Strengthening randomized evaluations with qualitative research, part 2: Matching provider race to increase take-up of preventive health services
For the second blog in our blog series on incorporating qualitative research into randomized evaluations, we spoke with US Health Care Delivery Initiative Co-Chair Marcella Alsan about her research team’s experience using qualitative research methods in the scoping and analysis phases of their randomized evaluation.
In 2017-2018, Alsan, Owen Garrick, and Grant Graziani conducted a randomized evaluation to test the impact of financial incentives and race concordance (between patients and health care professionals) on the take-up of preventive health care services by Black men.
Before embarking on the project, the research team felt that it was important to get to know the population they would be working with for the study. Led by Bridge Clinical Research and its president and CEO, Owen Garrick, the research team conducted a series of focus groups with Black men recruited from Oakland barbershops to inform the study’s design.
“We walked into every single barbershop that we could find within a ten-mile radius of the clinic where our study would take place and recruited Black men from those barbershops to conduct several focus groups before actually enrolling anyone in a pilot. Led by Dr. Owen Garrick, the focus groups were carried out in a way that encouraged participants to speak as freely as possible—we didn’t ask for personal information and had a scribe take notes instead of recording the session. We wanted to ensure that we would learn as much as possible about the participants’ lived experiences.
It was incredibly helpful to have Bridge Clinical Research and Dr. Garrick as a partner in this study. They were deeply invested in the science behind the evaluation and also helped bridge the divide that existed between academia and the population that we're trying to serve with our research.”
Insights from the focus groups affirmed that the topic of the diversity of health care professionals was relevant to the lived experiences of the study population. The focus group conversations also helped the research team iron out critical design features of the randomized evaluation.
“Since the outcome of the study was take-up of preventive health care like BMI measurement and flu shots, procedures that do not require a medical doctorate, there was an open question around whether we should use nurses or physicians in the study. The focus groups showed that the men had a strong preference for physicians since they felt like physicians were not readily available to them as patients. Specifically, they felt like they were often paired with less qualified staff and that that was disrespectful. These conversations made the decision very easy since the aim of the study was to examine what fostered trust and respect between Black men and health care professionals.”
In addition to answering key study design questions like whether the intervention would use nurses or physicians, the focus groups helped refine other logistical details of the study. For example, based on participant feedback that advertising flu shots could suppress demand for the clinic’s services, the research team decided not to mention flu shots and only to mention cardiovascular screenings on the flyers advertising the clinic.
Ultimately, the research team conducted the study in two phases. In the first phase, study participants—Black men recruited from Oakland, California barber shops—arrived at the clinic and received a tablet with information about their visit. Researchers randomly assigned study participants to see Black or non-Black doctors and a financial incentive of $0, $5, or $10 if they chose to get the flu shot.
The participants then received a list of services and were told that their assigned doctor would provide all preventive services they selected. Participants were then asked to choose the preventive health care services they would like to receive. In phase two, participants met with the doctor whose image was displayed on the tablet and had another opportunity to decide which preventive services to receive.
The study found that seeing a Black male doctor significantly increased demand for all preventive health services. Those who saw a Black doctor were 11 percentage points more likely to choose to get their blood pressure measured (a 15 percent increase) and 16 percentage points more likely to choose to get their BMI measured (a 27 percent increase).
Seeing a Black doctor had an even larger impact on the take-up of more invasive procedures like diabetes screenings, cholesterol screenings, and flu vaccines. The qualitative data collected during the randomized evaluation shed light on potential mechanisms driving these effects.
“We used word clouds to compare the open-ended comments on the feedback forms from patients and found that the comments from patients who saw both Black and non-Black physicians were remarkably similar. This suggested that participants were happy with the care that they were getting from both Black and non-Black physicians. The excellent feedback of the non-Black doctors also helped rule out discriminatory behaviors towards patients as a factor driving the observed effects.
Where we did see differences were in the written notes physicians took during the visits. We found that the type of information that Black physicians versus non-Black physicians could extract was completely different. These findings bolstered our hypothesis that the driving mechanism was better communication between race concordant physicians and patients and not discrimination on the physicians’ part.”
Alsan feels that, when possible, researchers should try to incorporate qualitative methods into their research for several reasons.
“There are many times where, as researchers, we can lose touch with what the real questions, constraints, and realities are. In general, I think qualitative data can be incredibly fruitful. Not only does it let us understand what kind of variation we want to introduce or how we might leverage administrative data, but qualitative research can lead us to ask a whole new set of research questions that weren't even on the agenda.”
