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Metsis K, Inchley J, Williams AJ, Vrahimis S, Brown L, Sullivan F. Conceptualisation of health among young people: a protocol for systematic review and thematic synthesis of qualitative studies. Syst Rev 2024; 13:200. [PMID: 39068481 PMCID: PMC11283722 DOI: 10.1186/s13643-024-02614-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/14/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Self-reported health is a widely used health indicator in surveys and questionnaires. The measure gained attention when research identified its association with mortality in the 1970s and 1980s. The measure is also associated with morbidity and other health outcomes such as the utilisation of health services. Self-reported health is a particularly useful measure for young people because this age group is generally clinically healthy. However, it is known that many chronic conditions have long latency periods that are initiated early in life. Because of its predictive nature, self-reported health can be used to estimate young people's current and future health. Despite its widespread use, however, self-reported health remains a poorly understood concept. This paper presents the protocol for a systematic review that will identify and synthesise qualitative studies that investigate the factors that are considered by young people when they assess their health, and when they talk about health overall. METHODS The population of the review is young people aged 10-24 years, with or without health conditions. We will search the databases of MEDLINE (Ovid®), PsycINFO (APA PsycNet), ProQuest Sociology Collection, and Web of Science Core Collection™. We will also utilise techniques of reference checking and forward citation searching, as this strategy has been shown to result in a higher number of high-quality studies in social science systematic reviews. Google Scholar and Google Search were used during preliminary searches; Google Scholar will be utilised for forward citation searching. We will include studies written in English, German, or Finnish; there will be no lower date limit. One reviewer will screen all citations. A second reviewer will independently screen a sample of 20% of the abstracts. Data will be extracted by one researcher, two other researchers will independently review all data extracted, and quality appraisal will be completed by the first reviewer. We will utilise the Quality Framework for the appraisal of included articles and thematic synthesis of qualitative studies. DISCUSSION The results of this systematic review will improve the understanding of the factors that are considered during the self-assessments of health; this will improve the interpretation of the results of quantitative research. Also, an improved understanding of the conceptualisation of health will inform the development of health policies and interventions that support young people's health. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022367519.
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Affiliation(s)
- Katrin Metsis
- School of Medicine, University of St Andrews, North Haugh, St Andrews, KY16 9TF, UK.
| | - Joanna Inchley
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, 90 Byres Road, Glasgow, G12 8TB, UK
| | | | - Sebastian Vrahimis
- School of Medicine, University of St Andrews, North Haugh, St Andrews, KY16 9TF, UK
| | - Lamorna Brown
- School of Medicine, University of St Andrews, North Haugh, St Andrews, KY16 9TF, UK
| | - Frank Sullivan
- School of Medicine, University of St Andrews, North Haugh, St Andrews, KY16 9TF, UK
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Norman Å, Malek ME, Nyberg G, Patterson E, Elinder LS. Effects of Universal School-Based Parental Support for Children's Healthy Diet and Physical Activity-the Healthy School Start Plus Cluster-Randomised Controlled Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024:10.1007/s11121-024-01697-4. [PMID: 38987407 DOI: 10.1007/s11121-024-01697-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/12/2024]
Abstract
Health promotion from an early age is key to preventing unhealthy weight development in childhood, and parental involvement is essential. The school-based Healthy School Start intervention aims to promote healthy dietary and activity habits in the home environment and prevent child obesity through parental support. This study evaluated the effectiveness of the third iteration of the programme on children's dietary and activity behaviours, and body composition through a cluster-randomised controlled trial. The trial included 17 schools (8 intervention) in disadvantaged areas in mid-Sweden with 353 families with 5- to 7-year-old children. The primary outcomes were intake of selected healthy and unhealthy foods and beverages measured using photography. Secondary outcomes were physical activity and sedentary time measured by accelerometry, and measured weight and height. All outcomes were assessed at baseline and post-intervention (8 months). Linear multi-level regression showed significant favourable effects of the intervention for intake of sweet beverages (b = - 0.17, p = 0.04), intake of healthy foods (b = 0.11, p = 0.04), and more time in moderate to vigorous physical activity during weekdays (b = 5.68, p = 0.02). An unfavourable sub-group effect of the intervention was found for children from families with low education regarding sedentary time on weekends (b = 23.04, p = 0.05). The results align with the previous two trials of the programme, indicating that school-based parental support is a useful approach for health promotion in young children in disadvantaged areas. Trial registration: ClinicalTrials.gov: No. NCT03390725, retrospectively registered on January 4, 2018, https://clinicaltrials.gov/ct2/show/NCT03390725 .
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Affiliation(s)
- Åsa Norman
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden.
- Department of Clinical Neurosciences, Karolinska Institutet, Nobels Väg 9, 171 65, Solna, Sweden.
| | | | - Gisela Nyberg
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
- The Swedish School of Sport and Health Sciences, Lidingövägen 1, 114 33, Stockholm, Sweden
| | - Emma Patterson
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
- Section for Risk and Benefit Assessment, Swedish Food Agency, Box 622, 751 26, Uppsala, Sweden
| | - Liselotte Schäfer Elinder
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, 104 31, Stockholm, Sweden
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Meunier A, Opeifa O, Longworth L, Cox O, Bührer C, Durand-Zaleski I, Kelly SP, Gale RP. An eye on equity: faricimab-driven health equity improvements in diabetic macular oedema using a distributional cost-effectiveness analysis from a UK societal perspective. Eye (Lond) 2024; 38:1917-1925. [PMID: 38555401 PMCID: PMC11226444 DOI: 10.1038/s41433-024-03043-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 02/26/2024] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND/OBJECTIVES Diabetic macular oedema (DMO) is a leading cause of blindness in developed countries, with significant disease burden associated with socio-economic deprivation. Distributional cost-effectiveness analysis (DCEA) allows evaluation of health equity impacts of interventions, estimation of how health outcomes and costs are distributed in the population, and assessments of potential trade-offs between health maximisation and equity. We conducted an aggregate DCEA to determine the equity impact of faricimab. METHODS Data on health outcomes and costs were derived from a cost-effectiveness model of faricimab compared with ranibizumab, aflibercept and off-label bevacizumab using a societal perspective in the base case and a healthcare payer perspective in scenario analysis. Health gains and health opportunity costs were distributed across socio-economic subgroups. Health and equity impacts, measured using the Atkinson inequality index, were assessed visually on an equity-efficiency impact plane and combined into a measure of societal welfare. RESULTS At an opportunity cost threshold of £20,000/quality-adjusted life year (QALY), faricimab displayed an increase in net health benefits against all comparators and was found to improve equity. The equity impact increased the greater the concerns for reducing health inequalities over maximising population health. Using a healthcare payer perspective, faricimab was equity improving in most scenarios. CONCLUSIONS Long-acting therapies with fewer injections, such as faricimab, may reduce costs, improve health outcomes and increase health equity. Extended economic evaluation frameworks capturing additional value elements, such as DCEA, enable a more comprehensive valuation of interventions, which is of relevance to decision-makers, healthcare professionals and patients.
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Affiliation(s)
| | | | | | - Oliver Cox
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse, Basel, Switzerland
| | | | | | | | - Richard P Gale
- Hull York Medical School, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
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Askgaard G, Jepsen P, Jensen MD, Kann AE, Morling J, Kraglund F, Card T, Crooks C, West J. Population-Based Study of Alcohol-Related Liver Disease in England in 2001-2018: Influence of Socioeconomic Position. Am J Gastroenterol 2024; 119:1337-1345. [PMID: 38299583 PMCID: PMC11208057 DOI: 10.14309/ajg.0000000000002677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/28/2023] [Indexed: 02/02/2024]
Abstract
INTRODUCTION England has seen an increase in deaths due to alcohol-related liver disease (ALD) since 2001. We studied the influence of socioeconomic position on the incidence of ALD and the mortality after ALD diagnosis in England in 2001-2018. METHODS This was an observational cohort study based on health records contained within the UK Clinical Practice Research Datalink covering primary care, secondary care, cause of death registration, and deprivation of neighborhood areas in 18.8 million residents. We estimated incidence rate and incidence rate ratios of ALD and hazard ratios of mortality. RESULTS ALD was diagnosed in 57,784 individuals with a median age of 54 years and of whom 43% had cirrhosis. The ALD incidence rate increased by 65% between 2001 and 2018 in England to reach 56.1 per 100,000 person-years in 2018. The ALD incidence was 3-fold higher in those from the most deprived quintile vs those from the least deprived quintile (incidence rate ratio 3.30, 95% confidence interval 3.21-3.38), with reducing inequality at older than at younger ages. For 55- to 74-year-olds, there was a notable increase in the incidence rate between 2001 and 2018, from 96.1 to 158 per 100,000 person-years in the most deprived quintile and from 32.5 to 70.0 in the least deprived quintile. After ALD diagnosis, the mortality risk was higher for patients from the most deprived quintile vs those from the least deprived quintile (hazard ratio 1.22, 95% confidence interval 1.18-1.27), and this ratio did not change during 2001-2018. DISCUSSION The increasing ALD incidence in England is a greater burden on individuals of low economic position compared with that on those of high socioeconomic position. This finding highlights ALD as a contributor to inequality in health.
