Black American experiences in healthcare: Past, present, and (improving the) future

Black Americans presently and have historically faced disproportionately negative experiences in the U.S. healthcare system, as spotlighted by the COVID-19 pandemic. In my dissertation, I employ diverse methodologies, including quantitative analyses of nationally representative data, qualitative analyses of focus groups, and experimental methods aiming to understand and illuminate potential ways to address Black Americans' experiences of injustice in healthcare. The introduction (Chapter 1) builds upon previous research to illustrate a model which emphasizes the importance of individuals and systems (and the histories of individuals and systems) to better understand racial injustice in healthcare. In Chapter 2, I provide a narrative review of the present and historical experiences of Black Americans in the healthcare system. Next, in Chapter 3, across two studies (N=13,054), including a nationally representative sample of Black and White Americans during the COVID-19 pandemic, Black (relative to White) Americans reported less positive experiences in healthcare, which explained early COVID-19 vaccination hesitancy and lower medical system trust. Current knowledge of the Tuskegee Syphilis Study was not related significantly to medical trust or vaccination intention, however. In Chapter 4, qualitative data and thematic analysis were used to interrogate the quality of healthcare provider-Black patient interactions in a sample of 37 Black American women who had been diagnosed with breast cancer. In a community-academic collaboration, three focus groups were conducted across California. Results demonstrated that participants experienced discrimination, stereotyping, and hostility from healthcare providers and within the healthcare system which undermined their medical trust. Further, participants offered suggestions for improving the healthcare experiences of Black women diagnosed with breast cancer. A critical step toward dismantling racial injustice is acknowledging its existence. Thus, in Chapter 5, I tested specific ways to shift dominant group members' perceptions to recognize both individual and systemic racism and how to increase behavioral intentions to combat injustice in healthcare. Results from this online experiment conducted with 1853 adults suggested that when White Americans learned about critical Black history in healthcare (i.e., history of injustice) vs. celebratory Black history (i.e., history of achievement) or control information, they reported significantly more perspective-taking with Black Americans, which in turn predicted more individual and systemic racism recognition and support for anti-racist policies in healthcare. Ultimately, my dissertation studies highlight specific experiences of injustice that Black Americans face in healthcare and identifies a mechanism to increase White Americans' recognition of and support for addressing injustices toward Black Americans. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

"If You are Going to Step on This Campus, You Have to Get Vaccinated”: A Qualitative Understanding of COVID-19 Vaccine Hesitancy Among Black Emerging Adults Returning to College Campuses

For the academic year 2021–2022, many American colleges mandated the COVID-19 vaccine for students to return to campus. However, when academic leaders put these mandates into effect, they may have failed to consider the emotional impact on vaccine hesitant students, especially students who have been historically marginalized or underrepresented such as Black emerging adults. This qualitative study explored how vaccine hesitant Black emerging adults describe and understand their return to academia and, how the historical mistreatment of Black Americans influenced their feelings and decision-making process around the vaccine mandates. The researcher conducted semi-structured interviews with 14 respondents, ages 18–25. The following themes were identified using thematic analysis: "…The Black Experience”: Historical Racism and Medical Misrepresentation;Personal and External Reasons for Vaccine Hesitancy;Factors Impacting the Final Decision to get Vaccinated;Experiencing Varied Emotions about being Vaccinated. Findings demonstrate that the historical mistreatment of Black individuals shaped respondents' experience and informed their hesitancy about being vaccinated. Further, while all respondents ultimately complied with the vaccine mandate and were able to return to campus, overall feelings post vaccination varied. Implications for future research, higher education, and clinical practice are discussed. © 2023 Society for the Study of Emerging Adulthood and SAGE Publishing.

