Healthcare Experiences of Black Patients During and After Pregnancy: a Needs Assessment for Provider Training to Improve Quality of Care.

BACKGROUND: Black patients are at a higher risk of experiencing less safe and lower quality care during pregnancy and childbirth, compared to their White counterparts. Behaviors that healthcare professionals engage in that can facilitate or hinder high-quality care for this population are underexplored. We sought to explore Black patients' experiences with healthcare professionals during and after pregnancy, as a needs assessment to inform the development of training for healthcare professionals. METHODS: We conducted semi-structured interviews of Black patients who were in their third trimester of pregnancy or within 18 months of giving birth. Questions focused on experiences with healthcare professionals during pregnancy-related healthcare, including quality of care and discrimination. Thematic analysis was conducted using a combined deductive-inductive approach. Findings were considered in the context of the Institute of Medicine's Six Domains of Quality (equitable, patient-centered, timely, safe, effective, efficient). RESULTS: We interviewed 8 participants who received care from various clinics and institutions. Over half (62%) described experiencing discrimination or microaggressions during their pregnancy-related healthcare. Participants most commonly reflected upon experiences within the patient-centered care domain, regarding whether care was in alignment with their preferences, positive and negative interpersonal interactions, and varied experiences with patient education/shared decision-making. CONCLUSIONS: Black patients commonly report experiencing discrimination from healthcare professionals during pregnancy-related healthcare. Reducing microaggressions and improving patient-centered care is a key focus for healthcare professionals who serve this group. Training needs include addressing implicit bias, educating on common microaggressions, improving communication, and promoting an inclusive workplace.

Rural-Urban Disparities in Video Telehealth Use During Rapid Mental Health Care Virtualization Among American Indian/Alaska Native Veterans.

Importance: American Indian/Alaska Native veterans experience a high risk for health inequities, including mental health (MH) care access. Rapid virtualization of MH care in response to the COVID-19 pandemic facilitated care continuity across the Veterans Health Administration (VHA), but the association between virtualization of care and health inequities among American Indian/Alaska Native veterans is unknown. Objective: To examine differences in video telehealth (VTH) use for MH care between American Indian/Alaska Native and non-American Indian/Alaska Native veterans by rurality and urbanicity. Design, Setting, and Participants: In this cohort study, VHA administrative data on VTH use among a veteran cohort that received MH care from October 1, 2019, to February 29, 2020 (prepandemic), and April 1 to December 31, 2020 (early pandemic), were examined. Exposures: At least 1 outpatient MH encounter during the study period. Main Outcomes and Measures: The main outcome was use of VTH among all study groups (ie, American Indian/Alaska Native, non-American Indian/Alaska Native, rural, or urban) before and during the early pandemic. American Indian/Alaska Native veteran status and rurality were examined as factors associated with VTH utilization through mixed models. Results: Of 1 754 311 veterans (mean [SD] age, 54.89 [16.23] years; 85.21% male), 0.48% were rural American Indian/Alaska Native; 29.04%, rural non-American Indian/Alaska Native; 0.77%, urban American Indian/Alaska Native; and 69.71%, urban non-American Indian/Alaska Native. Before the pandemic, a lower percentage of urban (b = -0.91; SE, 0.02; 95% CI, -0.95 to -0.87; P < .001) and non-American Indian/Alaska Native (b = -0.29; SE, 0.09; 95% CI, -0.47 to -0.11; P < .001) veterans used VTH. During the early pandemic period, a greater percentage of urban (b = 1.37; SE, 0.05; 95% CI, 1.27-1.47; P < .001) and non-American Indian/Alaska Native (b = 0.55; SE, 0.19; 95% CI, 0.18-0.92; P = .003) veterans used VTH. There was a significant interaction between rurality and American Indian/Alaska Native status during the early pandemic (b = -1.49; SE, 0.39; 95% CI, -2.25 to -0.73; P < .001). Urban veterans used VTH more than rural veterans, especially American Indian/Alaska Native veterans (non-American Indian/Alaska Native: rurality b = 1.35 [SE, 0.05; 95% CI, 1.25-1.45; P < .001]; American Indian/Alaska Native: rurality b = 2.91 [SE, 0.38; 95% CI, 2.17-3.65; P < .001]). The mean (SE) increase in VTH was 20.34 (0.38) and 15.35 (0.49) percentage points for American Indian/Alaska Native urban and rural veterans, respectively (difference in differences [DID], 4.99 percentage points; SE, 0.62; 95% CI, 3.77-6.21; t = -7.999; df, 11 000; P < .001), and 12.97 (0.24) and 11.31 (0.44) percentage points for non-American Indian/Alaska Native urban and rural veterans, respectively (DID, 1.66; SE, 0.50; 95% CI, 0.68-2.64; t = -3.32; df, 15 000; P < .001). Conclusions and Relevance: In this cohort study, although rapid virtualization of MH care was associated with greater VTH use in all veteran groups studied, a significant difference in VTH use was seen between rural and urban populations, especially among American Indian/Alaska Native veterans. The findings suggest that American Indian/Alaska Native veterans in rural areas may be at risk for VTH access disparities.