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Affiliation(s)
- Gro Askgaard
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- Section of Gastroenterology and Hepatology, Medical Department, Zealand University Hospital, Køge, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Denmark
| | - Peter Jepsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Morten Daniel Jensen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Anna Emilie Kann
- Section of Gastroenterology and Hepatology, Medical Department, Zealand University Hospital, Køge, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Denmark
| | - Joanne Morling
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Frederik Kraglund
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Tim Card
- Nottingham University Hospitals NHS Trust and the University of Nottingham, NIHR Nottingham Biomedical Research Centre (BRC), Nottingham, United Kingdom
| | - Colin Crooks
- Nottingham University Hospitals NHS Trust and the University of Nottingham, NIHR Nottingham Biomedical Research Centre (BRC), Nottingham, United Kingdom
- Translational Medical Sciences, School of Medicine, University of Nottingham, United Kingdom
| | - Joe West
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Translational Medical Sciences, School of Medicine, University of Nottingham, United Kingdom
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Painter H, Parry E, McCann L, Dehn Lunn A, Ford J. Social needs screening in primary care: A tool in the fight for health equity? PUBLIC HEALTH IN PRACTICE 2024; 7:100466. [PMID: 38323126 PMCID: PMC10844637 DOI: 10.1016/j.puhip.2024.100466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 02/08/2024] Open
Abstract
Progress on addressing health inequalities is slow and in many places around the world the gap between the privileged and the disadvantaged is widening. This is driven largely by an unfair and unequal distribution of the social determinants of health. While upstream policy and agenda commitment is needed to improve social determinants of health at a population level, healthcare also has a role. Currently social information is sporadically collected and used in healthcare. Improving our understanding of social problems is crucial in targeting services and to reduce the overreliance on area-level measures of deprivation. This has the potential to improve patient care as well as more accurately capture socio-economic disadvantage. Here we argue that there is a role for primary care in screening for social needs to help address inequalities. Social needs screening, more commonly used in North America than Europe, aims to systematically collect social information in health and care settings. Healthcare professionals ask patients about social issues including employment, finances, housing, education and social isolation and this information is used to prompt referral to community services to address any need identified. Social needs screening has potential to address negative impacts of social determinants of health at an individual and population level. Providing a reliable measure of social need, screening gives healthcare professionals an opportunity to tailor and improve quality of care for patients and offer individualised support. It has been shown to improve individual social and health outcomes and positively impact healthcare utilisation. At a population level, social needs screening can improve the data on social determinants of health and therefore support policy makers and service delivery leaders to target resources and services more effectively to the communities most in need. Implementing social needs screening must take account of local healthcare service capacity and available community resources but where sustainable, effective programmes can be introduced, the potential benefits are manifold. While primary care alone cannot solve the root causes of health inequalities, we argue it could be a powerful actor in the fight for health equity.
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Affiliation(s)
- H. Painter
- Wolfson Institute for Population Health, Queen Mary University of London, UK
| | - E. Parry
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - L. McCann
- Wolfson Institute for Population Health, Queen Mary University of London, UK
| | - A. Dehn Lunn
- Wolfson Institute for Population Health, Queen Mary University of London, UK
| | - J. Ford
- Wolfson Institute for Population Health, Queen Mary University of London, UK
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Beard J, Katja H, Si Y, Thiyagarajan J, Moreno-Agostino D. Is 70 the new 60? A longitudinal analysis of cohort trends inintrinsic capacity in England and China. RESEARCH SQUARE 2024:rs.3.rs-4271576. [PMID: 38853854 PMCID: PMC11160896 DOI: 10.21203/rs.3.rs-4271576/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
To understand how the health of older adults today compares to that of previous generations, we estimated intrinsic capacity and subdomains of cognitive, locomotor, sensory, psychological and vitality capacities in participants of the English Longitudinal Study on Ageing (ELSA) and the China Health and Retirement Longitudinal Study (CHARLS). We applied multilevel growth curve models to examine change over time and cohort trends. We found that more recent cohorts entered older ages with higher levels of capacity, and their subsequent age-related declines were somewhat compressed compared to earlier cohorts. These improvements in capacity were large, with the greatest gains being in the most recent cohorts. For example, a 68-year-old ELSA participant born in 1950 had higher capacity than a 62-year-old born just 10 years earlier. Trends were similar for men and women, and findings were generally consistent across English and Chinese cohorts.
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Affiliation(s)
- John Beard
- Columbia University - Mailman School of Public Health
| | | | - Yafei Si
- The University of New South Wales
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Kanmodi KK, Amzat J, Aminu K. Theories, determinants, and intervention models and approaches on inequalities of undernutrition amongst under fives: A literature review. Health Sci Rep 2024; 7:e2078. [PMID: 38690007 PMCID: PMC11058263 DOI: 10.1002/hsr2.2078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 04/10/2024] [Accepted: 04/14/2024] [Indexed: 05/02/2024] Open
Abstract
Background and Aims One of the greatest public health problems of the 21st century is undernutrition in children under the age of 5 years (CAUFY). Globally, over 232 million CUAFY are undernourished and approximately 45% of mortality in this population are undernutrition-induced. This paper reviewed and critically explained the factors perpetuating undernutrition in CUAFY in the global space. It further explained the multi-level determinants that influence health inequalities and consequently exacerbate undernutrition amongst CUAFY globally. It also went further to explain the intervention models and approaches that can be used to tackle undernutrition in CUAFY. Methods/Literature Search Strategy Demiris et al.'s approach to narrative review was utilized for this paper. Relevant articles on child nutrition were retrieved from multiple credible databases and websites of foremost health organizations. Using an iterative process, multiple combinations of search terms were done by stringing relevant key terms and their synonyms with Boolean Operators. This process was constantly refined to align search results with the study aim. Database search produced relevant and resourceful publications which were utilized to develop this review. Results The global burden of undernutrition remains high, especially in Oceania with the highest prevalence of stunting and wasting (41.4% and 12.5%), with Africa and Asia following closely. Malnutrition eradication is a global health issue of high priority as demonstrated by the "Goal 2" of the Sustainable Development Goals (SDGs), and the United Nations (UN) Decade of Action on Nutrition 2016-2025. The review identified no significant positive outcome from previous interventions due to the endemic health inequalities. Determinants of the multi-level health inequalities associated with undernutrition in CUAFY, and probable solutions are explained with theoretical models of health inequalities. A diagonal intervention approach was proposed as a viable solution to ending undernutrition in CUAFY. Conclusion The application of relevant theoretical models and context-specific intervention approaches can be utilized by stakeholders to close the existing inequality gaps, thereby reducing undernutrition amongst CUAFY globally.