COVID-19 stress and the health of Black Americans in the rural south

Black Americans have been disproportionately affected by the COVID-19 pandemic. To better understand changes in and predictors of their mental and physical health, in the current study, we used three waves of data (two prepandemic and a third during summer 2020) from 329 Black men and women in the rural South. Results indicated that health worsened after the onset of the pandemic, including increased depressive symptoms and sleep problems and decreased self-reported general health. Greater exposure to COVID-19-related stressors was significantly associated with poorer health. Prepandemic stressors (financial strain, racial discrimination, chronic stress) and prepandemic resources (marital quality, general support from family and friends) were significantly associated with exposure to COVID-19-related stressors and with health during the pandemic. Findings underscore how the pandemic posed the greatest threats to Black Americans with more prepandemic psychosocial risks and highlight the need for multifaceted interventions that address current and historical stressors among this population. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

COVID-19 Vaccination: Comparison of Attitudes, Decision-Making Processes, and Communication among Vaccinated and Unvaccinated Black Americans.

BACKGROUND: COVID-19 vaccination rates remain suboptimal among Black Americans who disproportionately experience higher hospitalization and death rates than White Americans. METHODS: We conducted a multi-method (interviews and surveys) study among 30 Black Americans (n = 16 vaccinated, n = 14 unvaccinated) to explore factors related to vaccination hesitancy, decision-making processes, and communication related to uptake. Participants were recruited by using community-driven approaches, including partner collaborations. Thematic analysis was used to analyze qualitative data, and descriptive and bivariate analysis was used for quantitative data. RESULTS: Of those unvaccinated, 79% (n = 11) stated they were delaying and 21% (n = 3) were declining vaccination indefinitely. When asked about the likelihood of vaccine initiation in 6 months and 12 months, 29% (n = 4) and 36% (n = 5), respectively, stated that they would receive the vaccine. The following themes emerged: (1) COVID-19 vaccination hesitancy exists on a continuum; (2) varied decision-making processes for COVID-19 vaccination; (3) motivators among vaccinated individuals; (4) barriers among unvaccinated individuals; (5) retrieving and navigating vaccine information within the COVID-19 infodemic; and (6) parent perspectives on child vaccination. CONCLUSIONS: Findings suggest that vaccinated and unvaccinated participants had similar and dissimilar perspectives in decision-making processes and vaccine concerns as shown in the Decision-making Processes for the COVID-19 vaccination (DePC) model. Based on these findings, future studies should further explore how factors influencing decision-making can lead to divergent outcomes for COVID-19 vaccination.

"Ain't about the money, ain't about the haircut”: Experiences of servant leadership in black-owned barbershops and beauty salons during the COVID-19 pandemic

The COVID-19 pandemic had a disproportionate, negative effect on Black Americans. Black-owned barbershops/beauty salons are traditionally trusted, yet little is known regarding how these "virtue locales” were affected by the pandemic. This theory-guided, qualitative descriptive study explored owners' experiences in addressing their clients' and community well-being during the first pandemic year, revealing four emergent themes: 1) "blessings” and cultural expectations informed a moral imperative to become servant leaders, 2) long-standing relationships resulted in opportunities to engage on topics of physical and mental health, 3) Barbershop/beauty salon-based COVID-19 information and resources led to individual and community empowerment, and 4) Barbershops and beauty salons were "virtue locales”, or physical manifestations of social responsibility and psychological safety during the pandemic. These results support that these locations are trusted spaces where health issues can be discussed, and that their owners are willing and trusted community leaders that can be leveraged to implement culturally appropriate health interventions.

Black Americans Receiving the COVID-19 Vaccine and Effective Strategies to Overcome Barriers: An Integrative Literature Review.

