Health Inequalities in Access to Care among Latino Patients

拉丁裔患者在获得护理方面的健康不平等

• 批准号: 1911741
• 负责人: Dagoberto Cortez
• 金额: $ 13.8万
• 依托单位: Cortez, Dagoberto
• 依托单位国家: 美国
• 项目类别: Fellowship Award
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2021-12-31
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=1911741&HistoricalAwards=false
• 关键词: Health; Inequalities; Access; Care; among

This award was provided as part of NSF's Social, Behavioral and Economic Sciences (SBE) Postdoctoral Research Fellowships (SPRF) program and SBE's Social Psychology program. The goal of the SPRF program is to prepare promising, early career doctoral-level scientists for scientific careers in academia, industry or private sector, and government. SPRF awards involve two years of training under the sponsorship of established scientists and encourage Postdoctoral Fellows to perform independent research. NSF seeks to promote the participation of scientists from all segments of the scientific community, including those from underrepresented groups, in its research programs and activities; the postdoctoral period is considered to be an important level of professional development in attaining this goal. Each Postdoctoral Fellow must address important scientific questions that advance their respective disciplinary fields. Under the sponsorship of Dr. Mark Hayward at The University of Texas at Austin, this postdoctoral fellowship award supports an early career scientist investigating the influence that social inequalities exert on terminal cancer care for Latino patients. Research across multiple disciplines shows that Latino patients lack access to high-quality cancer care, are less likely to receive standard end-of-life care than other racial and ethnic groups, and face persistent health inequalities due to additional socioeconomic challenges. Yet, we know far less about how these social and health disparities influence care-seeking behavior. Additionally, we know even less about how patients attempt to overcome structural barriers and navigate the healthcare system. This project can produce societal benefits by providing key insights policymakers and community organizations can use to address health inequalities in Latino communities.This research explores the processes by which terminal Latino cancer patients and their family members access medical facilities, navigate healthcare institutions, attempt to treat the cancer, and plan for death. This project uses a multi-method design, which includes ethnographic observations, qualitative geographic imaging system (QGIS), "go alongs", and in-depth interviews. Specifically, data collection includes documenting and mapping the physical routes participants take to access care, observing how participants navigate healthcare bureaucracies, examining how participants talk about death (or ignore the subject) with loved ones, and analyzing how patients and family members come to some sort of consensus about future goals considering the dire medical circumstances. A multi-method qualitative research design generates various types of data, which allows for fine grain analyses, which in turn help trace the different mechanisms through which health inequalities are reproduced and the ways patients respond to experiencing such inequalities. This project makes novel contributions to existing knowledge by uncovering the ways health inequalities shape terminal cancer care for Latino patients. Studying how racial/ethnic inequalities influence healthcare access and the resources (both material and social) that patients use to navigate healthcare institutions can help generate policies that help lessen health disparities and support the care-seeking strategies patients are already successfully using. Findings from this study can also provide new insights for future researchers that want to study the relationship between race/ethnicity and health inequalities and the influence that socioeconomic factors have of healthcare access.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.

该奖项是NSF的社会，行为和经济科学（SBE）博士后研究奖学金（SPRF）计划和SBE的社会心理学计划的一部分。SPRF计划的目标是为学术界，工业或私营部门和政府的科学事业准备有前途的早期职业博士级科学家。SPRF的奖励包括在知名科学家的赞助下进行两年的培训，并鼓励博士后研究员进行独立研究。NSF致力于促进来自科学界各部门的科学家，包括来自代表性不足的群体的科学家参与其研究计划和活动;博士后期间被认为是实现这一目标的专业发展的重要水平。每个博士后研究员必须解决推进各自学科领域的重要科学问题。马克海沃德在得克萨斯大学奥斯汀分校的赞助下，这个博士后奖学金支持早期职业科学家调查社会不平等对拉丁美洲患者晚期癌症护理的影响。跨多个学科的研究表明，拉丁美洲患者无法获得高质量的癌症护理，与其他种族和族裔群体相比，他们接受标准临终护理的可能性较小，并且由于额外的社会经济挑战而面临持续的健康不平等。然而，我们对这些社会和健康差异如何影响就医行为知之甚少。此外，我们对患者如何试图克服结构性障碍并在医疗保健系统中导航的了解更少。该项目可以通过提供关键的见解政策制定者和社区组织可以用来解决拉丁裔community.This研究的健康不平等现象产生社会效益探讨了拉丁裔癌症晚期患者及其家庭成员访问医疗设施的过程，浏览医疗机构，尝试治疗癌症，并计划死亡。本研究采用多方法设计，包括民族志观察、质性地理影像系统（QGIS）、“同行”及深度访谈。具体来说，数据收集包括记录和绘制参与者获得护理的物理路线，观察参与者如何浏览医疗官僚机构，检查参与者如何与亲人谈论死亡（或忽略主题），并分析患者和家庭成员如何在考虑到可怕的医疗情况下就未来目标达成某种共识。多方法的定性研究设计产生了各种类型的数据，从而可以进行精细的分析，这反过来又有助于追踪健康不平等再现的不同机制以及患者对经历这种不平等的反应方式。该项目通过揭示健康不平等塑造拉丁美洲患者晚期癌症护理的方式，为现有知识做出了新的贡献。研究种族/民族不平等如何影响医疗服务的获得以及患者用于浏览医疗机构的资源（包括物质和社会），可以帮助制定政策，帮助减少健康差距，并支持患者已经成功使用的就医策略。这项研究的结果也可以为未来的研究人员提供新的见解，希望研究种族/民族和健康不平等之间的关系，以及社会经济因素对医疗服务的影响。该奖项反映了NSF的法定使命，并已被认为是值得支持的评估使用基金会的智力价值和更广泛的影响审查标准。