Dementia and COVID-19 among Older African American Adults: A Scoping Review of Healthcare Access and Resources

Round 1

Reviewer 1 Report (Previous Reviewer 2)

The manuscript has been revised according to my suggestions and expanded or reformulated in some parts, and is now largely acceptable for publication. 

I have only a few small further suggestions:

In line 272, 'eported' should be 'reported'

380:  presentation,   -> delete the comma

479:  illnesses vulnerabilities   -> illnesses represent vulnerabilities

512: ..Medicaid the older African Americas...  - > ..Medicaid for which the older African Americans

518: impacting -> impact

519-21: This will...............adults  : I suggest you go back to the better formulation in the original manuscript  (lines 444 to 446 in the original manuscript)

Author Response

Dear Reviewer,

Thank you for your comments. This is very useful to me as this will guide my career as a researcher.

In response to your comments which has been acknowledged and worked on, please see attached file for details.

Best,

Idorenyin Udoh

Author Response File: Author Response.docx

Reviewer 2 Report (Previous Reviewer 3)

Dear Authors,

All comments have been adequately taken into consideration and the quality of manuscript improved after revision. Based on this observation, I recommend "Accept".

Good luck with the next step of the processing of your paper.

1.      There are two research questions in the manuscript and it can be considered that the first question (“What is the emerging evidence on healthcare accessibility for African American older adults with Dementia and COVID-19?”) the authors discuss the evidence in a subsection “Healthcare Accessibility Disparities” (lines 255-359). This description corresponds well with the definition in lines 77-79.

However, regarding the second research question, the authors made a change during the review process; they added the concept „barriers” (from „healthcare access resources” in first version into „healthcare resource barriers” in second version). The addition of "barriers" to the second research question was not preceded by a definition and was not justified in the section “Introduction”. Currently, the authors do not use the term barriers and use the term resources, e.g. in lines 101-103: “Health resources refer to the means available for well-being, including financial issues, education, transportation, food security, housing, information, and communication aids [28,29]” and in other place (lines 248-251): “Half of the studies reported availability (or lack) of healthcare resources such as being with financial insecurities, lack of health care insurance, education/knowledge gaps, transportation, internet/phone or telemedicine, cognitive screening, ambulatory care and so on (26,37,38,40,41)”. On the other hand, there is contradiction in lines 93-94: “…systemic factors like lack of insurance, poor financial status, risk, and discrimination may be barriers to quality care [22]”.

Moreover, after adding "barriers" in the second research question, the authors still use the definition „healthcare access and resources” instead of “healthcare access and barriers”. In many places of the manuscript, authors discuss resources rather than barriers, but resources cannot be considered as barriers. The work is not consistent, and the terms resources and barriers should be defined and specified in the manuscript, and as well in the title of the work. The uncertainties in the application of the terms consequently make wrong argumentation in relation to the second research question. It should be corrected.

2.     Despite the lack of precision in the description of resources and barriers, I consider that the issue investigated in the work #ijerph-2170469 is original and appropriate for the field of public health. In addition, the topic is also important from a practical point of view, because Afro-Americans are a neglected group that requires attention from the policy makers in the US. Perhaps the discussion at the academic level would help to some extent to contribute for improving the health situation in this vulnerable group.

3.     A strong side of the study is the indication of evidence on specific factors of the health care system, associated with poorer health outcomes among Afro-Americans during the Covid-19 pandemic, and above all, excess mortality or premature mortality (what shows health inequity).

4.     Based on the comments contained in point 1, the authors should consider a correction in the methodology section consisting in the revision of the inclusion criteria, taking into account barriers and its search terms. In addition, in line 156, the analysis period starts in December 2019 - have there been any published works on this topic during the first month of the pandemic? It should be corrected.

5.     Conclusions of the article, because of the answer to the second research question, are inappropriate for the reason discussed in point 1.

6.     Some references, for instance, 36, 56, 57, and 58 may not be appropriate for the analyzed topic.

7.     In accordance with the notice presented in point 1, tables and figures also require correction.

Author Response

Dear Reviewer,

Thank you for your comments. This is very useful to me as it will help guide my career as a researcher.

In response to the points raised, please find attached our detailed actions and corrections as advised.

Best,

Idorenyin Udoh

Author Response File: Author Response.docx

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

This scoping review aggregates the evidence on health access disparities and resources for older Afri-56 can American adults with Dementia and COVID-19. The manuscript is well written and the topic is worth examining. I have a few points the authors may wish to consider.

 

1.     Page 2, line 58 Disparities in Health Care affecting African American Older Adults

In this paragraph, proportions of people died from COVID-19 are shown but the proportions of each racial population are not shown. This may be obvious for people in the US but not for people from other countries.

 

 

2.     Page 12, line 441 Implications for practice

The authors raised some implications: UHC and a long history of being discriminated. These are well known but not specific implications from this study. More concrete and feasible implications are better to be shown here.

 

3.     There are some typos.

Examples: page 11 line 426 “poort quality of care..”

Author Response

Dear Reviewer,

Thank you for your detailed comments and review. My co-authors and I are very pleased to submit a revised version of our manuscript making use of the constructive feedback by the external reviewers, for which we are most grateful.  We detail below how we addressed the feedback by reach of the reviewers:

1. Page 2, line 58 Disparities in Health Care affecting African American Older Adults

In this paragraph, proportions of people died from COVID-19 are shown but the proportions of each racial population are not shown. This may be obvious for people in the US but not for people from other countries.