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Affiliation(s)
- Kehinde Kazeem Kanmodi
- School of DentistryUniversity of RwandaKigaliRwanda
- Child Health and Wellbeing (CHAW) ProgramCephas Health Research Initiative IncIbadanNigeria
- Faculty of DentistryUniversity of PuthisastraPhnom PenhCambodia
- School of Health and Life SciencesTeesside UniversityMiddlesbroughUK
| | - Jimoh Amzat
- Department of SociologyUsmanu Danfodiyo UniversitySokotoNigeria
| | - Kafayat Aminu
- Center for Child and Adolescent Mental HealthUniversity College HospitalIbadanNigeria
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McManus J. Editorial. Perspect Public Health 2024; 144:130-131. [PMID: 38757940 DOI: 10.1177/17579139241249559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Affiliation(s)
- Jim McManus
- Guest Editor, National Director of Health and Wellbeing, Public Health Wales
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Sung B, O'Driscoll F, Gregory A, Grailey K, Franklin H, Poon S, Lawrence-Jones A, Shepherd L, McCrudden C, Klaber B, Pavlakis C, Darzi A, Huf S. Identifying barriers to outpatient appointment attendance in patient groups at risk of inequity: a mixed methods study in a London NHS trust. BMC Health Serv Res 2024; 24:554. [PMID: 38693519 PMCID: PMC11061980 DOI: 10.1186/s12913-024-10947-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/03/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND There is significant health inequity in the United Kingdom (U.K.), with different populations facing challenges accessing health services, which can impact health outcomes. At one London National Health Service (NHS) Trust, data showed that patients from deprived areas and minority ethnic groups had a higher likelihood of missing their first outpatient appointment. This study's objectives were to understand barriers to specific patient populations attending first outpatient appointments, explore systemic factors and assess appointment awareness. METHODS Five high-volume specialties identified as having inequitable access based on ethnicity and deprivation were selected as the study setting. Mixed methods were employed to understand barriers to outpatient attendance, including qualitative semi-structured interviews with patients and staff, observations of staff workflows and interrogation of quantitative data on appointment communication. To identify barriers, semi-structured interviews were conducted with patients who missed their appointment and were from a minority ethnic group or deprived area. Staff interviews and observations were carried out to further understand attendance barriers. Patient interview data were analysed using inductive thematic analysis to create a thematic framework and triangulated with staff data. Subthemes were mapped onto a behavioural science framework highlighting behaviours that could be targeted. Quantitative data from patient interviews were analysed to assess appointment awareness and communication. RESULTS Twenty-six patients and 11 staff were interviewed, with four staff observed. Seven themes were identified as barriers - communication factors, communication methods, healthcare system, system errors, transport, appointment, and personal factors. Knowledge about appointments was an important identified behaviour, supported by eight out of 26 patients answering that they were unaware of their missed appointment. Environmental context and resources were other strongly represented behavioural factors, highlighting systemic barriers that prevent attendance. CONCLUSION This study showed the barriers preventing patients from minority ethnic groups or living in deprived areas from attending their outpatient appointment. These barriers included communication factors, communication methods, healthcare the system, system errors, transport, appointment, and personal factors. Healthcare services should acknowledge this and work with public members from these communities to co-design solutions supporting attendance. Our work provides a basis for future intervention design, informed by behavioural science and community involvement.
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Affiliation(s)
| | - Fiona O'Driscoll
- Helix Centre, Institute of Global Health Innovation, Imperial College London, Room 1035/7, QEQM Wing, St Mary's Campus, London, W2 1NY, UK.
| | - Alice Gregory
- Helix Centre, Institute of Global Health Innovation, Imperial College London, Room 1035/7, QEQM Wing, St Mary's Campus, London, W2 1NY, UK
| | - Kate Grailey
- Helix Centre, Institute of Global Health Innovation, Imperial College London, Room 1035/7, QEQM Wing, St Mary's Campus, London, W2 1NY, UK
| | | | - Sharon Poon
- Imperial College Healthcare NHS Trust, London, UK
| | - Anna Lawrence-Jones
- Institute of Global Health Innovation, Imperial College London, London, UK
- National Institute for Health and Care Research (NIHR) North West London Patient Safety Research Collaboration (PSRC), London, UK
| | - Leila Shepherd
- Helix Centre, Institute of Global Health Innovation, Imperial College London, Room 1035/7, QEQM Wing, St Mary's Campus, London, W2 1NY, UK
| | - Clare McCrudden
- Helix Centre, Institute of Global Health Innovation, Imperial College London, Room 1035/7, QEQM Wing, St Mary's Campus, London, W2 1NY, UK
| | - Bob Klaber
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | - Chris Pavlakis
- Helix Centre, Institute of Global Health Innovation, Imperial College London, Room 1035/7, QEQM Wing, St Mary's Campus, London, W2 1NY, UK
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Sarah Huf
- Institute of Global Health Innovation, Imperial College London, London, UK
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Brewster L, Brennan L, Hindocha A, Lunn J, Isba R. Understanding responsibility for health inequalities in children's hospitals in England: a qualitative study with hospital staff. BMJ Open 2024; 14:e081056. [PMID: 38604623 PMCID: PMC11015292 DOI: 10.1136/bmjopen-2023-081056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/28/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVES This study aimed to understand how staff in children's hospitals view their responsibility to reduce health inequalities for the children and young people who access their services. DESIGN We conducted an exploratory qualitative study. SETTING The study took place at nine children's hospitals in England. PARTICIPANTS 217 members of staff contributed via interviews and focus groups conducted January-June 2023. Staff were represented at all levels of the organisations, and all staff who volunteered to contribute were included in the study. ANALYSIS Data were analysed using Rapid Research Evaluation and Appraisal (RREAL) methodology for rapid assessment procedures (RAP). RESULTS All of the children's hospitals were taking some action to reduce health inequalities. Two key themes were identified. First, it was clear that reducing health inequalities was seen as something that was of vital import and should be part of staff's day-to-day activity, framed as 'everyone's business.' Many staff felt that there was an obligation to intervene to ensure that children and young people receiving hospital treatment were not further disadvantaged by, for example, food poverty. Second, however, the deeply entrenched and intersectional nature of health inequalities sometimes meant that these inequalities were complex to tackle, with no clear impetus to specific actions, and could be framed as 'no-one's responsibility'. Within a complex health and social care system, there were many potential actors who could take responsibility for reducing health inequalities, and staff often questioned whether it was the role of a children's hospital to lead these initiatives. CONCLUSIONS Broadly speaking, senior leaders were clear about their organisational role in reducing health inequalities where they impacted on access and quality of care, but there was some uncertainty about the perceived boundaries of responsibility. This led to fragility in the sustainability of activity, and a lack of joined-up intervention. Most hospitals were forging ahead with activity, considering that it was more important to work to overcome health inequalities rather than debate whose job it was.
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Affiliation(s)
- Liz Brewster
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Louise Brennan
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Avni Hindocha
- Lancaster Medical School, Lancaster University, Lancaster, UK
- Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Judith Lunn
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Rachel Isba
- Lancaster Medical School, Lancaster University, Lancaster, UK
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Solomon D, Gibbs J, Burns F, Sabin CA. Exploring the concept of unmet need within sexual and reproductive health in England: A qualitative Delphi exercise. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 40:100969. [PMID: 38692138 DOI: 10.1016/j.srhc.2024.100969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/19/2024] [Accepted: 03/31/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Unmet need within sexual and reproductive health (SRH) is a concept that is difficult to define and measure. This qualitative Delphi exercise was used to ascertain the opinions of SRH professionals on the conceptualisation and measurement of unmet need within SRH. METHODS This exercise was carried out in two rounds. In the first round, respondents responded narratively to three prompts, which were then used to create a series of statements. In the second round, participants responded narratively to the statements created in the first round. Responses from both rounds were then coded and analysed thematically. RESULTS Participants felt that an understanding of unmet need is an important part of SRH service design and provision, and believed that certain populations are often underrepresented within the datasets that are used to assess unmet need. Many respondents felt that a full understanding of unmet need within SRH would only come from involvement of relevant stakeholders in the process of investigating unmet need, and that qualitative methods may also have a role to play in gaining a more holistic understanding of unmet need within SRH. CONCLUSIONS Respondents within this study felt that unmet need is complex concept that has a significant impact on service delivery and the outcomes and experiences of the most vulnerable populations. We need to improve our understanding of unmet need and prioritise stakeholder voices if we want to create interventions that address unmet need within SRH.
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Affiliation(s)
- Danielle Solomon
- Institute for Global Health, University College London (UCL), London, UK
| | - Jo Gibbs
- Institute for Global Health, University College London (UCL), London, UK
| | - Fiona Burns
- Institute for Global Health, University College London (UCL), London, UK; Royal Free London NHS Foundation Trust, London, UK
| | - Caroline A Sabin
- Institute for Global Health, University College London (UCL), London, UK.