Alsan also believes that qualitative research approaches can provide opportunities to generate buy-in from key stakeholders, including the communities the research aims to serve.
“If you're doing work in criminal justice or health care or education, we ultimately want doctors, nurses, patients, sheriffs, prosecutors, teachers, and principals to read our work. One way to get these key individuals invested in our research is to ask them to be a part of the discussion when we pose research questions and interpret the results. If they feel like they’ve helped shape the research, then they might be more open to the policy recommendations that come out of it.”
Part one of this four-part blog series highlights the value of incorporating qualitative methods into randomized evaluations and outlined specific tips for researchers. Part three looks at how Creating Moves to Opportunity randomized evaluation embedded qualitative research methods into its study design. Part four discusses how qualitative research helped the Oregon Health Insurance Experiment research team make sense of some of the study’s results. Part five highlights the value of qualitative research in providing a deeper understanding of mothers' experiences in the Baby's First Years study.
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J-PAL North America reflects on using qualitative research methods in randomized evaluations, and summarize a few practical tips for those interested in integrating a qualitative approach into their studies.
Randomized evaluations allow researchers to measure the impact of programs and policies on a range of outcomes. Using this approach in North America, J-PAL researchers have recently examined a wide range of topics, including the effects of Medicaid on rates of health care utilization and the impact of a housing mobility program on the likelihood of families moving to lower-poverty neighborhoods.
But what mechanisms are driving the effects of these programs and policies? How did the context, design, and implementation of the program or policy influence the result? If replicated in a different context, will the program have the same effects? Is the study asking the right question?
Researchers can often collect quantitative data and design evaluations to shed light on these types of questions, but there’s always more to learn. Qualitative methods, such as direct observation, in-depth interviews, and focus groups, allow researchers to dive into these questions by examining participants’ beliefs, attitudes, experiences, and perspectives. Data gleaned from these methods can help researchers gain insight into potential mechanisms or barriers, generate new hypotheses and questions, and understand the stories behind the quantitative results.
For decades, social science scholars within anthropology, sociology, and psychology have employed qualitative methods. In recent years, many researchers within the traditionally quantitative field of economics have also incorporated qualitative methods into their studies and built teams with qualitative expertise to strengthen their research.
From our conversations with several researchers who've conducted and relied on qualitative research methods as part of J-PAL-supported randomized evaluations, we've summarized a few practical tips for those interested in integrating a qualitative approach into their studies:
- While developing your randomized evaluation, don't discount questions that can be best addressed through qualitative methods. These questions may challenge certain assumptions or shed light on mechanisms, contexts, or outcomes that quantitative methods may not fully capture. For example, researchers may want to gain insight into the experience of staff implementing a particular program to identify the challenges and barriers they faced, understand their perception of the program’s successes or shortcomings, and identify potential obstacles to longer-term implementation or scale-up. While this may be difficult to assess in a survey, focus groups and qualitative interviews could provide valuable insights.
- Account for qualitative research in study proposals and budgets. Qualitative research can require a high time commitment and can benefit from the support of specialized team members.
- Cultivate relationships with implementing partners. Forming a strong relationship with implementing partners is one key component to a successful and policy-relevant study and can help build a foundation for conducting qualitative research. Implementing organizations interact closely with study participants and often play instrumental roles in shaping the design and implementation of randomized evaluations. They are also well-placed to help researchers determine the best approaches to carrying out the qualitative parts of a study.
- Diversify your research team. Consider building a research team of individuals from different disciplines. Scholars of psychology, anthropology, sociology, and social work often have extensive experience with qualitative methods and bring valued perspectives that economists may be missing.
This blog series highlights three examples of J-PAL research teams using qualitative research methods to inform and strengthen the design, implementation, and analysis of their randomized evaluations. For part two of the series, we interviewed Professor of Public Policy and US Health Care Delivery Initiative Co-Chair Dr. Marcella Alsan about how qualitative research helped motivate and shaped the central question and hypothesis for a study on racial concordance between physicians and patients. In part three, we spoke with Professor of Sociology & Social Policy Stefanie Deluca about how the Creating Moves to Opportunity randomized evaluation, a study she co-led, embedded qualitative research methods into its study design. Part four features a conversation with Associate Professor of Social Work and Oregon Health Insurance Experiment co-author, Heidi Allen, on how qualitative research helped the research team make sense of some of the study’s results. The series concludes with part five, where we spoke with researchers from the the Baby's First Years study about the value of qualitative research in providing a deeper understanding of mothers' experiences.
