PDF(Pubmed)
Abstract：
Among the consequences of systemic racism in health care are significant health disparities among Black/African American individuals with comorbid physical and mental health conditions. Despite decades of studies acknowledging health disparities based on race, significant change has not occurred. There are shockingly few evidence-based antiracism interventions. New paradigms are needed to intervene on, and not just document, racism in health care systems. We are developing a transformative paradigm for new antiracism interventions for primary care settings that integrate mental and physical health care. The paradigm is the first of its kind to integrate community-based participatory research and systems science, within an established model of early phase translation to rigorously define new antiracism interventions. This protocol will use a novel application of systems sciences by combining the qualitative systems sciences methods (group model building; GMB) with quantitative methods (simulation modeling) to develop a comprehensive and community-engaged view of both the drivers of racism and the potential impact of antiracism interventions. Community participants from two integrated primary health care systems will engage in group GMB workshops with researchers to 1) Describe and map the complex dynamic systems driving racism in health care practices, 2) Identify leverage points for disruptive antiracism interventions, policies and practices, and 3) Review and prioritize a list of possible intervention strategies. Advisory committees will provide feedback on the design of GMB procedures, screen potential intervention components for impact, feasibility, and acceptability, and identify gaps for further exploration. Simulation models will be generated based on contextual factors and provider/patient characteristics. Using Item Response Theory, we will initiate the process of developing core measures for assessing the effectiveness of interventions at the organizational-systems and provider levels to be tested under a variety of conditions. While we focus on Black/African Americans, we hope that the resulting transformative paradigm can be applied to improve health equity among other marginalized groups.
摘要：
在医疗保健中系统性种族主义的后果中，黑人/非裔美国人的身体和精神健康状况并存的人之间的健康差异很大。尽管几十年的研究承认基于种族的健康差异，没有发生重大变化。令人震惊的是，基于证据的反种族主义干预措施很少。需要新的范式来干预，不仅仅是文件，医疗系统中的种族主义。我们正在为整合精神和身体保健的初级保健环境制定新的反种族主义干预措施的变革范式。该范式是第一个将基于社区的参与式研究和系统科学相结合的范式，在早期阶段翻译的既定模型中，严格定义新的反种族主义干预措施。该协议将通过将定性系统科学方法（组模型构建；GMB）与定量方法（模拟建模）相结合，来使用系统科学的新应用，以发展对种族主义驱动因素和潜在影响的全面和社区参与的观点反种族主义干预措施。来自两个综合初级卫生保健系统的社区参与者将与研究人员一起参加GMB小组研讨会，以1）描述和绘制驱动卫生保健实践中种族主义的复杂动态系统，2)确定破坏性反种族主义干预的杠杆点，政策和做法，和3）审查并优先考虑可能的干预策略列表。咨询委员会将就GMB程序的设计提供反馈，筛选潜在的干预组件以产生影响，可行性,和可接受性，并确定进一步探索的差距。将基于背景因素和提供者/患者特征生成模拟模型。使用项目反应理论，我们将启动制定核心措施的过程，以评估组织系统和提供者级别的干预措施的有效性，并在各种条件下进行测试。虽然我们关注的是黑人/非裔美国人，我们希望由此产生的变革范式可以应用于改善其他边缘化群体的健康公平。
