Suchergebnisse

<p class="Pa7"><strong>Objective: </strong>Race consciousness serves as the foundation for Critical Race Theory (CRT) methodology. Colorblindness minimizes racism as a determinant of outcomes. To achieve the emancipatory intent of CRT and to reduce health care disparities, we must understand: 1) how colorblindness "shows up" when health care professionals aim to promote equity; 2) how their colorblindness informs (and is informed by) clinical prac­tice; and 3) ways to overcome colorblind­ness through strategies grounded in CRT.</p><p class="Pa7"><strong>Design/Setting/Participants: </strong>We conducted 21 semi-structured interviews with key informants and seven focus groups with personnel employed by a large Minnesota health care system. We coded transcripts in­ductively and deductively for themes using the constant comparative method. We used a race-conscious approach to examine how respondents' accounts align or diverge from colorblindness.</p><p class="Pa7"><strong>Results: </strong>Evading race, respondents consid­ered socioeconomic status, cultural differ­ences, and patients' choices to be the main contributors to health disparities. Few criti­cized the behavior of coworkers or that of the organization or acknowledged structural racism. Respondents strongly believed that all patients were treated equally by provid­ers and staff, in part due to race-neutral care processes and guidelines. Respondents also used several semantic moves common to colorblindness to refute suggestions of racial inequality.</p><p><strong>Conclusions: </strong>Colorblindness upholds the racial status quo and inhibits efforts to promote health equity. Drawing on CRT to guide them, health care leaders will need to develop strategies to counter personnel's tendency to focus on axes of inequality other than race, to decontextualize patients' health behaviors and choices, and to depend heav­ily on race-neutral care processes to produce equitable outcomes.</p><p><em>Ethn Dis. </em>2018;28(Sup­pl 1):235-240; doi:10.18865/ed.28.S1.235</p>

Objectives: To use the Consolidated Framework for Implementation Research (CFIR) adapted to a race-conscious frame to understand ways that structural racism interacts with intervention implementation and uptake within an equity-oriented trial designed to enhance student-school con­nectedness.Design: Secondary analysis of qualitative implementation data from Project TRUST (Training for Resiliency in Urban Students and Teachers), a hybrid effectiveness-imple­mentation, community-based participatory intervention.Setting: Ten schools across one urban school district.Methods: We analyzed qualitative ob­servational field notes, youth and parent researcher reflections, and semi-structured interviews with community-academic re­searchers and school-based partners within CFIR constructs based on framing questions using a Public Health Critical Race Praxis approach.Results: Within most CFIR constructs and sub-constructs, we identified barriers to implementation uptake not previously recognized using standard race-neutral definitions. Themes that crossed constructs included: 1) Leaders' willingness to examine Black, Indigenous, People of Color (BIPOC) student and parent experiences of school discrimination and marginalization had a cascading influence on multiple factors related to implementation uptake; 2) The race/ethnicity of the principals was related to intervention engagement and interven­tion uptake, particularly at the extremes, but the relationship was complex; 3) External change agents from BIPOC communities facilitated intervention uptake in indirect but significant ways; 4) Highly networked implementation champions had the ability to enhance commitment to intervention uptake; however, perceptions of these indi­viduals and the degree to which they were networked was highly racialized.Conclusions: Equity-oriented interventions should consider structural racism within the CFIR model to better understand inter­vention uptake.Ethn Dis. 2021;31(Suppl 1):375-388; doi:10.18865/ed.31.S1.375

As part of a pragmatic trial to reduce hypertension disparities, we conducted a baseline organizational assessment to identify aspects of organizational functioning that could affect the success of our interventions. Through qualitative interviewing and the administration of two surveys, we gathered data about health care personnel's perceptions of their organization's orientations toward quality, patient centeredness, and cultural competency. We found that personnel perceived strong orientations toward quality and patient centeredness. The prevalence of these attitudes was significantly higher for these areas than for cultural competency and varied by occupational role and race. Larger percentages of survey respondents perceived barriers to addressing disparities than barriers to improving safety and quality. Health care managers and policy makers should consider how we have built strong quality orientations and apply those lessons to cultural competency.

<p class="Pa6"><strong>Background: </strong>To fight racism and its poten­tial influence on health, health care profes­sionals must recognize, name, understand and talk about racism. These conversations are difficult, particularly when stakes feel high—in the workplace and in interracial groups. We convened a multidisciplinary, multi-racial group of professionals in two phases of this exploratory project to develop and pilot an intervention to promote effec­tive dialogues on racism for first year medi­cal students at the University of Minnesota Medical School.</p><p class="Default"><strong>Methods: </strong>Informed by a Public Health Crit­ical Race Praxis (PHCRP) methodology in Phase I, initial content was developed by a group of seven women primarily from racial and ethnic minority groups. In a later phase, they joined with five White (primarily male) colleagues to discuss racism and race. Participants met monthly for 12 months from Jan 2016-Dec 2016. All participants were recruited by study PI. An inductive approach was used to analyze meeting notes and post intervention reflections to describe lessons learned from the process of employing a PHCRP methodology to de­velop the aforementioned curriculum with a multidisciplinary and multi-racial group of professionals dedicated to advancing conversations on racial equity.</p><p class="Pa6"><strong>Results: </strong>Participants from Phase I described the early meetings as "powerful," allowing them to "bring their full selves" to a project that convened individuals who are often marginalized in their professional environ­ments. In Phase II, which included White colleagues, the dynamics shifted: "…the voices from Phase I became quieter…"; "I had to put on my armor and fight in those later meetings…"</p><p class="Default"><strong>Conclusions: </strong>The process of employing PHCRP in the development of an interven­tion about racism led to new insights on what it means to discuss racism among those marginalized and those with privilege. Conversations in each phase yielded new insights and strategies to advance a conver­sation about racism in health care. <em></em></p><p class="Default"><em>Ethn Dis. </em>2018;28(Suppl 1):271-278; doi:10.18865/ed.28.S1.271.</p>