No abstract

Microaggressions entail everyday brief, low-intensity events that convey negative messages toward marginalized groups. A systematic review of the literature on microaggressions in the learning environment of higher education was performed from 1998 to 2018 using a modified PRISMA outline. Forty articles on racial microaggressions were categorized as microaggression experiences of all races/ethnicity (27.5%), microaggression experiences of minorities (22.5%), difficult racial dialogues (10%), coping strategies for microaggressions (17.5%), and system interventions strategies (22.5%). Microinsults were reported in 82.5%, microinvalidations in 4.5%, microassaults in 20%, and institutional microaggressions in 27.5%. Microaggressions were prevalent and "invisible" in colleges with minority students seemingly worn down by ongoing strategies used to confront the inherent associated stresses. Difficult racial dialogues were characterized by intense emotions in both professors and students that interfered with successful learning experiences. Coping strategies that correlated positively with microaggression and psychological stress included disengagement, cultural mistrust, stigma for seeking psychological help, alcohol use, and intolerance of uncertainty. Factors tending to ameliorate microaggression and psychological stress included engagement, dispositional forgiveness, help-seeking attitudes, self-efficacy in coping with daily hassles, and social connectedness. Political activism was helpful in Latinx, but exacerbated microaggression related stress in African American students. Multicultural curricula were associated with increased racial awareness. Innovative intervention strategies included brief video interventions and utility of mobile apps. Microaggressions are associated with ongoing major negative impact on the learning environment. By ameliorative coping mechanisms and institution intervention strategies, the associated toll and stresses from microaggressions may be reduced.

Telehealth has been shown to have comparable health outcomes in terms of patient-physician communication, and patient satisfaction and engagement. Nevertheless, the digital divide has exacerbated the social and economic factors that create barriers to health and well-being. It, therefore, maybe a social determinant of health (SDOH). Such issues as decreased internet connectivity and a lack of Wi-Fi and video chat/webcam in both urban and rural areas can hinder the effectiveness of telehealth to its full capability, especially among communities of color, the poor, and medically underserved. The social aspects of the provision of health care by physicians and health care workers are utilized to combat mistrust and strengthen the physician–patient therapeutic relationship. Addressing policy changes to address the digital divide as a SDOH may strengthen existing health care and public health systems to allow for patient and community-centered approaches to expressing lived narratives, including in a digital format.