We now clarify that on page 2 Line 65

 

2. Page 12, line 441 Implications for practice

The authors raised some implications: UHC and a long history of being discriminated. These are well known but not specific implications from this study. More concrete and feasible implications are better to be shown here. -

 We now provide implications for practice on page 13 lines 450 to 462.

3. There are some typos.

Examples: page 11 line 426 “poort quality of care.”.

We corrected  the typo. Thank you  

 

Reviewer 2 Report

This is an interesting and well performed review on an important aspect of health care in the U.S.  However, the text does not read very well because of occasional syntactic errors. The text should be scrutinized for syntax, punctuation, and the use of capital initial letter. 

Lines 474-492: The authors should make the statements required.  What is represented here seems to be just a copy of the journal's instructions for the statement requirements.

Comments for author File: Comments.pdf

Author Response

Dear Reviewer,

Thank you for your detailed comments and review. My co-authors and I are very pleased to submit a revised version of our manuscript making use of the constructive feedback by the external reviewers, for which we are most grateful.  We detail below how we addressed the feedback by reach of the reviewers:

 

Lines 474-492: The authors should make the statements required.  What is represented here seems to be just a copy of the journal's instructions for the statement requirements.

            We have edited this statement to suit the applicability of the paper “Not Applicable”

 

We also corrected for all the typo errors you pointed out. Thank you for your kind help.

Reviewer 3 Report

Dear Authors,

The article makes an interesting contribution to the field of limited accessibility in healthcare for African American population burdened with dementia and Covid. This is generally a well-structured manuscript. However, I have a few comments before the manuscript could be considered for publication.  

 

1.      In the Introduction section, in order to present the better rationale of the study, it is necessary to add: the description of the characteristics of the African American population, and in what areas of the country they most often live, what is the percentage of them among the US population, what are the differences between uninsured Afro-American population and other inhabitants of the US (in %), and other important specific characteristics of this population.

2.      In addition, the Introduction needs to discuss the organization of the health care system and health insurance for African Americans due to the fact that the US system is one of the most unique health care systems in the world, and at the same time its structure is very complex and difficult to understand for people from other countries. Although the US health care system is technologically advanced, it is disappointing in terms of health outcomes. In this context, in the Introduction section, the concept of health inequalities, and the issue of structural inequity link to health status should be explained. 

3.      In the paragraph „Research Design”, there must be information, if the manuscript was based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) for scoping review.

4.      In lines 282-283 there is an incorrect text: "at each level of the socioecological model", which should be corrected, for instance, "regardless of socio-economic status”.

5.      Conclusions of the paper are incomplete, especially as regards the answer to the second research goal (lines 102-103). In addition, this section needs recommendation on how to improve health outcomes in the African American population.

6.      It is recommended to add to the key words: structural inequity, health inequalities, urbanization.

 

Please, highlight the changes to the revised version, using a different colour.

Author Response

Dear Reviewer,

Thank you for your detailed comments and review. My co-authors and I are very pleased to submit a revised version of our manuscript making use of the constructive feedback by the external reviewers, for which we are most grateful.  We detail below how we addressed the feedback by reach of the reviewers:

 

1. In the Introduction section, in order to present the better rationale of the study, it is necessary to add: the description of the characteristics of the African American population, and in what areas of the country they most often live, what is the percentage of them among the US population, what are the differences between uninsured Afro-American population and other inhabitants of the US (in %), and other important specific characteristics of this population.

We now provide information on characteristics of the Older African American population and the concept of health structural inequity linked to health statuses on page 1 lines 36 to 39

 

2. In addition, the Introduction needs to discuss the organization of the health care system and health insurance for African Americans due to the fact that the US system is one of the most unique health care systems in the world, and at the same time its structure is very complex and difficult to understand for people from other countries. Although the US health care system is technologically advanced, it is disappointing in terms of health outcomes. In this context, in the Introduction section, the concept of health inequalities, and the issue of structural inequity link to health status should be explained. 

            We now explicitly note these considerations on page 2 lines 55 to 58  

3. In the paragraph „Research Design”, there must be information, if the manuscript was based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) for scoping review.

We clarify on our use of PRISMA on page 3 line 113 to 115

4. In lines 282-283 there is an incorrect text: "at each level of the socioecological model", which should be corrected, for instance, "regardless of socio-economic status”.

This has been modified on page 9 lines 291 to 292 to read “This study revealed that the pandemic impacted people from ethnic minority backgrounds living with dementia and their carers due to their low socioeconomic status”.

 

5. Conclusions of the paper are incomplete, especially as regards the answer to the second research goal (lines 102-103). In addition, this section needs recommendation on how to improve health outcomes in the African American population.

The conclusion has been modified to answer the questions on what type of resources do older African Americans need to mitigate the effect of dementia and COVID-19 infections as on page 13 lines 483 to 485

Recommendations on how to improve health outcomes in older African American population has also been included and considered under Implications for practice on page 13 lines 456 to 464

 

6. It is recommended to add to the key words: structural inequity, health inequalities, urbanization. Please, highlight the changes to the revised version, using a different color.

 

Thank you for the suggestion. We now include structural inequity and health inequalities among the key words.