Advancing health disparities research within the health care system: a conceptual framework

Abstract

We provide a framework for health services-related researchers, practitioners, and policy makers to guide future health disparities research in areas ranging from detecting differences in health and health care to understanding the determinants that underlie disparities to ultimately designing interventions that reduce and eliminate these disparities. To do this, we identified potential selection biases and definitions of vulnerable groups when detecting disparities. The key factors to understanding disparities were multilevel determinants of health disparities, including individual beliefs and preferences, effective patient-provider communication; and the organizational culture of the health care system. We encourage interventions that yield generalizable data on their effectiveness and that promote further engagement of communities, providers, and policymakers to ultimately enhance the application and the impact of health disparities research.

FIGURE 1—

The 3 phases of the disparities research agenda. Note. In our framework, the health disparities research agenda progresses in 3 sequential phases of research. Phase 1 (detecting disparities) informs phase 2 studies (understanding disparities), which in turn informs phase 3 research (interventions to reduce or eliminate disparities).

FIGURE 2—

Understanding the origins of health and health care disparities from a health services research perspective: key potential determinants of health disparities within the health care system, including individual, provider, and health care system factors.