Addressing health-related social needs during clinical care can be challenging. Often, the approach in maternity services is to screen patients and respond to disclosures with referrals. However, this approach presents challenges. First, patients need to self-identify and disclose social needs prior to receiving resource information. Second, federal reporting requirements of social needs screening during clinical care are ever-changing – from voluntarily to mandatory and, most recently, rescinded. To help address health-related social needs, we propose that maternity health care teams consider “leading with resources.” This perspective promotes introducing services, programs, and community-based resources to all patients as an ethical imperative and workflow opportunity. Proactive resource sharing before and after screening can normalize information exchange on sensitive topics and encourage discussion of sources of support. Universally communicating resource information can occur alongside an intentional focus on enabling access to care for patients who are most disadvantaged. Addressing health-related social needs respectfully, supporting patient comprehension of resource information, and facilitating successful referral navigation are critical.
Objective We conducted a contextual inquiry to assess the acceptability of adapting an efficacious psychosocial intervention for Black women experiencing intimate partner violence (IPV) and depressive symptoms to incorporate PrEP education, skill building, and linkage to care. Method The Grady Nia Project is a psychoeducational group intervention shown to reduce depressive symptoms among Black women who have experienced IPV and suicide. To inform adaptation of the Nia Project in a new context, we recruited staff and residents from four residential substance use treatment facilities in Philadelphia for semi-structured interviews and a focus group. Interviews used the Consolidated Framework for Implementation Research (CFIR) and syndemic theory to understand (1) barriers and facilitators of delivery of the adapted intervention and (2) baseline knowledge, awareness, attitudes, and acceptability of PrEP within the organization and among the population they serve. Results Despite very low PrEP knowledge or awareness, participants expressed high PrEP acceptability and interest. All residents and staff thought the proposed intervention would provide relevant information related to HIV prevention and PrEP, not readily available through current programming. However, structural conditions shaped both enthusiasm for and feasibility of implementing the proposed intervention within the residential setting and staff and resident buy-in was contingent not only on intervention content, but on the organization’s capacity to support implementation. Conclusions Advancing equitable HIV prevention for Black women requires system-level integration of PrEP within intimate partner violence settings, alongside investment in organizational readiness, workforce capacity, and structural infrastructure to support sustainable PrEP delivery.
Context Engaging community coalitions to implement evidence-based interventions with an intentional focus on health equity may help address opioid use disorder related disparities; however, research is needed to elucidate how core elements of coalition capacity can be strengthened to facilitate these efforts. Objective To evaluate satisfaction with diversity of coalition membership following enhancements promoting health equity under the HEALing Communities Study (HCS). Setting The HCS was a community-level, cluster-randomized trial; the primary objective was to evaluate the effectiveness of the Communities That HEAL intervention on reducing opioid overdose deaths across four states. Design The HCS was implemented in two waves. Cross-sectional surveys from two timepoints in each wave from 66 HCS coalitions were analyzed. Participants 1,082 unique coalition members representing 66 communities. Intervention The CTH intervention was enhanced for Wave 2 to improve promotion of health equity. This study focuses on coalition membership diversity. Main Outcome Participants rated satisfaction with the diversity and participation of: influential people, community residents, general diversity, and racial and ethnic diversity of coalition members. Results Satisfaction with racial and ethnic diversity improved in Wave 2; satisfaction with the racial and ethnic diversity of coalition increased as the proportion of racial and ethnic members increased. However, less than 51% of members reported satisfaction with racial and ethnic diversity in either wave. Survey response rates ranged from 36% to 52%. Conclusion Community coalitions addressing the opioid overdose epidemic should incorporate explicit approaches for focusing health equity. Simply increasing diversity does not guarantee equitable representation or meaningful engagement.
Introduction: In “A Chorus of Pain in Four Parts,” we highlight the profound lack of pain management offered for many gynecological and reproductive health procedures. Materials and Methods: This poem allows readers to reimagine perinatal care by exploring the equity issues in failing to address perinatal pain. Whose pain is ignored; whose is overlooked? The italicized text represents direct quotes drawn from our research interviews, Reddit threads, and the Serial podcast “The Retrievals.” This four-part poem contrasts the lack of health equity in perceptions of and responses to pain during procedures such as intrauterine device insertions, egg retrievals, and C-sections with the minimal pain relief offered, underscoring the contrast with other procedures where sedation is standard practice (e.g., scopes in gastroenterology). Results: The poem documents instances of medical gaslighting, where patients’ pain is dismissed as “unusual” or “just anxiety,” invalidating their experiences and eroding trust. This invalidation fosters a pervasive sense of uncertainty and helplessness among individuals navigating a medical system that appears unwilling to address their suffering. Discussion: By weaving together firsthand accounts from various sources, the piece amplifies the urgent call for a reevaluation of reproductive pain protocols, advocating for a fundamental shift in how the medical community approaches perinatal pain. Conclusion: The piece centers the patient experience and explores their experience with perinatal pain as a barrier to safety and thus full health.
