Barriers to Urogynecologic Care for Racial and Ethnic Minority Women: A Qualitative Systematic Review.
Barriers to Urogynecologic Care for Racial and Ethnic Minority Women: A Qualitative Systematic Review.
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DOI：
10.1097/spv.0000000000001302
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发表时间：
2023-02-01
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研究试图评估在医疗保健方面持续存在差异的因素，包括妇科保健。然而，人们仍然缺乏对针对种族/少数民族人口的护理障碍的了解。我们的目标是报告美国(US)未被充分代表的种族和少数民族(URM)妇女在妇科护理方面存在的障碍(例如，对尿失禁(UI)、意外肠漏(ABL)、盆腔器官脱垂(POP)的症状/诊断的护理)。我们通过五个电子书目数据库对研究进行了系统的搜索。符合条件的研究的纳入标准包括：1)报告对那些有妇科症状/诊断的患者的护理障碍的研究，2)发表日期为2000年或之后的研究。排除标准包括有儿童的研究队列，完全是非美国人群，没有URM参与者的队列，以及没有定性研究方法的研究。研究方法、特点以及妇科护理的障碍和促进者通过主题综合方法被捕获。共确定了360项研究。12项研究符合标准：6项研究人群有尿失禁，3项有POP，2项有UI和/或POP，1项有ABL。有7个焦点小组研究(共44个小组，330个)，4个访谈研究(共160个访谈，160个)，1个两者兼有(10个访谈，6个小组，n=39)。大多数研究报告了患者相关障碍(n=10/12)和医生/提供者相关障碍(n=10/12)，而只有一半的研究报告了系统相关障碍(n=6/12)。对URM人群的妇科护理障碍进行了调查。研究结果可能不能完全反映URM人群在妇科护理方面的障碍。需要在研究中对健康和系统性种族主义的社会决定因素进行全面评估，以了解种族/族裔多样化人口面临的独特障碍。这项研究回顾了所有已发表的基于访谈的研究，以确定在美国治疗患有盆底疾病的种族/少数民族妇女的报道障碍。我们发现很少有(12)项研究集中在这一研究主题上，我们发现大多数研究讨论的是与患者(如尴尬、羞愧、恐惧、对其症状/状况的误解)或卫生保健专业人员(包括沟通不畅和解雇患者报告的症状)有关的护理障碍，而不是与卫生保健系统相关的障碍。值得注意的是，患者并未将种族主义视为障碍。
Studies have sought to evaluate factors that have perpetuated disparities in health care, including urogynecologic care. However, there remains a lack of understanding of barriers to care specific to racial/ethnic minority populations. We aimed to report identified barriers to urogynecologic care (e.g. care for symptoms/diagnoses of urinary incontinence (UI), accidental bowel leakage (ABL), pelvic organ prolapse (POP)) for underrepresented racial and ethnic minority (URM) women in the United States (US). We conducted a systematic search for studies through five electronic bibliographic databases. Inclusion criteria for eligible studies included: 1) studies reporting barriers to care for those with urogynecologic symptoms/diagnoses, 2) publication date year 2000 or later. Exclusion criteria included study cohorts with children, exclusively non-US populations, cohorts without URM participants, and studies without qualitative research methodology. Study methodology, characteristics, as well as barriers and facilitators to urogynecologic care were captured using a thematic synthesis approach. There were 360 studies identified. Twelve studies met criteria: 6 had study populations with UI, 3 with POP, 2 on UI and/or POP, and 1 on ABL. There were 7 focus group studies (total 44 groups, n=330), 4 interview studies (total 160 interviews, n=160), and 1 had both (10 interviews, 6 groups, n=39). Most studies reported on patient-associated barriers (n=10/12) and physician/provider-associated barriers (n=10/12) while only half reported system-associated barriers (n=6/12). Identified barriers to urogynecologic care for URM populations were examined. Findings likely do not fully reflect barriers to urogynecologic care for URM populations. Comprehensive evaluation of social determinants of health and systemic racism within studies is needed to understand the unique barriers present for racially/ethnically diverse populations. This research reviewed all published interview-based research to identify reported barriers to care for racial/ethnic minority women with pelvic floor disorders in the United States. We found few (12) studies focused on this research topic, and we found that most studies discussed barriers to care that were related to the patient (such as embarrassment, shame, fear, misunderstanding of their symptoms/condition) or the health care professional (including poor communication and dismissal of patient reported symptoms) rather than health care system related barriers. Notably, racism was not identified as a barrier by patients.