apuntaron diferencias significativas entre la percepción de adolescentes, por un lado, y de adultos y ancianos, por otro. Los adultos y las ancianas refirieron no sentirse discriminados por ser negros y moradores de quilombo, a diferencia de las adolescentes, que refirieron sufrir acoso escolar y en los entornos públicos como centros comerciales y comercio en general. Las ancianas refirieron sentirse discriminadas en función de la edad, pero nunca por su negritud o por el lugar donde viven. Se entiende que esa percepción tan diferente entre jóvenes y adultos y ancianos se debe principalmente al nivel de escolaridad más elevado de las adolescentes y, consecuentemente, a su mayor capacidad reflexiva. Esta les permite percibir por sí mismas lo que no les fue dicho en el grupo familiar y que les fue ocultado en los debates escolares....(AU)

Perceptions and experiences regarding the impact of race on the quality of healthcare in Southeast Brazil: a qualitative study.

Objective: To explore the impact of race on the quality of healthcare received by patients attending a primary care centre in Brazil.Design: This was a qualitative study consisting of 19 semi-structured interviews conducted on patients from six racial groups (as defined in Brazil as white, yellow, brown, black and indigenous and one self-identified 'other' group). The interviews were analysed using thematic analysis.Results: Four main themes were identified during analysis; factors affecting the access to healthcare, experiences regarding quality of healthcare, discrimination in healthcare and deep-rooted societal discrimination, which were categorised into a number of sub-themes. Within these themes, interviewees reported (1) experiences of racism in society towards the black racial group, (2) one personal perception and two observations of racial discrimination in healthcare, (3) perceived racial discrimination due to healthcare professional behaviour and (4) other factors, such as delays in appointments and long waiting times in health facilities were felt to impact access to care.Conclusion: The findings suggest that racial discrimination exists in Brazilian society but its direct impact on healthcare access was felt to be less obvious. Instead, organisational level factors were felt to contribute to difficulty accessing care. Interviewees perceived that racial discrimination may affect the quality of care, particularly for those designated as 'black'. Socio-economic factors were felt to influence discrimination in healthcare. The findings can help inform further studies and educational initiatives to help address discrimination and access to healthcare in Brazil.

El efecto de la discriminación racial y étnica sobre la autoestima individual y colectiva según el fenotipo autoreportado en migrantes colombianos en Chile / The effect of racial and ethnic discrimination on individual and collective self-esteem according to the self-reported phenotype in Colombian migrants in Chile

Resumen Mediante un diseño no experimental, analítico y transversal, se analizó el efecto que tiene la discriminación racial y étnica sobre la autoestima individual (AI) y colectiva (AC), según el fenotipo declarado. Para esto fueron encuestados 481 migrantes de nacionalidad colombiana (54 % mujeres y 46 % hombres), con edades entre los 18 y los 65 años, con una media de 35 años. Se aplicaron las escalas de AI de Rosenberg, de discriminación percibida de Krieger et al y la adaptación de Basabe de la escala de AC de Luthanen et al. Se observan efectos diferenciales de la discriminación étnica y/o racial sobre la AI y sobre la AC. En personas que se autoidentifican como "blancos", la percepción de discriminación racial se relaciona leve y positivamente con la AI; en quienes se perciben como "mestizos o nativos americanos", la discriminación racial tiene un efecto positivo moderado sobre la AC; en quienes se identifican como "afrodescendientes", ambas discriminaciones tienen un efecto positivo leve sobre la AI, mientras que la discriminación racial perjudicaría moderadamente la AC; y, finalmente, en quienes se identifican como "mulatos", ambas discriminaciones tendrían efectos leves o moderados positivos en los dos tipos de autoestima. Estos resultados aportan evidencia al efecto del fenotipo en la relación establecida entre la discriminación y la autoestima.

Abstract Through a non-experimental, analytical and cross-sectional design, we analyze the effect that racial and ethnic discrimination has on individual (ISE) and collective (CSE) self-esteem, according to the declared phenotype. 481 Colombian migrants (54 % women and 46 % men), aged between 18 and 65 (average of 35 years), were surveyed. Were applied the Rosenberg ISE scales, perceived discrimination of Krieger et al. and Basabe's adaptation of the CSE scale of Luthanen et al. Differential effects of ethnic and / or racial discrimination on ISE and on CSE are observed. In people who identify themselves as "white", the perception of racial discrimination is slightly and positively related to ISE. In those who are perceived as "mixed or Native American", racial discrimination has a moderate positive effect on CSE. In those who identify themselves as "Afro-descendants," both discriminations have a slight positive effect on ISE, while racial discrimination would moderately harm CSE. Finally, in those who identify themselves as "mulattos," both discriminations would have mild or moderate positive effects on both types of self-esteem. These results provide evidence to the effect of the phenotype on the relationship established between discrimination and self-esteem.

