Abstract
This chapter highlights traumatic brain injury (TBI) and various health disparities within this population, particularly gaps related to patients from culturally diverse backgrounds. A review of three main health disparities is included, related to increased risk for sustaining a TBI, intervention barriers related to TBI, and long-term outcome after TBI. This chapter also evaluates how culture influences aspects of TBI intervention by exploring cultural considerations apparent in diverse populations. The chapter concludes with an examination of a case study based on an actual patient who sustained a TBI and details how his Native American culture impacted his healthcare choices and how his healthcare providers adapted intervention strategies given cultural influences unique to his clinical presentation.
TopThere is evidence to suggest that health disparity gaps are prevalent in the TBI population (Lequerica & Krch, 2014; Niemeirer & Arango-Lasprilla, 2007). These disparities demonstrate that people from CLD backgrounds are at a greater risk for sustaining a TBI (Heffernan et al., 2011). Moreover, people from CLD backgrounds often face barriers that impact sufficient and appropriate intervention after TBI leaving them at an increased risk of poorer long-term outcome (Gao, Kumar, Wisniewski, & Fabio, 2018; Meagher, Beadles, Doorey, & Charles, 2015). These health disparities are multi-faceted, with a variety of driving issues, likely related to “mistrust of healthcare professionals, racism, environment barriers impacting accessibility, quantity and quality of education, lack of bilingual professionals, as well as the lack of culturally relevant assessment and intervention tools” (Lequerica & Krch, 2014, p. 645). The following section explores these three specific health disparities noted in patients experiencing TBI within CLD populations.
Key Terms in this Chapter
Healthcare Barriers: Barriers to health services include high cost of care, inadequate or no insurance coverage, lack of availability of services, and lack of culturally competent care.
Cognitive-Linguistic Impairment: Cognitive-linguistic impairments impact a person’s thinking skills and communication skills.
Health Disparity: A health disparity is a preventable difference in the burden of disease, injury, violence, or opportunity to achieve optimal health between groups of people.
Traumatic Brain Injury (TBI): A TBI occurs when there is sudden damage to the brain, typically caused by a blow or jolt to the head. Immediate or delayed symptoms may result, which can have a wide range of severity levels.
Outcome: Outcome is the probability that a consequence may occur. Outcome measures after TBI may be related to cognitive-linguistic abilities, physical abilities, community reintegration, and/or return to work/school.
Diffuse Axonal Injury (DAI): DAI is a form of TBI, which occurs when the brain rapidly shifts inside the skull. During this time, the long connecting fibers in the brain called axons are sheared, rotated, and/or twisted as the brain rapidly accelerates and decelerates.
Healthcare Gap: Gaps in medical care refer to disparities in healthcare access, healthcare needs and medical services when comparing different populations that fall along racial, ethnic, or socioeconomic lines.
Community Reintegration: Community reintegration is the process of integrating back into society following an injury. It is a broad term, encompassing the full participation of people back into community (home, work, church, neighborhood, etc.) life.