Racial disparities in health outcomes are a major policy concern in the United States. Across all population subgroups, Black men experience earlier morbidity and mortality from preventable or manageable conditions. One potential solution to this problem is increasing diversity and representation in the health care workforce. Researchers examined the impact of race concordance (when the race of a patient matches that of their physician) and incentives on the take-up of preventive health services by Black men. Results indicate that physician race concordance significantly boosted demand for all preventive health services, and especially for more invasive tests.
Policy issue
On average, Black people in the United States live 70.8 years, while white people live 76.4 years on average and Asian people live 83.5 years on average.1 More than half of the gap in life expectancy for Black men is associated with preventable chronic conditions such as hypertension, diabetes, HIV, and some forms of cancer, suggesting that some of the disparity is due to inferior care or underutilization of preventive health care services.234 Many factors may underlie this underutilization: Black communities often lack access to primary health care,5 are more likely to be uninsured,6 and are less likely to trust the health care system.7 This distrust often stems from present and historical discrimination including negative interactions with medical professionals, with nearly 20 percent of Black individuals reporting that they were personally treated unfairly while seeking medical care.8 Race-based discrimination is deeply rooted: in medicine, from the unethical surgical procedures on enslaved people9 to the U.S. Public Health Service’s Syphilis Study in Tuskegee,10 contributing to ongoing distrust.
Increasing minority representation in health professions may contribute to ameliorating this distrust and advancing health equity by facilitating communication or reducing the racial discrimination patients may face. However, as of 2009, Black individuals comprise 12.6 percent of the United States population and only 3.8 percent of physicians.11 This underrepresentation is unlikely to improve in the coming years as medical school attendance for Black applicants has decreased over time.12 There is little rigorous evidence on the impact of workforce diversity in health care on minority health outcomes.
Context of the evaluation
The study took place in Oakland, California. According to the 2010 census, approximately 28 percent of Oakland’s population identifies as Black or African-American.13 Researchers recruited and enrolled study participants primarily from barbershops frequented by Black men in Oakland. Recruitment from barbershops is a commonly used health outreach technique aimed at Black men. Physicians were also recruited from the local area.
Details of the intervention
Researchers conducted a two-phase randomized evaluation to examine the impacts of doctor race and a subsidy on the demand for preventive care services among Black men.
When barbershop clients agreed to participate in the study, they received a generic flier advertising preventive health care services (for blood pressure, diabetes, and cholesterol) at a local clinic. They received an incentive payment for visiting the clinic.
Phase one: After study participants arrived at the clinic, they received a tablet with a photo of a health care provider, randomly assigned to be either a non-Black or Black male doctor. The participant was then shown a list of services and told that their assigned doctor would provide all preventive services they chose (including all listed on the original flier and one service, not on the flier, a flu shot). In addition, the tablet showed that participants would receive an incentive—randomly set at $0, $5, or $10—if they chose to get the flu shot. Study participants then selected which (if any) of the preventive care services they would like to receive.
Phase two: Participants met with the doctor whose image was displayed on the tablet. At this point, they could change their decisions on which preventive services to receive.
Results and policy lessons
For Black men, seeing a Black male doctor significantly boosted demand for all preventive health services, and especially for more invasive tests.
Phase 1. After seeing a photo of their doctor, Black men selected to receive preventive services at the same rate regardless of the race of their doctor. Initially, around 50 percent of men elected to receive non-invasive screening, blood pressure, and BMI measurement, and around 35 percent of men selected more invasive tests, including diabetes and cholesterol screenings, which require finger pricks.
Financial incentives for the flu shot also increased demand for the vaccine. When participants learned about incentives for flu shots before meeting their doctor, a $5 dollar incentive increased demand by 19 percentage points and a $10 dollar incentive increased demand by 30 percentage points (from a baseline of 20 percent). Approximately 20 percent of participants selected the flu shot when they were not offered an incentive. While subsidies increase demand, researchers found that incentives did not completely substitute for meeting with a Black doctor—that is, participants who met with a Black doctor were still more likely to take up preventive services than those who were incentivized to agree to a flu shot but saw a white doctor. Moreover, Black doctors continued to increase demand even among subjects who initially refused a flu shot despite a financial incentive.