Personal-Level and Group-Level Discrimination and Mental Health: the Role of Skin Color.

OBJECTIVE: This study investigates the association between personal-level and group-level discrimination and common mental disorders (CMDs) among Afro-Brazilian women, aiming to explore the role of skin color on this association. METHODS: This is a cross-sectional study involving 1130 women who were participating in the Social Change, Asthma and Allergy in Latin America (SCAALA) study, whose children were recruited from 24 geographical micro-regions representative of the population without sanitation. Measures of discrimination were defined by: experiences (personal-level) and concern about discrimination (group-level) using the Experiences of Discrimination Scale. Skin color was registered by self-declaration, being classified as white, brown, and black. The association between "self-reported" discrimination and CMDs was evaluated using Poisson regression analysis. RESULTS: Prevalence of CMDs was high (38.3%), especially in the group exposed to discriminatory experiences and black women. Experiences and concern about discrimination were positive and significantly associated with mental health, before and after adjustment for potential confounders. The effect of discrimination on CMDs was lower among black women, suggesting the development of other strategies to confront racism. CONCLUSION: This study emphasizes the use of both personal- and group-level discrimination measures, as well as skin color, for the evaluation of mental disorders in public health research. Further studies of health consequences of discrimination will require investigation of protective factors for mental disorders in the population suffering discrimination and racism.

Desenvolvimento e validação do instrumento Percepção sobre Discriminação Racial Interpessoal nos Serviços de Saúde (DRISS) / Development and validity of the instrument Perception on Interpersonal Racial Discrimination in Healthcare Facilities (DRISS)

OBJETIVO: Desenvolver e validar um instrumento de medida das percepções sobre discriminação racial interpessoal no contexto dos serviços de saúde brasileiros. METODOLOGIA: Estudo do tipo metodológico conduzido com base na Teoria Clássica dos Testes para elaboração e validação psicométrica de instrumento. Para o desenvolvimento do pool de itens inicial, três fontes foram utilizadas: revisão de literatura sobre escalas já existentes; estudo qualitativo; e, sugestões de especialistas sobre racismo/desigualdades em saúde. O instrumento inicialmente proposto (versão 1) constava de 50 itens. Buscou-se verificar as evidências de validade de conteúdo e constructo e, para isso, a coleta de dados foi dividida em duas etapas. A primeira etapa consistiu na avaliação do instrumento proposto junto ao comitê de especialistas e a segunda etapa consistiu no preenchimento do instrumento pela população-alvo. A análise dos dados foi realizada no R e Stata 14.2. RESULTADOS: Na validação de face e conteúdo, a versão 1 foi submetida à avaliação por comitê de especialistas composto por um metodologista, um profissional de língua portuguesa, três especialistas em relações étnico-raciais e três membros da população-alvo. Dos 50 itens elaborados originalmente, foram excluídos 28 e restaram 22 (versão 2). O CVR (razão de validade de conteúdo) médio dos itens que restaram foi 0,74. Com relação à concordância entre os especialistas, o PABAK foi 0,30, considerado razoável. Entretanto, dos 22 itens que compuseram a versão 2, dois foram desmembrados, o que gerou a versão 3, com 24 itens. A versão 3 foi construída na plataforma digital Research Eletronic Data Capture (REDCap) e foi divulgada entre setembro e dezembro de 2017 por meio de um link (via redes sociais como Facebook e Whatsapp) que direcionou os respondentes para o instrumento. Ao todo, 480 pessoas acessaram o link, mas apenas 158 finalizaram o preenchimento do instrumento. A maior parte dos respondentes foi do sexo feminino (87,0%), autoclassificada como de raça/cor preta ou parda (97,5%) e pertencente ao grupo econômico A e B (61,4%). Prosseguiu-se com a avaliação da validade de constructo por meio da análise fatorial exploratória. KMO (Kaiser-Meyer-Okin) foi 0,736; o teste de esfericidade de Bartlett foi p<0,001; todas as cargas fatorias estiveram entre 0,3 e 0,9; e as comunalidades abaixo de 0,4. A avaliação do índice de confiabilidade Ômega de Mcdonald total foi 0,87, valor considerado bom. Dessa forma, produziu-se a versão 4, denominada DRISS, com 19 itens no total e seis dimensões, que são: sintomas somáticos, preparo, expressão emocional, percepção social, reação, consequências emocionais. Não foi observada diferença estatisticamente significativa nas médias dos escores em relação à idade, escolaridade, grupo econômico e outras variáveis sociodemográficas. CONCLUSÕES: Este estudo produziu uma escala que mede a percepção sobre discriminação racial interpessoal no contexto dos serviços de saúde, denominada DRISS, que apresenta adequadas propriedades psicométricas. O DRISS é direcionado especificamente às/aos usuárias/os dos serviços de saúde. Em nível populacional, produzirá dados relevantes para a tomada de decisões programáticas com foco na redução da discriminação racial nos serviços de saúde e consequente diminuição das iniquidades raciais em saúde.

