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Updated: May 10, 2025
Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Published on: February 16, 2011
Roads diverge: mapping the journey towards diagnostic health equity
Lakshmi Krishnan1,2,3, Yvonne Commodore-Mensah4, Kelly T Gleason4
1Department of Medicine, Georgetown University, Washington, District of Columbia, USA lakshmi.krishnan@georgetown.edu.
Background:
Diagnostic disparities significantly impact health outcomes, with various factors influencing differential access and treatment across communities. This paper explores the complex landscape of diagnosis and of variable diagnostic journeys, focusing on the multifaceted nature of diagnostic inequities and proposing a socioecological model to understand and address these disparities.
Methods:
The authors employed an interdisciplinary approach, synthesising insights from their respective knowledge domains. Through iterative discussions, visual diagramming and narrative development, a new framework was constructed to address the complexity of diagnostic inequities.
Results:
The 'diagnostic environment' model was developed, conceptualising diagnosis beyond the biomedical process to include three levels of influence: atmospheric (broad, pervasive societal factors), surface (direct healthcare interactions) and subterranean (underlying, often invisible societal norms and biases). This model integrates process, social phenomena and multilevel influences to more comprehensively address diagnostic disparities. Two additional frameworks: diagnostic journeys within this environment and issue constellations guiding navigation and intervention were developed.
Conclusions:
Diagnostic processes are influenced by a range of factors from individual to systemic levels, often leading to significant disparities in health outcomes. The proposed model offers a framework for understanding these disparities and suggests targeted interventions to address them. By integrating diverse perspectives and focusing on multilevel influences, the framework aims to improve diagnostic equity.
Implications:
This study highlights the need for a more holistic approach to diagnosis, acknowledging the complex interplay of factors that contribute to diagnostic disparities. The socioecological model provides a basis for future research and policy interventions aimed at reducing these disparities and improving overall diagnostic accuracy and equity.
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