Changes in perceptions and knowledge of health and healthcare disparities, after health equity training, among public health workers in Texas

Background: Increasing the awareness of racial/ethnic disparities in healthcare among key stakeholders has been recommended by the Institute of Medicine as a strategy for addressing healthcare disparities. Methods: Four-hour training workshops addressing health disparities were conducted between July and September 2012, for staff of 18 organizations (academic institutions, health departments, and non-profits) and their affiliates, participating in a Centers for Disease Control and Prevention (CDC)-funded statewide Community Transformation Grant in Texas. Pre- and post-training self-administered paper surveys were completed by consenting participants to assess their perceptions and knowledge regarding health and healthcare disparities (N=97). Due to the correlated nature of the data, Bhapkar's tests of marginal homogeneity were used to evaluate changes in the pre- and post-training responses. Results: 45% of participants were White/Caucasian, 33% were Hispanic, 17% were Black/African-American, and 5% were of other races/ethnicities. 38% of the participants worked at health departments, 34% at non-profits, 17% at academic institutions, and 10% at other organizations. Perceptions regarding race/ethnicity as a determinant of healthcare quality (p<0.01), and fairness in treatment (p<0.01) changed significantly. After the training, 74% of participants indicated that skin color affected healthcare quality compared to 47% at baseline. While 64% indicated that the healthcare system treats people unfairly based on their race/ethnicity ‘somewhat/very often' at baseline, this percentage increased to 88% afterwards. Perceptions regarding the contributing causes to disparities in infant mortality and life expectancy also changed (p<0.01 for both). More participants –- 26% and 31% -- identified prejudice as being responsible for the disparities in infant mortality and life expectancy compared to 6% and 7%, respectively, at baseline. Personal behavior was blamed for disparities in life expectancy by fewer respondents (15%) after the training compared to the baseline (32%). Knowledge of disparities in the incidence of chronic diseases such as cancer and cardiovascular disease also changed (p<0.01). While the majority of participants at baseline (71%) identified Whites/Caucasians as having the highest incidence of cancer, afterwards the majority (55%) chose Blacks/ African-Americans. More participants (69%) indicated that Blacks/African-Americans have the highest incidence of cardiovascular disease, after the training compared to 47% at baseline. Conclusion: Awareness of disparities in health and healthcare among public health and healthcare workers in a variety of organizations may be improved through targeted training. Heightening their awareness of health disparities will should lead to sustained changes in attitudes and translate into more equitable services in the communities they serve.