TABLE III.

Summarized barriers and action items identified by session 3 with associated structural competencies addressed

Domain	Barrier	Action	Structural competency addressed12,13
Food allergy	Financial barriers in care of patients with food allergy Socioeconomic status Nutritional support Food insecurity Access to epinephrine autoinjectors Access to subspecialists Structural barriers to attending appointments	Multidisciplinary approach incorporating social workers, dieticians, and community health workers Implement screeners to assess barriers to care Partner with community members to provide needed resources (eg, food pantries, support groups, food vouchers with local grocery stores/farmer’s markets, drug assistance programs, food policy council) Engage with primary care providers to educate and provide resources on food allergy	Recognize the influence of structures on patient health Recognize and respond to influences of structures on the clinical encounter Engage in structural humility
Atopic dermatitis	Lack of training of disease recognition in different skin types and pigmentation Cultural sensitivity for impact of pigmentation with medication initiation and disease severity Financial or time-consuming barriers to treatment (eg, access to bathtubs, financial/time burden of twice daily baths, or costs of emollients or wraps) Access to subspecialists and participation in research studies	Include images of affected individuals with diverse backgrounds and skin pigmentation in educational and training resources or materials Model discussing issues related to skin pigmentation during clinical interactions Coordinate efforts to connect with and engage communities of color affected by atopic dermatitis Improve efforts to recruit patients from diverse backgrounds to participate in clinical trials for atopic dermatitis	Demonstrate skills necessary to assess, diagnose, and manage atopic dermatitis in patients of diverse ethnic and cultural backgrounds Recognize and use extra-clinical resources to enhance patient care and outcomes in multicultural clinical settings Recognize the role of public health resources and agencies to enhance patient care and outcomes in multicultural settings Exhibit empathy and discuss alternate care options for patients in low-economic or -resource settings Engage in structural humility
Asthma	Access to subspecialist care Underestimation or unacknowledged assessment of barriers to health care Distrust of providers due to patient biases stemming from structural racism Lack of resources to attend visits or engage with health care system	Incorporate home or telemedicine visits into assessment of patients with poor clinical improvement or difficulty attending appointments Coordinate with social services to assist with building trust and bridging care gaps (eg, use of case managers or community health workers to perform home visits, adherence to medications, and health assessments) Improve assessment of social determinants of health (eg, assess presence of allergens/irritants in home, insurance status, access to medications, transportation) Improve recruitment practices and protocol design in clinical trials by recruiting clinical staff from diverse backgrounds Improve efforts to build trust in communities that experienced systemic oppression	Recognize and use extra-clinical resources to enhance patient care and outcomes in diverse cultural and socioeconomic settings Recognize and/or use the specialty specific role of interdisciplinary teams in addressing health equity Assess or design quality improvement interventions to improve diverse patient’s experience of health care Identify, evaluate, and incorporate clinical practices that promote health equity in clinical practice and/or medical research
Research design and recruitment	Mistrust between marginalized communities and centers for research Reduced number of pre-established relationships between marginalized communities and the health institutions that serve them Lack of cultural and ethnic diversity in study staff and leadership Improve efforts to appropriately identify and assess risks and socioeconomic status that impact patient outcomes while enrolled in a research study	Establish partnerships and relationships with community organizations and providers that care for marginalized communities Improve access by establishing and increasing community-based referrals to research studies Increase efforts to include vulnerable and marginalized populations in research studies Incentivize, track, and monitor diversity of participants recruited to a study Create a funded structure for accountability and addressing bias through feedback and monitoring of study participant demographics Assess diverse elements related to SDoH during the recruitment and enrollment of study participants	Identify strengths, deficiencies, and limits in one’s ability to address implicit bias and health equity in research Recognize how structural forces impact clinical and research outcomes Incorporate evidence-based practices to assess the impact of cultural barriers (social, infrastructural, economic factors) on research practices and outcomes Appraise and assess the quality of care provided to patients from diverse ethnic and socioeconomic backgrounds Appraise and assess the quality of research endeavors to accurately involve and serve diverse patient populations Use evidence-based models to identify strengths and weaknesses in care and research in patients from marginalized backgrounds

SDoH, Social determinants of health.