BACKGROUND: Black Americans have a greater likelihood of serious morbidity or mortality from contracting the coronavirus and represent the lowest percentage of vaccinated individuals by race. This integrative literature review aims to identify the major barriers to Black Americans receiving the COVID-19 vaccine and proposed solutions to improve vaccination rates among this population. METHOD: Databases CINAHL and LitCovid from the National Library of Medicine were utilized to find the articles included in this review. RESULTS: A total of seven articles were identified indicating five barriers preventing Black Americans from being vaccinated against COVID-19 that included (1) mistrust of the medical establishment, (2) uncertainty in vaccine safety, (3) limited access to healthcare, (4) inequitable access to resources, and (5) lower health literacy. The studies also indicated five strategies to increase the desire of Black Americans to be vaccinated including (1) utilizing trusted community leaders, (2) acknowledgment of the history of discrimination and trauma, (3) building more representative clinical trial cohorts, (4) continual investment into community-based organizations, and (5) mobile vaccine clinics. CONCLUSION: The medical establishment in the USA has significant work to do to gain the trust of Black Americans. Many of the strategies to increase vaccine uptake among Black Americans have yet to be implemented which limits the conclusions that can be drawn from them. A future study should examine the outcomes of these proposed solutions to see if they do indeed work as intended and increase vaccination rates among this population.

COVID-19 Disparities and Vaccine Hesitancy in Black Americans: What Ethical Lessons Can Be Learned?

OBJECTIVE: This state of the art review focuses on bioethical questions and considerations from research findings and methodological issues, including design and recruitment of participants, in studies related to COVID-19 vaccine hesitation in Black individuals. Ethical concerns identified were applied to otolaryngology with recommendations for improving health inequities within subspecialties. DATA SOURCES: An internet search through PubMed, CINAHL, and socINDEX was conducted to identify articles on COVID-19 vaccine hesitation among the Black population between 2020 and 2021. REVIEW METHODS: A systematic review approach was taken to search and analyze the research on this topic, which was coupled with expert analysis in identifying and classifying vital ethical considerations. CONCLUSIONS: The most common COVID-19 vaccine hesitation factors were related to the development of the vaccine, mistrust toward government agencies, and misconceptions about safety and side effects. These findings raised bioethical concerns around mistrust of information, low health literacy, insufficient numbers of Black participants in medical research, and the unique positions of health professionals as trusted sources. These bioethical considerations can be applied in otolaryngology and other health-related areas to aid the public in making informed medical decisions regarding treatments, which may reduce health inequalities among Black Americans and other racial and ethnic minority groups. IMPLICATIONS FOR PRACTICE: Addressing ethical questions by decreasing mistrust, tailoring information for specific populations, increasing minority representation in research, and using health professionals as primary sources for communicating health information and recommendations may improve relationships with Black communities and increase acceptance of new knowledge and therapies such as COVID-19 vaccination.

Black American experiences in healthcare: Past, present, and (improving the) future

Black Americans presently and have historically faced disproportionately negative experiences in the U.S. healthcare system, as spotlighted by the COVID-19 pandemic. In my dissertation, I employ diverse methodologies, including quantitative analyses of nationally representative data, qualitative analyses of focus groups, and experimental methods aiming to understand and illuminate potential ways to address Black Americans' experiences of injustice in healthcare. The introduction (Chapter 1) builds upon previous research to illustrate a model which emphasizes the importance of individuals and systems (and the histories of individuals and systems) to better understand racial injustice in healthcare. In Chapter 2, I provide a narrative review of the present and historical experiences of Black Americans in the healthcare system. Next, in Chapter 3, across two studies (N=13,054), including a nationally representative sample of Black and White Americans during the COVID-19 pandemic, Black (relative to White) Americans reported less positive experiences in healthcare, which explained early COVID-19 vaccination hesitancy and lower medical system trust. Current knowledge of the Tuskegee Syphilis Study was not related significantly to medical trust or vaccination intention, however. In Chapter 4, qualitative data and thematic analysis were used to interrogate the quality of healthcare provider-Black patient interactions in a sample of 37 Black American women who had been diagnosed with breast cancer. In a community-academic collaboration, three focus groups were conducted across California. Results demonstrated that participants experienced discrimination, stereotyping, and hostility from healthcare providers and within the healthcare system which undermined their medical trust. Further, participants offered suggestions for improving the healthcare experiences of Black women diagnosed with breast cancer. A critical step toward dismantling racial injustice is acknowledging its existence. Thus, in Chapter 5, I tested specific ways to shift dominant group members' perceptions to recognize both individual and systemic racism and how to increase behavioral intentions to combat injustice in healthcare. Results from this online experiment conducted with 1853 adults suggested that when White Americans learned about critical Black history in healthcare (i.e., history of injustice) vs. celebratory Black history (i.e., history of achievement) or control information, they reported significantly more perspective-taking with Black Americans, which in turn predicted more individual and systemic racism recognition and support for anti-racist policies in healthcare. Ultimately, my dissertation studies highlight specific experiences of injustice that Black Americans face in healthcare and identifies a mechanism to increase White Americans' recognition of and support for addressing injustices toward Black Americans. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Ethical Approaches to Vaccine Allocation and Administration in Carceral Settings, With a Focus on Youth.

