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 该项目介绍了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/族裔少数民族都构成 在美国人口中占重要份额。两个人群都有更高的延迟率 医疗保健，未满足的护理需求和较差的护理质量比各自的多数人。然而， 虽然先前的研究试图确定导致医疗灾难的关键因素 他们经常忽略少数性的性取向和种族/种族的交集如何 复杂化的护理利用和障碍。尽管黑人对性保健的研究不断增加 以及西班牙裔性少数群体，亚洲，黑人和西班牙裔性少数民族的初级保健经历 由于数据限制的主要原则，尚未系统地检查男女。由 卫生服务相交性和行为模型使用的框架，该项目的目的是：（1） 在有色人种的性少数群体中，全面证明初级保健利用的不平等 与他们的异性恋和白色对应物进行比较，（2）确定了依据的独特机制 面对每个弱势群体的不平等。 我们将在理解性取向和性取向和 通过分析国家健康访谈调查中的两个大型基于人群的数据集，种族/民族 （2013-20）和行为风险因素监视系统（2014-20）。这些数据集足够 研究性少数群体的样本大小，有关医疗保健经验的丰富信息以及 医疗保健利用率和社会人口统计学特征因素的可比措施。他们也是 在他们的调查设计和医疗保健测量中相互补充。功率分析表明 有色人种的性少数族裔的样本足够大，可以在功率> 0.8的情况下检测出小的效果。我们 将使用多个回归分析和北川 - oaxaca-blinder分解方法来评估 初级保健不平等和与不平等相关的多方面途径。 总体影响。该项目将提供第一个系统和基于人群的初级保健分析 种族/种族和性取向的交汇处的不平等及其基本机制。会 阐明有色人种的性少数民族面临的独特初级保健挑战，服务不足和 经历重大和持续性健康障碍的人口正在研究。调查结果将告知 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 不平等，AHRQ的主要目标。更广泛地，该项目将提高对的理解和应用 卫生保健研究中的交叉性。