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Johnson MI, Page K, Woodall J, Thompson K. Perspectives on community-based system change for people living with persistent pain: insights from developing the "Rethinking Pain service". FRONTIERS IN PAIN RESEARCH 2024; 5:1299027. [PMID: 38571563 PMCID: PMC10987759 DOI: 10.3389/fpain.2024.1299027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 03/08/2024] [Indexed: 04/05/2024] Open
Abstract
In this perspective article we advocate community-based system change for people living with persistent pain. Our view is that greater use of the voluntary and community sector, in partnership with the clinical sector, creates the conditions for a "whole person" approach to pain management, leading to greater personalised care for adults living with long-term pain whilst having the potential to ease some of the pressures on General Practitioners and other clinical services. We advocate pain care that is socially connected, meaningful within socio-cultural contexts and aligned with the principles of salutogenesis. We provide an example of a UK National Health Service (NHS) commissioned pain service called "Rethinking Pain" that operationalises this perspective. Led by the voluntary and community sector, Rethinking Pain works in partnership with the clinical sector to provide a central holistic pathway of care for people experiencing persistent pain. This is the first time that this model of care has been commissioned for persistent pain in this area of England. The Rethinking Pain service is underpinned by core values to work with people to manage their pain holistically. The Rethinking Pain team proactively engage with people in the community, actively approaching and engaging those who experience the biggest health inequalities. In this article we provide an overview of the context of pain services in the UK, the rationale and supporting evidence for community-based system change, and the context, pathway, values, goals, and aspirations of the Rethinking Pain service.
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Affiliation(s)
- Mark I. Johnson
- Centre for Pain Research, School of Health, Leeds Beckett University, Leeds, United Kingdom
| | - Kerry Page
- Rethinking Pain Programme, Keighley Healthy Living (KHL) & Health Action Local Engagement (HALE), Bradford, United Kingdom
| | - James Woodall
- Centre for Pain Research, School of Health, Leeds Beckett University, Leeds, United Kingdom
- Centre for Health Promotion, School of Health, Leeds Beckett University, Leeds, United Kingdom
| | - Kate Thompson
- Centre for Pain Research, School of Health, Leeds Beckett University, Leeds, United Kingdom
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13
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Laranjeira C, Querido A. Mental Health Promotion and Illness Prevention in Vulnerable Populations. Healthcare (Basel) 2024; 12:554. [PMID: 38470664 PMCID: PMC10930927 DOI: 10.3390/healthcare12050554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Several cases of social and health inequity have occurred in recent centuries [...].
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Affiliation(s)
- Carlos Laranjeira
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic University of Leiria, Campus 5, Rua das Olhalvas, 2414-016 Leiria, Portugal
- School of Health Sciences, Polytechnic University of Leiria, Campus 2-Morro do Lena, Alto do Vieiro-Apart. 4137, 2411-901 Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-801 Évora, Portugal
| | - Ana Querido
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic University of Leiria, Campus 5, Rua das Olhalvas, 2414-016 Leiria, Portugal
- School of Health Sciences, Polytechnic University of Leiria, Campus 2-Morro do Lena, Alto do Vieiro-Apart. 4137, 2411-901 Leiria, Portugal
- Center for Health Technology and Services Research (CINTESIS), NursID, University of Porto, 4200-450 Porto, Portugal
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Wray-Lake L, Dunn D, Freund V, Kloska DD. The contribution of community service during the transition to adulthood to health in adulthood. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2024. [PMID: 38378910 DOI: 10.1111/jora.12922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/03/2024] [Accepted: 01/15/2024] [Indexed: 02/22/2024]
Abstract
Prior studies have linked young people's community service to indicators of health, yet little research takes the long view by connecting youth's community service to health in the next decade of life. Using a lifespan developmental lens, this study examined community service over the transition to adulthood and uses change over time in community service to predict indicators of behavioral, physical, and psychological health at ages 35 and 40. Data were taken from Monitoring the Future U.S. national multi-cohort data spanning ages 18-40 in high school cohorts from 1976 to 1995 for age 40 (N = 4300) and 1976 to 2000 for age 35 (N = 5879). Models estimated a growth curve model for community service from ages 18 to 30 and found that the slope for community service was associated with alcohol use, binge drinking, marijuana use, healthy behaviors, and life satisfaction at ages 35 and 40, with cigarette use at age 35 only, and with self-esteem and depressive symptoms at age 40 only. Less decline in community service over the transition to adulthood was associated with lower substance use, more healthy behaviors, and higher psychological well-being in adulthood. This study contributes evidence that community service and health are linked across the lifespan and suggests the value of examining the long-term implications of developmental change across adolescence and the transition to adulthood.
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Affiliation(s)
- Laura Wray-Lake
- Department of Social Welfare, University of California, Los Angeles, California, USA
| | - Danielle Dunn
- Department of Social Welfare, University of California, Los Angeles, California, USA
| | - Valerie Freund
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Deborah D Kloska
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
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15
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Prieto L. Exploring the Influence of Social Class and Sex on Self-Reported Health: Insights from a Representative Population-Based Study. Life (Basel) 2024; 14:184. [PMID: 38398693 PMCID: PMC10890034 DOI: 10.3390/life14020184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024] Open
Abstract
This study investigates the intricate interplay between social class, sex, and self-reported health (SRH) using data from the European Health Survey of Spain 2020 (EESE2020). Employing a cross-sectional design and a representative sample of 22,072 individuals, the analysis explores the persistence of disparities after adjusting for covariates, focusing on health-related variables. The study employs logistic regression models and directed acyclic graphs (DAGs) to delineate the direct effects of social class and sex on SRH, identifying a minimum adjustment set to control for confounding variables. Results reveal a gradient effect of social class on SRH, emphasizing the enduring impact of socioeconomic factors. Sex-based disparities in SRH diminish after considering additional health-related variables, highlighting the importance of a holistic approach. DAGs serve as transparent tools in disentangling complex relationships, guiding the identification of essential covariates. The study concludes that addressing health inequalities requires comprehensive strategies considering both individual health behaviours and socio-economic contexts. While recognizing limitations, such as the cross-sectional design, the findings contribute to a nuanced understanding of health disparities, informing evidence-based interventions and policies for a more equitable healthcare system.
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Affiliation(s)
- Luis Prieto
- Distance Learning, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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16
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Chung SY, Lee RG, Park SY, Oh IH. Disability-Related Mortality Inequity in South Korea: Comparison in Terms of Seoul Metropolitan/Non-Metropolitan Areas and Income Levels. Healthcare (Basel) 2024; 12:293. [PMID: 38338178 PMCID: PMC10855041 DOI: 10.3390/healthcare12030293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 02/12/2024] Open
Abstract
Despite the improved living standards in South Korea, people with disabilities still experience health disparities. Therefore, we analyzed differences in mortality rates among people with disabilities according to income level and residential area using representative data from the National Health Insurance Service in South Korea. Descriptive statistics and Cox proportional risk models were used to identify the risk factors for mortality affecting people with disabilities stratified by income level and residential area. Those living in non-metropolitan areas and low-income households had high mortality risks, suggesting that income level and residential area were related to mortality risk. The mortality risk of those with a high-income level was 1.534 times higher in non-metropolitan areas than in Seoul metropolitan areas (95% confidence interval [CI] = 1.44-1.63). Among people with low income living in non-metropolitan areas, the crude hazard ratios of mortality risk were 1.26 (95% CI = 1.14-1.39), 1.44 (95% CI = 1.34-1.54), and 1.39 (95% CI = 1.20-1.61) for those with brain lesions, sensory impairment (visual/hearing/speech impairment), and kidney failure, respectively. No significant differences were observed between people with autism in non-metropolitan and Seoul metropolitan areas and those with low- and high-income levels. Health issues and countermeasures are crucial to reduce mortality risk among people with disabilities.
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Affiliation(s)
- Seo-Yeon Chung
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea; (S.-Y.C.); (R.-G.L.)
| | - Ru-Gyeom Lee
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea; (S.-Y.C.); (R.-G.L.)
| | - So-Youn Park
- Department of Medical Education and Humanities, School of Medicine, Kyung Hee University, Seoul 02453, Republic of Korea
| | - In-Hwan Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea; (S.-Y.C.); (R.-G.L.)