COVID-19 has disproportionately impacted Americans in carceral settings and secure facilities. A disproportionate number of persons who are confined to carceral settings and secure facilities are members of racial, ethnic, and socioeconomic groups who experience a significant burden of COVID-19 morbidity and mortality. The pandemic-related disparities experienced by minoritized and detained adult populations have received national attention, but the burden of COVID-19 risk among justice-involved youth has been largely absent from these national conversations. With more than 40,000 youth in carceral settings, their COVID-19 risks and prevention needs warrant specific consideration, especially as vaccine distribution programs expand. Youth have been assigned a lower priority status in most state vaccine allocation plans, but youth in carceral settings are at increased risk compared with their peers, raising important questions about how to ethically allocate and administer vaccines to them. In this article we examine ethical issues that arise in the health care of minors in carceral settings and identify an ethical model that could be used to reconsider the allocation of COVID-19 vaccines.

African Americans and the COVID-19 pandemic: A qualitative inquiry of preparedness, challenges, and strategies on how we can move forward.

RATIONALE: The COVID-19 pandemic has disproportionately impacted Black Americans. Inequities in systems and social determinants of health along with racial health disparities impact degree of pandemic preparedness. OBJECTIVE: In early pandemic stages, we aimed to explore: 1) state of pandemic preparedness; 2) effects of socio-ecological factors on preparedness; and 3) multi-level strategies to increase preparedness among uniquely, vulnerable Black American subgroups. METHODS: We conducted 62 in-depth interviews with Black American community members representing parents, individuals with underlying medical conditions, essential workers, and young adults. Based on the McLeroy's Model Ecological for Health Promotion, an inductive-deductive content analysis approach was used to analyze the interview data around the factors influencing preparedness on individual, interpersonal processes and primary groups, community/institutional, and public policy. RESULTS: Majority (56.5%) of the participants stated they were somewhat or very prepared. We identified four themes: 1) Lived Experiences during the COVID-19 Pandemic; 2) Challenges experienced during the COVID-19 Pandemic; 3) I would do this differently they say; 4) Changes Needed to Survive the Pandemic relate to Public Policy, Community/institutional factors, and Interpersonal processes and primary group(s). All participants described their adjustments to live in the new norm. Participants identified perceived challenges and solutions on multi-levels, driven by subgroup. CONCLUSIONS: Pandemic response plans should use targeted strategies across multi-levels to enhance the preparedness of Black Americans, especially those in vulnerable groups. This could reduce the disproportionate COVID-19 disease burden exhibited by Black Americans and better prepare for future pandemics.

Leveraging Black pharmacists to promote equity in COVID-19 vaccine uptake within Black communities: A framework for researchers and clinicians.

