Devising, implementing, and evaluating interventions to eliminate health care disparities in minority children.
Despite an accumulating body of literature addressing racial/ethnic disparities in children's health and health care, there have been few published studies of interventions that have been successful in eliminating these disparities. The objectives of this article, therefore, are to (1) describe 3 interventions that have been successful in eliminating racial/ethnic disparities in children's health and health care, (2) highlight tips and pitfalls regarding devising, implementing, and evaluating pediatric disparities interventions, and (3) propose a research agenda for pediatric disparities interventions. Key characteristics of the 3 successful interventions include rigorous study designs; large sample sizes; appropriate comparison groups; community-based interventions that are culturally and linguistically sensitive and involve collaboration with participants; research staff from the same community as the participants; appropriate blinding of outcomes assessors; and statistical adjustment of outcomes for relevant covariates. On the basis of these characteristics, I propose tips, pitfalls, an approach, and a research agenda for devising, implementing, and evaluating successful pediatric disparities interventions. Examination of 3 successful interventions indicates that pediatric health care disparities can be eliminated. Achievement of this goal requires an intervention that is rigorous, evidence-based, and culturally and linguistically appropriate. The intervention must also include community collaboration, minimize attrition, adjust for potential confounders, and incorporate mechanisms for sustainability.
University of Texas Southwestern Medical Center, Division of General Pediatrics, Department of Pediatrics, 5323 Harry Hines Blvd, Dallas, TX 75390, USA. glenn.flores@utsouthwestern.edu
Glenn
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Flores
D000293:Adolescent; D001741:Black or African American; D001942:Breast Feeding; D019090:Case Management; D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D003431:Cross-Cultural Comparison; D019317:Evidence-Based Medicine; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D006284:Health Plan Implementation; D006297:Health Services Accessibility / Q000458:organization & administration*; D006302:Health Services Research / Q000458:organization & administration; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D007198:Indians, North American; D007223:Infant; D007231:Infant, Newborn; D033183:Interdisciplinary Communication; D008297:Male; D017057:Medically Uninsured; D008913:Minority Groups; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D014481:United States