OBJECTIVE: To develop and validate an instrument to measure perceptions about interpersonal racial discrimination in Brazilian healthcare facilities context. METHODOLOGY: This is a methodological study based on Classical Theory of Tests. For the development of the initial items pool, three sources were used: literature review on existing scales; qualitative study; and, expert on racism health inequalities suggestions. Initially, the version 1 was composed by 50 items. In order to test content and construct validity evidence, data collection was divided into two steps. The first step consisted of the analysis of version 1 instrument to an expert committee and the second step consisted of the submission of the instrument to the target population. Data analysis was performed with R and Stata 14.2. RESULTS: Face and content validation of version 1 was performed by expert committee composed by a psychometrist, a Portuguese language expert, three experts in ethnic-racial relations and three members of the target population. From the 50 originally drafted items, 28 were excluded and 22 remained (version 2). The average CVR (content validity ratio) of the items was 0.74. Regarding the agreement among the experts, PABAK was 0.30, considered reasonable. Two items from version 2 were dismembered, which generated version 3, with 24 items. Version 3 was included on the Research Eletronic Data Capture (REDCap) digital platform and was released between September and December 2017 in a link (via social networks like Facebook and Whatsapp). Altogether, 480 people accessed the link, but only 158 completed the instrument. Most respondents were female (87.0%), self-classified as black or brown (97.5%) and were at economic group A and B (61.4%). We proceeded with the evaluation of construct validity through exploratory factorial analysis. KMO (Kaiser-Meyer-Okin) was 0.736; Bartlett Sphericity Test was p <0.001; all factor loads were between 0.3 and 0.9; and commonalities below 0.4. The McDonalds Omega Total reliability rating was 0.87, which is considered good. In this way, version 4, named DRISS, was produced with a total of 19 items and six dimensions, that are: somatic symptoms, preparation, emotional expression, social perception, reaction, and emotional consequences. No statistically significant difference was observed in the means of the DRISS scores in relation to age, schooling, economic group and other sociodemographic variables. CONCLUSIONS: This study produced a scale that measures the 'perception about interpersonal racial discrimination in the healthcare facilities context, called DRISS, with adequate psychometric properties. DRISS is specifically targeted to the health services users. At the population level, it may produce relevant data for programmatic decision-making focused on reducing racial discrimination in healthcare facilities, and as a consequence, racial inequities in health.

Perceptions and experiences regarding the impact of race on the quality of healthcare in Southeast Brazil: a qualitative study

OBJECTIVE: To explore the impact of race on the quality of healthcare received by patients attending a primary care centre in Brazil. DESIGN: This was a qualitative study consisting of 19 semi-structured interviews conducted on patients from six racial groups (as defined in Brazil as white, yellow, brown, black and indigenous and one self-identified 'other' group). The interviews were analysed using thematic analysis. RESULTS: Four main themes were identified during analysis; factors affecting the access to healthcare, experiences regarding quality of healthcare, discrimination in healthcare and deep-rooted societal discrimination, which were categorised into a number of sub-themes. Within these themes, interviewees reported (1) experiences of racism in society towards the black racial group, (2) one personal perception and two observations of racial discrimination in healthcare, (3) perceived racial discrimination due to healthcare professional behaviour and (4) other factors, such as delays in appointments and long waiting times in health facilities were felt to impact access to care. CONCLUSION: The findings suggest that racial discrimination exists in Brazilian society but its direct impact on healthcare access was felt to be less obvious. Instead, organisational level factors were felt to contribute to difficulty accessing care. Interviewees perceived that racial discrimination may affect the quality of care, particularly for those designated as 'black'. Socio-economic factors were felt to influence discrimination in healthcare. The findings can help inform further studies and educational initiatives to help address discrimination and access to healthcare in Brazil.