Assessment of COVID-19 Website Communication in Languages Other than English by Local Health Departments in the United States.

Managing the information needs of diverse populations through accessible, high-quality, and evidence-based health communication is critical to controlling the COVID-19 pandemic. Access to comprehensive information is especially important for the >25 million limited English proficient (LEP) individuals in the U.S. who prefer to communicate in languages other than English. We assessed the alignment of COVID-19 communication with LEP constituents' needs by examining multilingual content availability on the health department websites of the largest U.S. cities by population. To guide content analysis, we designed a codebook to evaluate six content types, six delivery modes, and three score measures for each website; for each, we measured Holsti's percent of agreement. We then compared the amount of information provided in all combined content types across cities and languages by delivery mode. We thematically analyzed open-ended responses about users' experiences with each city's webpages. We found that COVID-19 information was not presented consistently across languages: many cities provided less information among several delivery modes in other languages compared to English. We found a discrepancy in the amount of information, presentation quality, and ease of navigability of the information among languages and between cities. Users described having negative experiences with most cities' COVID-19 websites in languages other than English. Our findings indicate a gap in the application of the cultural sensitivity approach by local health departments to address issues related to equitable multilingual, multimodal emergency communication, and underscore the need to improve guidelines for communicating public health information as a component of advancing health equity.

Spanish-Language Communication of COVID-19 Information Across US Local Health Department Websites.

The COVID-19 pandemic has brought new urgency to a longstanding problem: the US health system is not well-equipped to accommodate the country's large limited English proficient (LEP) population in times of national emergency. We examined the landscape of Spanish-language COVID-19 website information compared to information in English provided by health departments of the top 10 cities by population in the USA. For each city, coders evaluated three score measures (amount of information, presentation quality, and ease of navigation) for six content types (general information, symptoms, testing, prevention, vaccines, and live statistics) across six delivery modes (print resources, website text, videos, external links, data visualization, and media toolkits). We then calculated a grand average, combining all cities' values per score measure for each content type-delivery mode combination, to understand the landscape of Spanish-language information across the country. Overall, we found that, for all cities combined, nearly all content types and delivery modes in Spanish were inferior or non-existent compared to English resources. Our findings also showed much variability and spread concerning content type and delivery mode of information. Finally, our findings uncovered three main clusters of content type and delivery mode combinations for Spanish-language information, ranging from similar to worse, compared to information in English. Our findings suggest that COVID-19 information was not equivalently provided in Spanish, despite federal guidance regarding language access during times of national emergency. These results can inform ongoing and future emergency communication plans for Spanish-preferring LEP and other LEP populations in the USA.

Understanding factors associated with intent to receive the COVID-19 vaccine.

INTRODUCTION: As of December 1, 2020, when the Advisory Committee on Immunization Practices published their COVID-19 vaccine distribution and prioritization recommendations, health care workers (HCWs) and the elderly were deemed to be at greatest risk of contracting the coronavirus. Limited extant research suggests that most HCWs are willing to receive the COVID-19 vaccine, and findings from studies examining vaccine uptake in non-HCW samples also have reported high vaccination willingness. The health belief model (HBM) and the theory of planned behavior (TPB) suggest that beliefs about severity and susceptibility of disease, perceived benefits of and obstacles to vaccination, and normative beliefs of others affect vaccine uptake. Further, perceptions of safety, side effects, and demographic factors can uniquely impact COVID-19 vaccine uptake. METHOD: Using a cross-sectional design, we recruited 526 participants via social media, through snowball emailing methods, and from university settings. RESULTS: The present findings demonstrate that 37% of participants intend to get the vaccine, and 35% reported that they might get the vaccine. No relationships among demographic factors, willingness to receive the vaccine, and level of intent were observed. However, those who reported that they would not receive the COVID-19 vaccine demonstrated fewer positive attitudes, less agreement, fewer normative views, and less anticipatory regret regarding the COVID-19 vaccine. Also, perceptions of susceptibility, severity, and barriers were associated with participants' willingness to get the COVID-19 vaccine. DISCUSSION: Our results suggest that factors related to the HBM and TPB might uniquely impact COVID-19 vaccine acceptability and could guide the crafting of interventions meant to encourage vaccine uptake. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Colon cancer survival in California from 2004 to 2011 by stage at diagnosis, sex, race/ethnicity, and socioeconomic status.

