Systems Connected to Inequities in Access to Kidney Transplantation and the Value of Intersectionality

Patients from minoritized backgrounds based on race/ethnicity, gender, sexuality, and other social identities are more likely to experience inequities in access in kidney transplantation. Although these inequities have been reported over the decades, limited research focuses on the experiences of patients with intersecting minoritized social statuses and the mechanisms that contribute to their reduced access to transplantation. Intersectionality, a framework for understanding the ways in which multiple social identities represent interacting systems of oppression and privilege, offers a nuanced approach for understanding the experiences of patients diagnosed with end-stage organ disease with intersecting social identities. This article outlines complex systems that perpetuate inequities by highlighting the value of intersectionality in studying disparate outcomes to transplant and providing recommendations for the transplant community. This article aligns with the ESOT call for action to promote equity in transplantation worldwide

FACTORS PREDICTING AFRICAN AMERICAN RENAL PATIENTS’ COMPLETION OF THE MEDICAL EVALUATION PROCESS FOR KIDNEY TRANSPLANTATION

African Americans (AA) are more susceptible to end-stage renal disease (ESRD) for several reasons. Treatment options for patients with ESRD include dialysis therapy and transplantation, with the latter typically producing better outcomes. AA are less likely to complete the medical evaluation process, which requires patients to consult with doctors and undergo a series of tests and examinations. This study sought to determine the factors that predict completion of the medical evaluation for AA ESRD patients using a mixed methods design. Participants consisted of transplant professionals (N=23) recruited from nine transplant centers in the Mid-Atlantic, Mid-Western and Southeastern parts of the United States, and kidney patients (N=30 patients) recruited from one transplant center in the Mid-Atlantic region. Semi-structured interviews and nominal focus groups were conducted to gather qualitative data; quantitative survey data were also collected. The results revealed factors classified as impacting patients at the individual-level and systemic level, and others classified as health-related and informational/educational. Participants ranked insurances issues, limited income, lack of a personal means of transportation, lack of patient motivation, the number of procedures required to complete the evaluation, scheduling difficulties and time constraints as top barriers to completing the medical evaluation process. Top motivators consisted of informational support, social support, religious beliefs, patients’ desire to get off dialysis, support from the transplant staff, center-based education, patient’s knowledge of the benefits of transplantation and patient navigators. These findings provide valuable information on factors that impact AA renal patients’ completion of the medical evaluation

How Do Humility Prototypes Affect the Association between Perceptions of Spouse’s Humility and Depressive Symptoms and Couple Conflict?

Relational humility (RH) is associated with positive outcomes (e.g., fewer depressive symptoms; less couple conflict). Traditional conceptualizations of RH rely on other-report measures, but do not account for how one\u27s perception of another\u27s humility relates to one\u27s RH prototype (i.e., one\u27s expectations of how humble others, such as a spouse, should be). The current study (N = 69 couples; mean age = 30.80 years; 71% white) analyzed the effect of RH prototypes on the association between participants\u27 perception of their spouse\u27s RH and their reports of depressive symptoms and couple conflict. RH prototype was tested as both a moderator and a mediator to these associations. Actor-partner independence moderation and mediation models indicated that RH prototype functions as a moderator in the association between perceived spousal RH and both depressive symptoms and couple conflict, wherein greater discrepancies between spousal RH and RH prototype was associated with more depressive symptoms and conflict

Communicating about choices in transplantation (COACH): results of a pilot test using matched controls

Previous research highlights the difficulties patients with end-stage renal disease awaiting kidney transplant experience while attempting to manage both the logistical and the content-related aspects of discussions about transplantation. This article presents pilot results of the behavioral communication intervention program, Communicating about Choices in Transplantation (COACH), designed to improve transplant candidates’ communication about transplantation. Research Questions: As compared to matched controls, increases in knowledge of deceased and living donor transplantation, communication self-efficacy, intentions to hold conversations about transplantation, and self-reported discussion were expected for pilot participants from pre- and postassessment; decreases in conversational difficulties were also posited. Design: Using a nonrandomized quasi-experimental design, we compared transplant knowledge and communication between patients completing a 2-hour COACH session (pilot sample) to a sample of matched controls (n = 10). Data were collected via semi-structured telephone interviews upon enrollment and 1 month after enrollment or attendance at a COACH program session. Results: The results revealed significant differences in knowledge from pre- to postassessment between the pilot and control samples ( P = .02). Although no other statistically significant between-group differences were found, paired-sample t tests revealed significant pre–post increases in transplant knowledge (7.6 [standard deviation, SD = 2.0] to 9.5 [SD =1.8]; P = .05) and communication self-efficacy (1255.8 [SD = 239.7] to 1513.8 [SD = 114.3]; P = .009) for pilot participants. Decreases in perceived conversational difficulties were also observed ( P = .53). Discussion: Results provide preliminary support for the program’s impact. Moreover, participant evaluations of the COACH were overwhelmingly positive. A more definitive program evaluation with a larger, more diverse sample is currently underway

A Cross-Species Examination of Pro-White Color Bias Using a Novel Implicit Association Test

There is abundant evidence for pro-White color bias across the social psychology literature. In human–animal interaction work, black dog syndrome (BDS) refers to preference toward lighter-colored dogs over black dogs, leading to differences in rates of euthanasia and adoption. BDS has received mixed support in prior studies. Results from studies examining explicit color preference toward animals are also inconsistent. Numerous studies report strong support for implicit pro-White bias toward humans, but no studies have examined implicit pro-White bias toward animals. Thus, the primary aim of the current research was to test for implicit pro-White bias across various stimuli and species, using both novel and well-established Implicit Association Tests (IATs). In study 1 (n = 127) and study 2 (n = 141), IATs assessed pro-White bias across five different stimuli: objects, rabbits, dogs, skin tone, and race, using data collected from college students. Participants were categorized into three groups based on race and ethnicity (non-Hispanic White, non-Hispanic Black, and all other racial/ethnic participants). In both studies, there was evidence of pro-White bias across all five IATs. However, both studies also revealed significant racial differences. In both studies, pro-White bias was significant among White and other racial/ethnic participants but not among Black participants. Racial/ethnic differences were also found in prevalence of pet ownership and attitudes toward pets, but neither ownership nor attitudes were significantly associated with pro-White bias. Results from this study provide indirect support for BDS, in that individuals showed an implicit bias toward White dogs, although this bias is not present among Black individuals

Collective Self-Esteem and Well-Being among College Students in Ghana

Collectivist values may influence one\u27s display of self-esteem. Past research has established an association between psychological well-being and individuals\u27 appraisal of their value as a member of a social group, self-evaluation as an individual, and perception of others\u27 evaluation of their group (collective self-esteem). This study examined collective self-esteem, specifically whether private and public collective self-esteem and member self-esteem predicted psychological well-being alongside individual self-esteem in a sample (N = 416) of university students in Ghana. A linear regression tested the predictive ability of collective self-esteem for depression and anxiety symptoms. The results indicated that while individual self-esteem was related to lower levels of anxiety and depression symptoms, collective self-esteem was unrelated. In our sample of Ghanaian students, these findings suggest that personal self-esteem is more meaningful than collective self-esteem for their psychological well-being. This knowledge is instrumental for informing mental health interventions for this group