Black Americans are disproportionately represented among coronavirus disease 2019 (COVID-19)-related morbidities and mortalities. While the COVID-19 vaccines are positioned to change this disparity, vaccine hesitancy, attributed to decades of systemic racism and mistreatment by the United States health care system, heavily exists among this racially and ethnically minoritized group. In addition, social determinants of health within Black communities including the lack of health care access and inequitable COVID-19 vaccine allocation, further impacts vaccine uptake. Black pharmacists have worked to address the pandemic's deleterious effects that have been recognized within Black communities, as they are intimately aware of the structural and systematic limitations that contribute to lower vaccination rates in comparison to other racial and ethnic groups. Black pharmacists have been integral to promoting equity in COVID-19 uptake within Black communities by disseminating factual, trustworthy information in collaboration with community leaders, advocating for the equitable access to the immunizations into vulnerable areas, and creating, low-barrier, options to distribute the vaccines. Herein, we thoroughly explain these points and offer a framework that describes the role of Black pharmacists in narrowing vaccine equity gaps.

Exploring culturally competent mental health outreach to Black churches

Black individuals and communities have held distrust toward mental health services and experience barriers in seeking services. Although the church is a significant support system in the Black community, it can also pose a barrier to congregation members seeking mental health services, as the Black church community has often stigmatized those seeking mental health services as weak. Ways to reach the Black community with trauma-informed, culturally competent, and spiritually sensitive mental health services through establishing connections with Black churches and church leaders were explored in this study. Previous research indicated that the COVID-19 pandemic increased depression and anxiety in the Black community because of disproportionate illnesses and deaths. This study explored ways Black churches can provide access to trustworthy, culturally competent, and spiritually sensitive mental health services. The Baldrige Framework of Excellence was the conceptual framework. Data were collected through six semistructured interviews with the senior leaders of the behavioral health organization who agreed to participate in the study. Secondary data were also collected and included meeting minutes, strategic plans, the organizational website, and information from the organization's library of resources. Findings showed that Black women were able to seek counseling comfortably because of increases in teletherapy and preparedness to handle increased demand during the coronavirus pandemic. This study's findings contribute to positive social change by providing behavioral health leaders with insights on how to establish trust and normalization of mental health services through effective outreach to local Black churches. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Exploring COVID-19 Vaccine Hesitancy Amongst Black Americans: Contributing Factors and Motivators.

PURPOSE: To determine reasons for hesitancy towards COVID-19 vaccination and motivators to increase COVID-19 vaccine uptake among Black Americans. DESIGN: Mixed-methods. SETTING: Individual interviews in March-April 2021. PARTICIPANTS: Black adults (20-79 years) who attended a church in Boston, MA and identified as "vaccine hesitant" (n = 18). METHODS: Individual in-depth Zoom interviews to elicit participant views on vaccines in general, specific reasons for COVID-19 vaccine hesitancy, and trusted sources of information. Participants were also asked about possible motivators that could increase COVID-19 vaccine uptake. Transcripts were de-identified and analyzed for major themes using an inductive approach. RESULTS: Analysis included 18 complete interviews. Lack of trust in the government, healthcare, or pharmaceutical companies (n = 18), rushed development (n = 14), fear of side effects (n = 12), history of medical mistreatment (n = 12), and a perception of low risk of disease (n = 9) were the top-cited reasons for COVID-19 vaccine hesitancy. Motivators likely to increase COVID-19 vaccine uptake included more data (n = 17), friends and family getting vaccinated (not celebrities) (n = 11), and increased opportunities that come along with being vaccinated (n = 8). CONCLUSION: There were many reasons for COVID-19 vaccine hesitancy, as reported by participants who were all Black Americans in the Boston area. The public health challenge of increasing vaccine uptake in the Black community is nuanced and intervention efforts may be more successful if delivered by trusted members of the community and tailored to the needs of individuals.

An experimental study of the effects of messaging strategies on vaccine acceptance and hesitancy among Black Americans.