BACKGROUND: Disparities in cancer survival exist between groups. This study aims to examine these disparities in stage-, sex-, race/ethnicity-, and socioeconomic-specific colon cancer net survival in California for adults diagnosed between 2004 and 2011. METHODS: We estimated age-standardized net survival using the Pohar Perme estimator for colon cancer by stage at diagnosis (localized, regional, and distant), sex, race/ethnicity (Non-Hispanic White, Non-Hispanic Black, and Hispanic), and socioeconomic status (SES). Data from the Surveillance, Epidemiology, and End Results database on adults diagnosed with malignant colon cancer during 2004-2011 in California were included (n = 78,285). County-level SES was approximated using quintile groupings based on the Federal Poverty Level. RESULTS: Five-year survival for all included adults was 66.0 % (95 % CI: 65.6 %-66.4 %). The difference between Non-Hispanic White (White) adults and Non-Hispanic Black (Black) adults was 9.3 %, and between White adults and Hispanic adults was 3.4 %. A higher proportion of Black (24.5 %) and Hispanic (21.4 %) adults were diagnosed with distant disease compared to White adults (19.4 %). Differences in sex-specific survival were minimal, with only differences between Hispanic men (62.0 % [60.5 %-63.4 %]) and women (65.9 % [64.4 %-67.3 %]). SES differences were largest between the lowest quintile 63.0 % (62.3 %-65.2 %) and the highest quintile 67.8 % (66.8 %-68.8 %). SES-, stage-, and race/ethnicity-stratified analysis demonstrated improving trends for White adults with localized and regional disease, and Hispanic adults with regional disease. CONCLUSION: Colon cancer survival in California is lower for Black and Hispanic adults than for White adults in all three categories: stage, sex, and SES, suggesting the need for improved health policy for Hispanic and Black adults.

Development of a Hybrid, Interprofessional, Interactive Quality Improvement Curriculum as a Model for Continuing Professional Development.

Over the past 20 years, there has been an increased focus on quality improvement (QI) in health care, which is critical in achieving care that is patient-centered, safer, timelier, and more effective, efficient, and equitable. At the center of this movement is QI education, which is known to lead to learning, behavior change, and improved outcomes. However, there is a need for the development and provision of long-duration, interactive, interprofessional training in QI, to allow for in-depth learning and application of learned skills. To this end, we designed a curriculum for an established interprofessional, interactive, web-based QI fellowship for doctorally prepared clinicians. Curricular content is delivered virtually to geographically dispersed learners over a 2-year time span. The didactic curriculum and experiential learning opportunities provide learners with the foundational knowledge and practical skills to engage in-and eventually, lead-QI initiatives around the country. Evaluation of learner satisfaction and cognitive, affective, and skills-based learning has found that this model is an effective method to train geographically distributed learners. A hybrid training structure is used, where learners interact with the material through 3 distinct delivery modes: (1) virtual instruction in QI topics; (2) face-to-face training, mentorship, and the opportunity for practical application of applied knowledge and skills through the completion of QI projects; and (3) opportunities for other types of training, tailored to each learner's Individual Development Plan. This training program model holds value for QI learning in various health care settings, which are interprofessional by nature. These foundational concepts of hybrid learning to distributed learners-wherein an instructor delivers curriculum in small, face-to-face batches, interprofessional learning is supplemented in a virtual, longitudinal manner, and learners are allowed the opportunity to put skills into action for real-world problems in interdisciplinary clinical teams-can be applied in a multitude of settings, with comparatively lower time and cost expenditure than traditional training programs.

Evaluation of a Distance Learning Curriculum for Interprofessional Quality Improvement Leaders.

As health care systems move toward value-based care, training future leaders in quality improvement (QI) is essential. Web-based training allows for broad dissemination of QI knowledge to geographically distributed learners. The authors conducted a longitudinal evaluation of a structured, synchronous web-based, advanced QI curriculum that facilitated engagement and real-time feedback. Learners (n = 54) were satisfied (overall satisfaction; M = 3.31/4.00), and there were improvements in cognitive (immediate QI knowledge tests; P = .02), affective (self-efficacy of QI skills; P < .001), and skill-based learning (Quality Improvement Knowledge Application Tool; P < .001). There was significant improvement in affective transfer (interprofessional attitudes on the job; p < .01) but no significant change on cognitive (distal QI knowledge test; P = .91), or skill-based transfer (self-reported interprofessional collaboration job skills; P = .23). The findings suggest that this model can be effective to train geographically distributed future QI leaders.