Health Disparities

HD: Availability and Access to Healthcare (2009)

• Assessment
  What evidence demonstrates that access to nutrition/dietetic services and educational resources among health disparities populations differs based on socio-economic status (low income, uninsured), racial/ethnic groups or geographic location?

  • Conclusion

    Two cross-sectional studies evaluated nutrition services provided by health professionals to ethnic minorities and low-income populations in hospital settings. It is unknown whether dietitians provided these services.

    One study (Cropley and Herwehe 2002) found that all nine hospitals in metropolitan New Orleans provided written breastfeeding education materials and education to maternity patients receiving Medicaid or WIC services that delivered at their facilities. At least two thirds of these hospitals had specialized lactation staff to address breastfeeding concerns and had explicit policies in place for promoting breastfeeding. 

    Another study (Hasnain-Wynia et al 2007) in teaching hospitals across the US found that minority patients who had congestive heart failure (CHF), compared to non-minority patients, were significantly less likely to receive CHF discharge counseling (which included diet instruction). The investigators concluded that care provided for minority patients is often of lower quality than care provided for non-minority patients, that disparities in care are often the result of differences in the locations where minority and non-minorities tend to seek care, and that differences in services requiring counseling exist even after controlling for the site of care.

    More research is needed to demonstrate if access to nutrition and dietetic services and educational resources differs among health disparities populations based on socio-economic status, racial/ethnic groups and geographic locations.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Access to Nutrition/Dietetics Services and Educational Resources
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Cropley L, Herwehe JC. Evaluation of institutional support for breastfeeding among low-income women in the metropolitan New Orleans area. J Am Diet Assoc. 2002 Jan; 102(1): 94-96.
      • Hasnain-Wynia R, Baker DW, Nerenz D, Feinglass J, Beal AC, Landrum MB, Behal R, Weissman JS. Disparities in health care are driven by where minority patients seek care: Examination of the hospital quality alliance measures. Arch Intern Med. 2007 Jun 25; 167 (12): 1,233-1,239. Erratum in: Arch Intern Med. 2007 Oct 22; 167 (19): 2,147.
  • Search Plan and Results: HD: Access to Nutrition/Dietetic Services and Resources 2009