Black Americans have been disproportionately affected by COVID-19 but have comparatively low vaccination rates, creating a need for vaccine messaging strategies that are tailored to this population. We conducted an experimental study to examine the effects of three messaging strategies on Black Americans' reported willingness to receive the vaccine and vaccine hesitancy. We also recruited White and Hispanic Americans to assess any potential backfire effects of the tailored strategies for non-Black participants. A total of 739 participants completed the study. Results from 4x2 ANCOVAs indicate that, among Black participants, messaging that acknowledged past unethical treatment of Black Americans in medical research and emphasized current safeguards to prevent medical mistreatment was associated with significantly less vaccine hesitancy than the control condition. The same effects were not observed for messaging strategies that provided general safety information about the vaccine or that emphasized the role of the vaccine in reducing racial inequities. There were no significant differences across conditions for participants of other races. Results demonstrate that public health messages tailored to address specific vaccine concerns may aid future vaccination campaigns.

Impact of Structural Racism on Kidney Health: A Scoping Review

Structural racism remains a fundamental reason for persistent health disparities in the United States. The coronavirus disease 2019 (COVID-19) pandemic has highlighted that structural racism persists and negatively impacts the health of Black Americans. Despite significant evidence demonstrating the impact of structural racism on health, there is a lack of evidence explicitly focusing on kidney health. This scoping review was conducted to analyze the available evidence to identify the best strategies nephrology nurses can utilize to dismantle structural racism and improve kidney health in Black Americans. Results of this scoping review (n = 12) identified significant gaps in the literature regarding strategies to improve kidney health in Black Americans. There is a need for future research to understand the effect of structural racism on kidney health. Copyright© by the American Nephrology Nurses Association.

Actual Racial/Ethnic Disparities in COVID-19 Mortality for the Non-Hispanic Black Compared to Non-Hispanic White Population in 353 US Counties and Their Association with Structural Racism.

INTRODUCTION: Although disparities in COVID-19 mortality have been documented at the national and state levels, no previous study has quantified such disparities at the county level by explicitly measuring race-specific COVID-19 death rates. In this paper, we quantify the racial/ethnic disparities in COVID-19 mortality between the non-Hispanic Black and non-Hispanic White populations at the county level by estimating age-adjusted, race-specific death rates. METHODS: Using COVID-19 case data from the Centers for Disease Control and Prevention, we calculated crude and indirect age-adjusted COVID-19 mortality rates for the non-Hispanic White and non-Hispanic Black populations in each of 353 counties for the period February 2, 2020, through January 30, 2021. Using linear regression analysis, we examined the relationship between several county-level measures of structural racism and the observed differences in racial disparities in COVID-19 mortality across counties. RESULTS: Ninety-three percent of the counties in our study experienced higher death rates among the Black compared to the White population, with an average ratio of Black to White death rates of 1.9 and a 17.5-fold difference between the disparity in the lowest and highest counties. Three traditional measures of structural racism were significantly related to the magnitude of the Black-White racial disparity in COVID-19 mortality rates across counties. CONCLUSIONS: There are large disparities in COVID-19 mortality rates between the Black and White populations at the county level, there are profound differences in the level of these disparities, and those differences are directly related to the level of structural racism in a given county.

Young African Americans' Communication with Family Members About COVID-19: Impact on Vaccination Intention and Implications for Health Communication Interventions.

Communication with family members about the COVID-19 vaccine may play an important role in vaccination decisions, especially among young people. This study examined the association between family communication about the COVID-19 vaccine and vaccination intention. Participants were Black/African Americans aged 18-30 years (N = 312) recruited through an online survey in June 2020. We assessed family communication, vaccine attitudes, perceived norms, outcome expectancies, and vaccination intention. More than half (62%) of the participants had talked to family members about the vaccine. Females were more likely than males to have engaged in family communication (63% vs. 59%) (p. > .05). Family communication, injunctive norms, and descriptive norms were significantly (p. < .01) associated with vaccination intention. Family communication was the strongest predictor of intention.Promoting discussions about vaccinations between young Black adults and their families may increase the likelihood of adopting positive vaccination beliefs and influencing vaccine decision-making.