Phase 2. After meeting with the doctor, Black men who were randomly assigned to see a Black doctor were much more likely to select every preventive service, particularly invasive services. Seeing a Black doctor increased the take-up of blood pressure measurement by 11 percentage points, compared to an average take-up rate of 72 percent for patients who were seen by a non-Black doctor (an increase of 15 percent). Likewise, seeing a Black doctor increased the take-up of BMI measurement by 16 percentage points, compared to an average of 60 percent for patients who were assigned to a non-Black doctor (an increase of 27 percent). The impact of being assigned to see a Black doctor has an even larger effect on more invasive tests like diabetes screenings, cholesterol screenings, and flu vaccines. Note that regardless of the race of the doctor, the average demand for preventive services increased after the in-person meeting. However, demand increased more for patients who were seen by Black doctors.
Hill, Latoya, and Samantha Artiga. 2023. “What Is Driving Widening Racial Disparities in Life Expectancy?” 2023. KFF. https://www.kff.org/racial-equity-and-health-policy/issue-brief/what-is-driving-widening-racial-disparities-in-life-expectancy/.
Currie, Janet and Hannes Schwandt. 2016. “Mortality Inequality: The Good News from a County-Level Approach.” Journal of Economic Perspectives 30, no 2 (Spring): 29-52. https://doi.org/10.1257/jep.30.2.29.
Harper, Sam, Dinela Rushani, and Jay S. Kaufman. 2012. "Trends in the Black-White Life Expectancy Gap, 2003-2008." JAMA 307, no. 21 (June): 2257-259. https://doi.org/10.1001/jama.2012.5059.
Silber, Jeffrey H., Paul R. Rosenbaum, Richard N. Ross, Bijan A. Niknam, Justin M. Ludwig, Wei Wang, Amy S. Clark, Kevin R. Fox, Min Wang, Orit Even-Shoshan, and Bruce J. Giantonio. 2014. "Racial Disparities in Colon Cancer Survival." Annals of Internal Medicine 161, no. 12 (December): 845. https://doi.org/10.7326/m14-0900
Brown Elizabeth J., Daniel Polsky, Corentin M. Barbu, Jane W. Seymour, and David Grande, 2016, “Racial Disparities In Geographic Access To Primary Care In Philadelphia.” Health Affairs 35, no. 8 (August). https://doi.org/10.1377/hlthaff.2015.1612
Nambi Ndugga and Samantha Artiga, “Disparities in Health and Health Care: 5 Key Questions and Answers,” Kaiser Family Foundation, 11 May 2021, https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question-and-answers/
Hamel, Liz, Lunna Lopes, Cailey Muñana, Samantha Artiga, and Mollyann Brodie. 2022. “KFF/The Undefeated Survey on Race and Health,” Kaiser Family Foundation, https://www.kff.org/report-section/kff-the-undefeated-survey-on-race-and-health-main-findings/#HealthCareSystem
Hamel, Liz, Lunna Lopes, Cailey Muñana, Samantha Artiga, and Mollyann Brodie. 2022. “KFF/The Undefeated Survey on Race and Health,” Kaiser Family Foundation, https://www.kff.org/report-section/kff-the-undefeated-survey-on-race-and-health-main-findings/#HealthCareSystem
“Life Story: Anarcha, Betsy, and Lucy,” Women and the American Story, Accessed 11 November 2022, https://wams.nyhistory.org/a-nation-divided/antebellum/anarcha-betsy-lucy/
Heller, Jean. 2017. “AP Was there: Black men untreated in Tuskegee Syphilis Study,” The Associated Press https://apnews.com/article/business-science-health-race-and-ethnicity-syphilis-e9dd07eaa4e74052878a68132cd3803a
Ellyn Boukus, Alwyn Cassil, and Ann S. O’Malley. 2009. “A Snapshot of U.S. Physicians: Key Findings from the 2008 Health Tracking Physician Survey.” Data Bulletin no. 35 (September) Center for Studying Health System Change. https://www.rwjf.org/content/dam/farm/reports/issue_briefs/2009/rwjf45703.
Devin B. Morris, Philip A. Gruppuso, Heather A. McGee, Anarina L. Murillo, Atul Grover, and Eli Y. Adashi. 2021.“Diversity of the National Medical Student Body — Four Decades of Inequities.” New England Journal of Medicine. 384:1661-1668. doi.org/10.1056/NEJMsr2028487
Bay Area Census (City of Oakland, Alameda County, Race, Black or African American, Census 2010; accessed March 2, 2018), http://www.bayareacensus.ca.gov/cities/Oakland.htm.