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17
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der Meer SMV, Smit DJM, Hutting N, van Lankveld W, Engels J, Reneman M, Pelgrim T, Staal JB. Facilitators and Barriers to Implementing Interventions to Prevent Musculoskeletal Disorders in Blue-Collar Workers: A Scoping Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-023-10162-y. [PMID: 38218906 DOI: 10.1007/s10926-023-10162-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE Blue-collar workers generally have less healthy lifestyles, poorer health, and a lower life expectancy than white-collar workers. At least in part this may be attributed to their work and working conditions. Employers increasingly provide interventions to improve health and wellbeing and prevent musculoskeletal disorders. However, they often do not reach blue-collar workers. The aim of this scoping review was to identify the facilitators for and barriers to implementing such interventions among blue-collar workers. METHODS A scoping review in which the study population of the selected studies consists of blue-collar workers (≥ 18 years old) in paid employment. Furthermore, included studies should report facilitators and barriers to implementing interventions to prevent musculoskeletal disorders. The literature search was conducted in six databases. The resulting studies were extracted with the help of the updated Consolidated Framework for Implementation Research. RESULTS 15 articles were included; these were reviews, intervention studies, qualitative studies and process evaluations. A main facilitator was a participatory approach, which involves the blue-collar worker in the entire process of defining, developing, and implementing a multidimensional preventive intervention. The main barriers on the worker level were unfavorable worker characteristics and unsupportive behavior/attitudes. The main barriers on the organization level were a culture with a high production standard, a hierarchical culture, inflexible work, and an unsupportive attitude from the employer. CONCLUSION This review showed the multifaceted nature of implementation. A tailored implementation plan that involves the stakeholders (including workers) is important.
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Affiliation(s)
- Suzan Mooren-van der Meer
- Musculoskeletal Rehabilitation Research Group, School for Allied Health, HAN University of Applied Sciences, Nijmegen, The Netherlands.
| | - Denise J M Smit
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Nathan Hutting
- Research Group Occupation and Health, School of Organisation and Development, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Wim van Lankveld
- Musculoskeletal Rehabilitation Research Group, School for Allied Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Josephine Engels
- Research Group Occupation and Health, School of Organisation and Development, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Michiel Reneman
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thomas Pelgrim
- Research Department Emergency and Critical Care, Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - J Bart Staal
- Musculoskeletal Rehabilitation Research Group, School for Allied Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
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18
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Atoloye AT, Akinsola O, Murillo M. Examining Factors Associated with the Use of Community Food Resources: An Application of the Andersen Model to Inform Future Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:76. [PMID: 38248540 PMCID: PMC10815130 DOI: 10.3390/ijerph21010076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/31/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024]
Abstract
The role of the food environment in shaping nutrition and health has gained substantial attention from policymakers, public health researchers, and advocacy groups. To promote equities in food access and nutrition outcomes, understanding factors linked with the utilization of local community food resources is crucial. Using Andersen's service utilization model, we explained how adults use their neighborhood food resources. In a cross-sectional study design, an online survey was conducted in REDCap Version 13.4.0 via the Amazon Mechanical Turk (MTurk) involving 1830 adults with a mean age of 37.9 ± 12.1 years. Participants answered questions on predisposing, enabling, and need factors that influence their use of different community food resources. The predisposing factors that were statistically significant included age, family size, marital status, race, and ethnicity. The enabling factors included travel time, travel mode, income, and shopping decision motivators (such as being able to use Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) vouchers, delivery services, great sales, and coupons). Food security and community food resources need for lower food price were the significant need factors. However, these factors vary by the types of food resources. In conclusion, enhancing the utilization of community-based food access initiatives and programs among underserved families requires consideration of family composition, racial and ethnic diversity, and transportation access.
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Affiliation(s)
- Abiodun T. Atoloye
- Department of Nutrition, Dietetics, and Food Sciences, Utah State University, Logan, UT 84322, USA
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19
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Tian Y, Fan L, Zhou M, Du W. Impact of long-term care insurance on health inequality in older adults in China based on the concentration index approach. Int Health 2024; 16:83-90. [PMID: 37039047 PMCID: PMC10759298 DOI: 10.1093/inthealth/ihad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/23/2023] [Accepted: 03/24/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Several studies have shown that social security would reduce health inequalities. However, little was known about the relationship between long-term care insurance and health inequality. We aimed to evaluate the impact of long-term care insurance on health status and health inequality in older adults using a nationally representative cohort. METHODS Based on four waves of data from the China Health and Retirement Longitudinal Study (CHARLS 2011, 2013, 2015 and 2018), we used the staggered difference in difference (DID) design with the order probit regression models and the concentration index approach as well as decomposition analysis to assess the contribution of long-term care insurance towards residents' health status and health inequality in older adults aged ≥65 y. We further used the semi-parametric DID model for robustness testing. RESULTS Long-term care insurance demonstrated its role, improving self-assessed health in the study population (βcoefficient: 0.090, 95% CI 0.087 to 0.092, p<0.001). The estimation results of the semi-parametric DID were consistent with those of the staggered DID. The income-related health concentration index was 0.0005, having a contribution rate of 1.639% to health inequality in older adults. Decomposition analysis revealed that different policies and residential areas were more influential on the observed health inequalities. CONCLUSIONS The findings implied that long-term care insurance has widened the health inequality while improving health status in older adults. Additional investment in more comprehensive insurance coverage and increased accessibility to enhance implementation of long-term care insurance is warranted to close the gap.
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Affiliation(s)
- Yong Tian
- School of Public Health, Southeast University, 87 Dingjiaqiao, Gulou district, Nanjing 210009, Jiangsu, China
| | - Lijun Fan
- School of Public Health, Southeast University, 87 Dingjiaqiao, Gulou district, Nanjing 210009, Jiangsu, China
| | - Menghan Zhou
- School of Public Health, Southeast University, 87 Dingjiaqiao, Gulou district, Nanjing 210009, Jiangsu, China
| | - Wei Du
- School of Public Health, Southeast University, 87 Dingjiaqiao, Gulou district, Nanjing 210009, Jiangsu, China
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20
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Mescouto K, Olson RE, Costa N, Evans K, Dillon M, Walsh K, Jensen N, Hodges PW, Lonergan K, Weier M, Setchell J. Fostering equitable change in health services: Using critical reflexivity to challenge dominant discourses in low back pain care in Australia. J Health Serv Res Policy 2024; 29:12-21. [PMID: 37553877 DOI: 10.1177/13558196231193862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
OBJECTIVES Justice and equity-focused practices in health services play a critical but overlooked role in low back pain (LBP) care. Critical reflexivity - the ability to examine and challenge power relations, and broader social issues embedded in everyday life - can be a useful tool to foster practices that are more socially just. No research has yet explored this approach in back pain health services. This study sought to understand how clinicians construct LBP in relation to broader socio-cultural-political aspects of care and explore if those constructions changed when clinicians engaged with critically reflexive dialogues with researchers. METHODS Using critical discourse analysis methods, this qualitative study explored institutionalised patterns of knowledge in the construction of LBP care. We conducted 22 critically reflexive dialogues with 29 clinicians from two health services in Australia - a private physiotherapy clinic and a public multidisciplinary pain clinic. RESULTS Our analyses suggested that clinicians and services often constructed LBP care at an individual level. This dominant individualistic discourse constrained consideration of justice-oriented practices in the care of people with LBP. Through dialogues, discursive constructions of LBP care expanded to incorporate systems and health service workplace practices. This expansion fostered more equitable clinical and service practices - such as assisting patients to navigate health care systems, considering patients' socioeconomic circumstances when developing treatment plans, encouraging staff discussion of possible systemic changes to enhance justice, and fostering a more inclusive workplace culture. Although such expansions faced challenges, incorporating broader discourses enabled recommendations to address LBP care inequities. CONCLUSIONS Critical reflexivity can be a tool to foster greater social justice within health services. By expanding constructions of LBP care beyond individuals, critical reflexive dialogues can foster discussion and actions towards more equitable workplace cultures, services and systems.
