Understanding primary care utilization and barriers to care among sexual and racial/ethnic minority populations

了解性少数群体和种族/族裔群体中初级保健的利用和保健障碍

• 批准号: 10637523
• 负责人: Ning Hsieh
• 金额: $ 5万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10637523
• 关键词: Understanding; primary; care; utilization; barriers

Project Summary This project addresses AHRQ’s two Special Emphasis Notices on advancing primary care research and health equity (NOT-HS-22-011 and NOT-HS-21-014). Both sexual and racial/ethnic minority populations make up a significant and growing share of the U.S. population. Both populations experience higher rates of delayed health care, unmet care needs, and poorer quality of care than their respective majority counterparts. However, while prior studies have attempted to identify key factors leading to health care disadvantages in either population, they often overlook how the intersection of minoritized sexual orientation and race/ethnicity may complicate utilization of and barriers to care. Despite increasing research on sexual health care among Black and Hispanic sexual minority men, primary care experiences across Asian, Black, and Hispanic sexual minority women and men have not been systematically examined due primarily to data limitations. Guided by the framework of intersectionality and Behavioral Model of Health Services Use, this project aims to: (1) comprehensively document inequities in primary care utilization among sexual minority people of color in comparison to their heterosexual and White counterparts, and (2) identify unique mechanisms underlying the inequities facing each disadvantaged group. We will break new ground in understanding primary care inequities at the intersection of sexual orientation and race/ethnicity by analyzing two large population-based datasets from the National Health Interview Survey (2013-20) and the Behavioral Risk Factor Surveillance System (2014-20). These datasets have adequate sample sizes for studying sexual minority groups of color, rich information on health care experiences, and comparable measures for factors of health care utilization and sociodemographic characteristics. They also complement each other in their survey designs and health care measurements. Power analysis indicates that the samples of sexual minority people of color are sufficiently large to detect small effects at power>0.8. We will use multiple regression analyses and the Kitagawa-Oaxaca-Blinder decomposition approach to assess primary care inequities and multifaceted pathways linked to the inequities. Overall impact. This project will provide the first systematic and population-based analysis of primary care inequities and their underlying mechanisms at the intersection of race/ethnicity and sexual orientation. It will elucidate unique primary care challenges faced by sexual minority people of color, an underserved and understudied population that experiences significant and persistent health disadvantages. Findings will inform clinical practices, medical education, and policy designs of effective interventions to reduce health care inequities, a major goal of AHRQ. More broadly, the project will advance the understanding and application of intersectionality in health care research.

项目摘要 该项目涉及AHRQ关于推进初级保健研究和健康的两个特别强调通知 权益（NOT-HS-22-011和NOT-HS-21-014）。性别和种族/少数民族人口构成了一个 在美国人口中所占的比例越来越大。这两个群体的延迟发病率都较高， 保健、未得到满足的保健需求以及保健质量低于其各自的大多数同行。然而，在这方面， 虽然先前的研究试图确定导致健康护理不利的关键因素， 他们往往忽视了少数民族性取向和种族/民族的交叉点如何可能 护理的复杂利用和障碍。尽管越来越多的研究对黑人的性保健 亚裔、黑人和西班牙裔性少数群体的初级保健经验 主要由于数据有限，没有对妇女和男子进行系统研究。为指导 本项目的目标是：（1）建立卫生服务使用的交叉性和行为模式框架; 全面记录了有色人种中性少数群体在初级保健利用方面的不公平现象， 比较他们的异性恋和白色同行，（2）确定独特的机制， 每个弱势群体面临的不平等。 我们将在理解性取向和性别交叉点的初级保健不平等方面开辟新的天地。 通过分析来自国家健康访谈调查的两个大型人口数据集， （2013-20）和行为风险因素监测系统（2014-20）。这些数据集具有足够的 研究有色人种性少数群体的样本量，丰富的医疗保健经验信息， 卫生保健利用和社会人口特征因素的可比措施。他们还 在调查设计和卫生保健计量方面相互补充。功效分析表明， 有色人种的性少数群体的样本足够大，可以检测到功率>0.8的小效应。我们 将使用多元回归分析和Kitagawa-Oaxaca-Blinder分解方法评估 初级保健的不平等以及与不平等相关的多方面途径。 整体影响。该项目将首次对初级保健进行系统的、基于人口的分析 在种族/族裔和性取向的交叉点上的不平等及其根本机制。它将 阐明独特的初级保健所面临的挑战性少数人的颜色，一个服务不足， 未得到充分研究的人口经历了重大和持续的健康劣势。调查结果将告知 临床实践，医学教育和有效干预措施的政策设计，以减少医疗保健 不平等，AHRQ的一个主要目标。更广泛地说，该项目将促进对 医疗保健研究中的交叉性。