Better understanding and addressing the social determinants of health is critical to improving individual and population health and advancing health equity. J-PAL North America’s COVID-19 Recovery and Resilience Initiative aims to contribute to knowledge in this area by testing strategies to minimize the short and long-term public health impacts of COVID-19 and address inequities in access and care.
The COVID-19 pandemic has placed unprecedented strain on the American healthcare system, and in doing so has brought to light many of its most persistent shortcomings. Despite spending far more than any other country on healthcare, the United States has reported the highest number of coronavirus cases and the highest number of related deaths, causing many to question the underlying structures of the nation’s health care system. Gaps in health care access, coverage, and quality based on race, socioeconomic status, and geographic location are, in the midst of a global pandemic, rapidly widening and becoming more apparent than ever.
As nationwide protests against police violence and systemic racism continue across the United States, blatant disparities in COVID-19 infections and deaths point to the pressing need to address inequities in health and a myriad of other areas. Narrowing the significant socioeconomic gaps in health care access during the pandemic and post-pandemic context is an imperative undertaking.
Better understanding and addressing the social determinants of health is critical to improving individual and population health and advancing health equity; without taking an intersectional approach to addressing health, disparities will persist and communities will be left behind in the fight to mitigate the impact of COVID-19 and recover from the pandemic.
J-PAL North America’s COVID-19 Recovery and Resilience Initiative aims to contribute to knowledge in this area by testing strategies to minimize the short and long-term public health impacts of COVID-19 and address inequities in access and care. By teaching policymakers what programs and policies work to improve health equity and access, rigorous evidence can play a fundamental role in helping the nation respond effectively to COVID-19 while building a more equitable healthcare system in the long-run.
Pre-existing inequity in health care delivery and access
Communities of color have been hit the hardest by the COVID-19 pandemic, reflected in higher infection and death rates for Black, Hispanic, and Indigenous populations. These disparities in COVID-19 diagnoses and deaths are the result of pre-pandemic realities that have long limited access to health care and wealth. Structural factors—such as residential segregation and gentrification, workplace conditions, and economic security—have worked to reinforce and intensify health disparities by socioeconomic status, and contributed to rates of pre-existing health conditions that correlate with higher vulnerability to COVID-19.
Additionally, Black, Hispanic, and Indigenous communities in the United States often have less access to quality health care: even before the arrival of the novel coronavirus they were significantly more likely to be un- or under-insured. Immigrant communities are especially likely to be uninsured, as they are overrepresented in jobs that do not provide health insurance coverage, and undocumented individuals are explicitly barred from accessing most public and employer-sponsored plans.
There is also a history of distrust between these communities and the American health care system stemming from inaccessible care, disparities in health outcomes, a lack of Black, Hispanic and Indigenous physicians, and, for Black Americans, a longstanding history of medical exploitation and abuses dating to slavery.
Contact tracing, a public health tool that asks individuals to divulge personal, detailed information, inherently requires a degree of trust that our healthcare system has failed to earn from many communities of color. The combination of systemic distrust coupled with disparities in the quality of housing, jobs, and care available to communities of color has resulted in disastrous health outcomes for Black, Hispanic, and Indigenous communities during the COVID-19 crisis.
The impact of COVID-19
Amidst a global health crisis that has had catastrophic impacts on public health globally, the United States’ healthcare system has been hit particularly hard: the country has 4 percent of the world’s population, but about 24 percent of its COVID-19 cases and 22 percent of its COVID-19 deaths (as of September 1).
Overburdened hospitals serving the most hard-hit regions are struggling to pay for critical health services amidst rising equipment costs and declining revenues. They are also less able to provide quality primary care, mental health care, and care for chronic conditions in the struggle to funnel resources toward responding to COVID-19.
Deaths from noncommunicable diseases such as heart disease and diabetes have increased during the pandemic, possibly because individuals are afraid to seek emergency care out of fear of being exposed to the virus. On top of this, the United States is facing an unprecedented mental health crisis, with people experiencing higher rates of depression, anxiety, substance use, and suicidal ideation due to coping with the pandemic.
Nationally, Black and Hispanic populations have been disproportionately impacted by the virus, accounting for higher rates of infection and death than would be expected given their share of the national population. Of the 20 counties in the United States that have the highest level of COVID-19 deaths per capita, 11 counties have populations in which Black, Hispanic, or Indigenous people represent the largest racial group.