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Affiliation(s)
- Karime Mescouto
- Postdoctoral Research Fellow, RECOVER Injury Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Rebecca E Olson
- Associate Professor, School of Social Science, The University of Queensland, Brisbane, QLD, Australia
| | - Nathalia Costa
- Lecturer in Physiotherapy, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
- Adjunct Research Fellow, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Kerrie Evans
- Group Chief Education and Research Officer, Healthia Limited, Brisbane, QLD, Australia
- Senior Research Fellow, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Miriam Dillon
- PhD Candidate, School of Social Science, The University of Queensland, Brisbane, QLD, Australia
| | - Kelly Walsh
- Senior Physiotherapist, Metro South Health Pain Rehabilitation Centre, Brisbane, QLD, Australia
| | - Niamh Jensen
- Clinical Psychologist, Metro South Health Pain Rehabilitation Centre, Brisbane, QLD, Australia
| | - Paul W Hodges
- Professor & NHMRC Leadership Fellow, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | | | - Megan Weier
- Senior Lecturer, Centre for Social Impact, University of New South Wales, Sydney, NSW, Australia
| | - Jenny Setchell
- Senior Research Fellow, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
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21
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Zvolensky MJ, Shepherd JM, Garey L, Woody M, Otto MW, Clausen B, Smit T, Mayorga NA, Bakhshaie J, Buitron V. Negative emotional reactivity to minority stress: measure development and testing. Cogn Behav Ther 2024; 53:1-28. [PMID: 37766610 PMCID: PMC10840979 DOI: 10.1080/16506073.2023.2260560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
The purpose of the present investigation was to develop and test a measure of negative emotional reactivity to racial/ethnic minoritized stress. In Study 1, we developed item content for a measure of negative emotional reactivity to racial/ethnic minoritized stress. We then evaluated item performance and produced a refined 15-item scale among a large sample of racial/ethnic minority adults (N = 1,343). Results supported a unidimensional construct and high levels of internal consistency. The factor structure and internal consistency were replicated and extended to a sample of Latinx persons who smoke (N = 338) in Study 2. There was evidence of convergent validity of the Emotional Reactivity to Minoritized Stress (ERMS) total score in terms of theoretically consistent and statistically significant relations with indices of mental health problems, social determinants of health, and substance use processes. There was also evidence that the ERMS demonstrated divergent validity in that it was negatively associated with psychological well-being, health literacy, subjective social status in Study 1, and positive abstinence expectancies in Study 2. Overall, the present study establishes the reliability and validity of measuring individual differences in negative emotional reactivity to racial/ethnic minority stress with the ERMS and that such responsivity is associated with behavioral health problems.
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Affiliation(s)
- Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
| | | | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
| | - Mary Woody
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael W. Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Bryce Clausen
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Nubia A. Mayorga
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Jafar Bakhshaie
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, 1 Bowdoin Square, Suite 100, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Victor Buitron
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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22
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Timpson K, McCartney G, Walsh D, Chabanis B. What is missing from how we measure and understand the experience of poverty and deprivation in population health analyses? Eur J Public Health 2023; 33:974-980. [PMID: 37862435 PMCID: PMC10710332 DOI: 10.1093/eurpub/ckad174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Explaining why some populations are healthier than others is a core task of epidemiology. Socioeconomic position (SEP), encompassing a broad range of exposures relating to economic circumstances, social class and deprivation, is an important explanation, but lacks a comprehensive framework for understanding the range of relevant exposures it encompasses. METHODS We reviewed existing literature on experiential accounts of poverty through database searching and the identification of relevant material by experts. We mapped relevant concepts into a complex systems diagram. We developed this diagram through a process of consultation with academic experts and experts with direct experience of poverty. Finally, we categorized concepts on the basis of whether they have previously been measured, their importance to the causal flow of the diagram, and their importance to those consulted, creating a list of priorities for future measurement. RESULTS There are a great many aspects of SEP which are not frequently measured or used in epidemiological research and, for some of these, work is needed to better conceptualize and develop measures. Potentially important missing aspects include stigma, social class processes, access to education, sense of lost potential, neighbourhoods, fairness and justice, emotional labour, masking poverty, being (in)visible, costs, and experiences of power. CONCLUSIONS Analyses seeking to understand the extent to which SEP exposures explain differences in the health of populations are likely to benefit from a comprehensive understanding of the range and inter-relationships between different aspects of SEP. More research to better conceptualize and measure these aspects is now needed.
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Affiliation(s)
| | - Gerry McCartney
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - David Walsh
- Glasgow Centre for Population Health, Glasgow, UK
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23
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Knitowski B. Drought:: Ten to Do Ten. Dela J Public Health 2023; 9:26-32. [PMID: 38283718 PMCID: PMC10810295 DOI: 10.32481/djph.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024] Open
Affiliation(s)
- Bridget Knitowski
- Intern, Delaware Academy of Medicine/Delaware Public Health Association
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24
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Khalifeh R, D’Hoore W, Saliba C, Salameh P, Dauvrin M. Healthcare bias and health inequalities towards displaced Syrians in Lebanon: a qualitative study. Front Public Health 2023; 11:1273916. [PMID: 38098832 PMCID: PMC10720425 DOI: 10.3389/fpubh.2023.1273916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/06/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction According to Lebanese official data, Lebanon hosts over 1.5 million displaced Syrians (DS). Research shows that migrants encounter barriers when accessing healthcare. The social determinants of health (SDOH) related to migration are an additional challenge for DS in Lebanon, though bias plays a significant factor in exacerbating health inequalities. This study aims to identify DS perception of healthcare biases in the Lebanese healthcare system, and its consequences on DS' accessing and receiving quality healthcare in Lebanon. Methods A qualitative analysis using in-depth, semi-structured interviews was utilized. 28 semi-structured interviews were conducted with doctors (n = 12) and nurses (n = 16) in 2021. Six group interviews were conducted with DS (n = 22) in Lebanese healthcare facilities. The recruitment of participants relied on reasoned and targeted sampling. Thematic analysis was performed to identify common themes in participants' experiences with DS accessing Lebanese healthcare. Results The findings indicated that there were barriers to accessing healthcare related to the SDOH, such as transportation and financial resources. The results also suggested that DS perceived health biases, including discriminatory behavior from Lebanese healthcare providers, stereotypes and racism leading to health inequalities. Conclusion Based on the perceptions and experiences reported by participants, the underlying causes of biases are due to the fragility of the Lebanese healthcare system when facing a humanitarian crisis as well as a collapsing infrastructure torn by past wars and the current socio-political and financial crises in the country. Global initiatives are required to provide the necessary resources needed for offering equitable health services. Such initiatives involve addressing biases, health inequities, discrimination, and the lack of a Lebanese infrastructure system for the provision of healthcare. Addressing health inequalities remains a major health objective in achieving health equity on the micro level (cultural awareness and competencies) and macro level (equitable distribution of resources, implementation of a universal health coverage) in order to guarantee quality healthcare services to DS.
