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.

项目概要 该项目涉及 AHRQ 关于推进初级保健研究和健康的两项特别强调通知 公平（NOT-HS-22-011 和 NOT-HS-21-014）。 这两个群体在美国人口中所占的比例都很高，而且还在不断增加。 然而，医疗保健、未满足的护理需求以及护理质量比各自的大多数邻居差。 而之前的研究必须确定导致医疗保健劣势的关键因素 人口中，他们经常忽视少数性取向和种族/民族的交叉点如何可能 尽管对黑人性保健的研究不断增加，但护理的利用和障碍仍然很复杂。 和西班牙裔性少数男性，亚裔、黑人和西班牙裔性少数群体的初级保健经验 主要由于数据的限制，尚未对女性和男性进行系统的检查。 交叉性和卫生服务使用行为模型的框架，该项目旨在：（1） 全面记录有色人种性少数群体在初级保健利用方面的不平等 与他们的异性恋和白唇进行比较，以及（2）确定潜在的独特机制 每个弱势群体面临的不平等。 我们将在理解性取向和性取向交叉点上的初级保健不平等方面开辟新天地 通过分析国家健康访谈调查中两个基于人口的大型数据集来了解种族/民族 (2013-20) 和行为风险因素监测系统 (2014-20) 这些数据集有足够的数据。 研究有色人种性少数群体的样本量、有关医疗保健经验的丰富信息，以及 他们还对医疗保健利用因素和社会人口特征进行了可比较的衡量。 彼此的调查设计和医疗保健测量结果表明， 有色人种的性少数群体的样本足够大，可以检测到功效 > 0.8 时的微小影响。 将使用多元回归分析和 Kitakawa-Oaxaca-Blinder 分解方法来评估 初级保健不平等以及与不平等相关的多方面途径。 该项目将提供第一个基于人口的系统性初级保健分析。 种族/族裔和性取向交叉点的不平等及其根本机制。 阐明有色人种、服务不足和服务不足的性少数群体所面临的独特的初级保健挑战 研究结果将为那些经历严重且持续的健康劣势的人群提供信息。 减少医疗保健的有效干预措施的临床实践、医学教育和政策设计 更广泛地说，该项目将促进对不平等的理解和应用。 医疗保健研究中的交叉性。