Adjusting for age, the coronavirus death rate for Hispanic populations is 2.5 that of white populations. For Black communities the numbers are even more harrowing, with Black populations dying at a rate of 3.6 times that of white populations. Part of the reason behind such disproportionate rates of infection and mortality stems from the fact that Black workers, Hispanic workers, immigrants, and women are disproportionately represented in essential, frontline jobs which dramatically increase one’s risk of exposure to the virus.
The economic impacts of the COVID-19 pandemic have had disastrous impacts on health inequities as well: the number of Americans living without health insurance has nearly doubled in size since late February, and families who have been financially impacted by the virus are struggling to pay for basic care. A disproportionate number of those losing employer-based coverage have been Black and Hispanic individuals. Without coverage, these families are likely to face more barriers to accessing quality care and may face significant negative health impacts as a result.
On top of this, the pandemic has negatively impacted families’ financial stability, which in turn has drastic implications for widening health disparities. As a result of job loss, financial shocks, and reduced income, a growing share of the population is struggling to afford nutritious food, access quality medical care, remain safe and stably housed, and pay for costs related to education—factors which serve as central determinants of health. As state moratoriums on evictions come to an end, an increase in the number of individuals experiencing homelessness and housing instability will leave more communities vulnerable to the virus, as well as vulnerable to long-term negative health outcomes.
Tenants of color are disproportionately impacted by evictions, and cities across the nation such as Boston, Los Angeles, and New York are preparing to see an increase in the rate of individuals experiencing homelessness among Black, Hispanic, and immigrant communities. Within this context, it is becoming more and more clear that addressing health disparities that stem from unequal social and economic conditions is of absolute necessity to fight and recover from COVID-19.
Research to improve health care delivery and expand health care access
The COVID-19 pandemic has already placed an indelible mark on nearly every aspect of the United States healthcare system. To deal with an unprecedented crisis, we need new research demonstrating what works to adapt our health care practices, programs, and policies to best respond to and recover from the pandemic as quickly and effectively as we can.
What are effective and equitable strategies to deliver quality health care given new constraints imposed by COVID-19?
Community health workers are frontline public health workers who are trusted members of the communities they serve. Better understanding how these workers can facilitate access to health, social, and community services in a pandemic setting may be a critical component in ameliorating the impact of COVID-19 on communities with specific health needs, such as Indigenous communities and other communities of color.
Additionally, in a time of social distancing, when many health care services are no longer provided in-person or in clinical settings, it is important to better understand how interventions such as telehealth can be used and adapted to meet the needs of different communities, especially those where health care access is limited.
How can health officials increase take-up of positive health behaviors?
The widespread adoption of positive health behaviors is necessary to minimize the spread of COVID-19. Researchers should work with public health authorities to identify ways to improve take-up of positive behaviors such as wearing a mask, avoiding unnecessary crowds, and, when it becomes possible, receiving the COVID-19 vaccine. Examples of interventions to increase take-up may include information campaigns, direct encouragement to take-up services, or increased access to free masks.
What can health care delivery organizations do to provide accessible and impactful mental health care?
In a period of increased social isolation, uncertainty, and financial stress, accessible and impactful mental health services are more critical than ever. Loneliness and social isolation are linked to poor health and mental health outcomes.
Due to the closure of clinics, provision of mental health services and counseling are more difficult for individuals to access, and for many, accessing counseling is cost-prohibitive. It is critical to have data on the efficacy of innovative strategies to deliver mental health care in this new context, including telehealth and app-based mental health services.
How can health officials address the unique health needs for those experiencing major barriers to health care, including those who are uninsured, incarcerated, or experiencing homelessness?
People without insurance in the United States often minimize their use of health care due to the high cost of seeking care, and may be hesitant to seek out critical COVID-19 testing or treatment. Further, individuals who are incarcerated and those experiencing homelessness represent two groups who are at high-risk of COVID-19 infection, lack access to adequate health care, and are unable to practice the positive health behaviors recommended to limit the spread of COVID-19.
Researchers should work with community agencies and health officials to identify effective ways to encourage the take up of health care for groups who largely lack access to care opportunities. Programs to broaden the reach of mental and physical health care service (such as mobile or telehealth platforms), increase trust in health systems and services, and connect individuals with social safety net programs may be important.
This post is an installation in J-PAL North America's "Building An Effective COVID-19 Response" research guide blog series. The complete series highlights the interaction between COVID-19, research, and the policy areas of health care delivery, jobs and the social safety net, and education.