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Affiliation(s)
- Riwa Khalifeh
- Institute of Health and Society (IRSS), UCLouvain, Brussels, Belgium
- Legal Way for Advocacy and Research, Beirut, Lebanon
| | - William D’Hoore
- Institute of Health and Society (IRSS), UCLouvain, Brussels, Belgium
| | - Christiane Saliba
- Faculty of Public Health—Section 2 (CERIPH), Lebanese University, Fanar, Lebanon
| | - Pascale Salameh
- School of Medicine, Lebanese American University, Byblos, Lebanon
- Institut National de Santé Publique d’Épidémiologie Clinique et de Toxicologie-Liban (INSPECT LB), Beirut, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
| | - Marie Dauvrin
- Institute of Health and Society (IRSS), UCLouvain, Brussels, Belgium
- Belgian Health Care Knowledge Center, KCE, Brussels, Belgium
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Marquez J, Humphrey N, Black L, Cutts M, Khanna D. Gender and sexual identity-based inequalities in adolescent wellbeing: findings from the #BeeWell Study. BMC Public Health 2023; 23:2211. [PMID: 37946184 PMCID: PMC10636841 DOI: 10.1186/s12889-023-16992-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 10/13/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Gender and sexual minority adolescents experience greater symptoms of psychological distress than their peers, but little is known about broader aspects of their wellbeing. This study examines wellbeing inequalities relating to gender and sexual identity among adolescents from Greater Manchester in the United Kingdom. METHOD 37,978 adolescents (aged 12-15, attending 165 secondary schools) completed surveys of life satisfaction, positive and negative affect (hedonic framework); autonomy, self-esteem, optimism, and positive relationships (eudaimonic framework); and, symptoms of distress and mental wellbeing (complete state framework). Structural correlated factors models were used to assess gender and sexual identity wellbeing inequalities. RESULTS The magnitude of wellbeing inequalities pertaining to gender and sexual identity were routinely substantially greater than those concerning other characteristics (e.g., socio-economic disadvantage). Gender identity wellbeing inequalities followed a consistent pattern, with the largest disparities evident between gender diverse adolescents and boys. Sexual identity wellbeing inequalities also followed a consistent pattern, with the largest disparities evident between sexual minority youth (both gay/lesbian and bi/pansexual) and their heterosexual peers. Finally, variation was evident across wellbeing domains. For example, observed gender identity (boys vs. girls) and sexual identity (heterosexual vs. sexual minority) disparities were substantially greater for symptoms of distress than for mental wellbeing in the complete state model. CONCLUSIONS LGBTQ + adolescents experience lower wellbeing than their peers, and this is evident across a range of wellbeing domains. Accordingly, there is an urgent need for the prioritisation of improved prevention and intervention efforts that can better meet the needs of gender diverse and sexual minority youth, and future research should be conducted to improve understanding of the mechanisms underpinning the wellbeing inequalities observed.
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Affiliation(s)
- Jose Marquez
- Manchester Institute of Education, University of Manchester, Manchester, M13 9PL, UK.
| | - Neil Humphrey
- Manchester Institute of Education, University of Manchester, Manchester, M13 9PL, UK
| | - Louise Black
- Manchester Institute of Education, University of Manchester, Manchester, M13 9PL, UK
| | - Megan Cutts
- Manchester Institute of Education, University of Manchester, Manchester, M13 9PL, UK
| | - Devi Khanna
- Manchester Institute of Education, University of Manchester, Manchester, M13 9PL, UK
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26
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O'Dwyer MC, Adetoye M, Morrison L, McEvoy A, Tellez T, Sidhar K, Wong J, Lee L, Rew KT, Bishop T, Greenberg JB. Beyond Quality: Redesigning a Quality Conference With a Focus on Health Equity. PRIMER (LEAWOOD, KAN.) 2023; 7:36. [PMID: 38149279 PMCID: PMC10751094 DOI: 10.22454/primer.2023.249832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Affiliation(s)
| | - Mercy Adetoye
- Department of Family Medicine, University of Michigan, Ann Arbor
| | - Leigh Morrison
- Department of Family Medicine, University of Michigan, Ann Arbor
| | - Anna McEvoy
- Department of Family Medicine, University of Michigan, Ann Arbor
| | - Tim Tellez
- Department of Family Medicine, University of Michigan, Ann Arbor
| | - Kartik Sidhar
- Department of Family Medicine, University of Michigan, Ann Arbor
| | - Jean Wong
- Department of Family Medicine, University of Michigan, Ann Arbor
| | - Laura Lee
- Department of Family Medicine, University of Michigan, Ann Arbor
| | - Karl T Rew
- Department of Family Medicine, University of Michigan, Ann Arbor
| | - Thomas Bishop
- Department of Family Medicine, University of Michigan, Ann Arbor
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27
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Lennox L, Lambe K, Hindocha CN, Coronini-Cronberg S. What health inequalities exist in access to, outcomes from and experience of treatment for lung cancer? A scoping review. BMJ Open 2023; 13:e077610. [PMID: 37918927 PMCID: PMC10626811 DOI: 10.1136/bmjopen-2023-077610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVES Lung cancer (LC) continues to be the leading cause of cancer-related deaths and while there have been significant improvements in overall survival, this gain is not equally distributed. To address health inequalities (HIs), it is vital to identify whether and where they exist. This paper reviews existing literature on what HIs impact LC care and where these manifest on the care pathway. DESIGN A systematic scoping review based on Arksey and O'Malley's five-stage framework. DATA SOURCES Multiple databases (EMBASE, HMIC, Medline, PsycINFO, PubMed) were used to retrieve articles. ELIGIBILITY CRITERIA Search limits were set to retrieve articles published between January 2012 and April 2022. Papers examining LC along with domains of HI were included. Two authors screened papers and independently assessed full texts. DATA EXTRACTION AND SYNTHESIS HIs were categorised according to: (a) HI domains: Protected Characteristics (PC); Socioeconomic and Deprivation Factors (SDF); Geographical Region (GR); Vulnerable or Socially Excluded Groups (VSG); and (b) where on the LC pathway (access to, outcomes from, experience of care) inequalities manifest. Data were extracted by two authors and collated in a spreadsheet for structured analysis and interpretation. RESULTS 41 papers were included. The most studied domain was PC (32/41), followed by SDF (19/41), GR (18/41) and VSG (13/41). Most studies investigated differences in access (31/41) or outcomes (27/41), with few (4/41) exploring experience inequalities. Evidence showed race, rural residence and being part of a VSG impacted the access to LC diagnosis, treatment and supportive care. Additionally, rural residence, older age or male sex negatively impacted survival and mortality. The relationship between outcomes and other factors (eg, race, deprivation) showed mixed results. CONCLUSIONS Findings offer an opportunity to reflect on the understanding of HIs in LC care and provide a platform to consider targeted efforts to improve equity of access, outcomes and experience for patients.
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Affiliation(s)
- Laura Lennox
- Primary Care and Public Health, Imperial College London, London, UK
- NIHR Applied Research Collaboration Northwest London, London, UK
| | - Kate Lambe
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Chandni N Hindocha
- Primary Care and Public Health, Imperial College London, London, UK
- NIHR Applied Research Collaboration Northwest London, London, UK
| | - Sophie Coronini-Cronberg
- Primary Care and Public Health, Imperial College London, London, UK
- NIHR Applied Research Collaboration Northwest London, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- West London NHS Trust, London, UK
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28
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Canfield KN, Sterling AR, Hernández CM, Chu SN, Edwards BR, Fontaine DN, Freese JM, Giroux MS, Jones AE, McCarty AJ, Morrissette HK, Palevsky HI, Raker CE, Robuck AR, Serrato Marks G, Thibodeau PS, Windle AE. Building an inclusive wave in marine science: Sense of belonging and Society for Women in Marine Science symposia. PROGRESS IN OCEANOGRAPHY 2023; 218:1-15. [PMID: 38269259 PMCID: PMC10805246 DOI: 10.1016/j.pocean.2023.103110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Achieving gender equity is a long-standing and ubiquitous challenge in marine science. Creating equitable experiences for all genders in marine science requires recognizing scientists' intersectional identities, and how this leads to unique lived experiences of privilege and marginalization. One approach to increase equitable experiences for women in marine science is to create affinity groups where women can learn from each other, share their experiences, and provide support and mentorship. The Society for Women in Marine Science (SWMS) is one such organization, founded to amplify the work of early career women in marine science and create community, through events such as full-day symposium events. This study investigates the experiences of symposium attendees for four events held from 2018 through 2020, as reported in pre- and post-symposium surveys. We used quantitative analysis of the open-ended survey questions to examine the demographics of attendees and their fields of study. Qualitative thematic analysis identified the most effective aspects of the symposia, areas of logistical and content improvement for future symposia, and emphasized the unique challenges women in marine science experience. The majority of symposium attendees were white graduate students. Nearly all attendees identified as women, with a small number of men and non-binary individuals. Symposia attendees enjoyed opportunities for professional development and interactions with colleagues across career stages. We present recommendations for continuing to foster a sense of belonging in marine science and STEM more broadly, both specific to SWMS and transferable actions that can be applied for other affinity groups. These suggestions include empathetic event logistics, continual democratic evaluation, identity reflexivity among group leaders, and professional development activities targeted towards the unique needs of the affinity group. The positive responses received from SWMS's adaptive integration of survey results into symposia demonstrate that incorporating these recommendations and findings will help create an inclusive wave in marine science.
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Affiliation(s)
- Katherine N. Canfield
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Environmental Measurement and Modeling, Atlantic Coastal Environmental Sciences Division, Narragansett, RI 02882, USA
| | - Alexa R. Sterling
- U.S. Environmental Protection Agency, Region 1, Water Division, Boston, MA 02109, USA
| | - Christina M. Hernández
- Cornell University, Department of Ecology and Evolutionary Biology, Ithaca, NY 14850, USA
- Woods Hole Oceanographic Institution, Biology Department, Woods Hole, MA 02543, USA
| | | | - Bethanie R. Edwards
- University of California Berkeley, Earth and Planetary Science Department, Berkeley, CA 94720, USA
| | - Diana N. Fontaine
- University of Rhode Island, Graduate School of Oceanography, Narragansett, RI 02882, USA
| | - Jillian M. Freese
- J. Craig Venter Institute, Infectious Diseases, La Jolla, CA 92037, USA
| | - Marissa S. Giroux
- Oak Ridge Institute for Science and Education, c/o U.S. Environmental Protection Agency, Office of Research and Development, Center for Environmental Measurement and Modeling, Atlantic Coastal Environmental Sciences Division, Narragansett, RI 02882, USA
| | - Aubree E. Jones
- University of Rhode Island, Biological and Environmental Sciences, Kingston, RI 02881, USA
| | - Alexandra J. McCarty
- Virginia Institute of Marine Science, College of William & Mary, Marine Advisory Program, Gloucester Point, VA 23062, USA
| | - Hannah K. Morrissette
- Smithsonian Environmental Research Center, Marine Conservation Lab, Edgewater, MD 21037, USA
| | - Hilary I. Palevsky
- Boston College, Department of Earth and Environmental Sciences, Chestnut Hill, MA 02467, USA
| | - Catherine E. Raker
- University of Rhode Island, Biological and Environmental Sciences, Kingston, RI 02881, USA
| | - Anna R. Robuck
- U.S. Environmental Protection Agency, Office of Research and Development, Center for Environmental Measurement and Modeling, Atlantic Coastal Environmental Sciences Division, Narragansett, RI 02882, USA
| | | | - Patricia S. Thibodeau
- University of New England, School of Marine and Environmental Programs, Biddeford, MA 04005, USA
| | - Anna E. Windle
- University of Maryland Center for Environmental Science, Horn Point Laboratory, Cambridge, MD 21613, USA
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Lansey DG, Ramalingam R, Brawley OW. Health Care Policy and Disparities in Health. Cancer J 2023; 29:287-292. [PMID: 37963360 DOI: 10.1097/ppo.0000000000000680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
ABSTRACT The United States has seen a 33% decline in age-adjusted cancer mortality since 1991. Despite this achievement, the United States has some of the greatest health disparities of any developed nation. US government policies are increasingly directed toward reducing health disparities and promoting health equity. These policies govern the conduct of research, cancer prevention, access, and payment for care. Although implementation of policies has played a significant role in the successes of cancer control, inconsistent implementation of policy has resulted in divergent outcomes; poorly designed or inadequately implemented policies have hindered progress in reducing cancer death rates and, in certain cases, exacerbated existing disparities. Examining policies affecting cancer control in the United States and realizing their unintended consequences are crucial in addressing cancer inequities.
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Affiliation(s)
| | - Rohan Ramalingam
- From the Department of Oncology, Johns Hopkins School of Medicine
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30
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Medvedyuk S, Raphael D. Defining health through a critical materialist political economy lens. Glob Health Promot 2023:17579759231194600. [PMID: 37823385 DOI: 10.1177/17579759231194600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
It has been recognized since antiquity that the organization of society and how it distributes resources are the primary determinants of health. Yet most definitions of health in the academic and practice literatures limit their focus to the individual's experience of health and functional abilities, neglecting the structures and processes of societies in which the individual is embedded. We draw upon developments in the critical health communication and critical materialist political economy of health literatures to provide a definition of health that directs attention to the role that economic and political systems play in either equitably or inequitably distributing the resources necessary for health. Since these distributions interact with the individual's unique biological and psychological dispositions and situations to produce health, it is important to identify their sources and means of making their distributions more equitable. Because it is through communication that humans interpret society, themselves, and others, a concise definition of health that draws attention to these societal features and their roles on a day-to-day basis in promoting or threatening health is essential.
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Affiliation(s)
- Stella Medvedyuk
- Graduate Program in Health Policy and Equity, York University, Toronto, Canada
| | - Dennis Raphael
- School of Health Policy and Management, York University, Toronto, Canada
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31
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Senn KC, Thiele S, Gumbert L, Krause S, Walter MC, Nagels KH. Inclusion body myositis-health-related quality of life and care situation during phases of the "patience journey" in Germany: results from a qualitative study. Health Qual Life Outcomes 2023; 21:111. [PMID: 37817114 PMCID: PMC10566017 DOI: 10.1186/s12955-023-02196-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 09/28/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND To understand the health-related quality of life (HRQoL) in inclusion body myositis (IBM) from a holistic perspective on the background of a complex care situation. The focus was on how the patient journey may be structured over the course of this rare disease. METHODS An exploratory qualitative study was performed via in-depth semi-structured interviews. Seven patients (males n = 5) with 2011 European Neuromuscular Centre (ENMC) IBM criteria from the German IBM patient registry were interviewed for this study. The dynamic network approach of resilience and the throughput-model of health services research were used to structure the qualitative analysis. RESULTS Our results suggest that IBM patients experience the holistic HRQoL and care situation typically in four phases: (1) uncertainty about physical vulnerability until diagnosis, (2) promising treatment approaches, (3) self-management and dyadic coping, (4) weak body, busy mind and caregiver burden. The homophonous in-vivo code "patience journey" describes the frequently reported emotional perspective of the patient journey. Although the overarching theme of perceived social support varied throughout these phases, a reliable patient-partner-dyad may lead to improved HRQoL in the long-term. CONCLUSIONS New hypotheses for future quantitative research were generated to better understand the IBM patients' burden in the long term. The identified relevance of social support emphasizes the patients' need to handle IBM as manageable in medical settings. During exhausting phases of IBM progression, more effective care elements for patients and their partners could disclose varying needs. Strengthening multi-professional healthcare services via individualised informational, practical, or emotional support could improve HRQoL, especially since there is no curative treatment available so far.
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Affiliation(s)
- Katja C Senn
- University of Bayreuth, Chair of Healthcare Management and Health Services Research, Parsifalstrasse 25, 95445, Bayreuth, Germany.
| | - Simone Thiele
- Department of Neurology, Friedrich Baur Institute, LMU University Hospital, LMU Munich, Ziemssenstrasse 1, 80336, Munich, Germany
| | - Laura Gumbert
- University of Bayreuth, Chair of Healthcare Management and Health Services Research, Parsifalstrasse 25, 95445, Bayreuth, Germany
- SMA Europe, Im Moos 4, 79112, Freiburg, Germany
| | - Sabine Krause
- Department of Neurology, Friedrich Baur Institute, LMU University Hospital, LMU Munich, Ziemssenstrasse 1, 80336, Munich, Germany
| | - Maggie C Walter
- Department of Neurology, Friedrich Baur Institute, LMU University Hospital, LMU Munich, Ziemssenstrasse 1, 80336, Munich, Germany
| | - Klaus H Nagels
- University of Bayreuth, Chair of Healthcare Management and Health Services Research, Parsifalstrasse 25, 95445, Bayreuth, Germany
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32
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Skandrani A, Pichot H, Pegon-Machat E, Pereira B, Tubert-Jeannin S. Influence of an oral health promotion program on the evolution of dental status in New Caledonia: A focus on health inequities. PLoS One 2023; 18:e0287067. [PMID: 37788243 PMCID: PMC10547163 DOI: 10.1371/journal.pone.0287067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 05/30/2023] [Indexed: 10/05/2023] Open
Abstract
New Caledonia is a sui generis collectivity of overseas France situated in the south Pacific Ocean. Geographical and social inequalities are superimposed on ethnic disparities with high prevalence of chronic diseases such as oral diseases. In 2012, the health agency has evaluated the children's health status. Then, an oral health promotion program was developed in 2014. Another study was conducted in 2019 in New Caledonia to appreciate the evolution of children's oral health. A sample of 488 9-years-old children was randomly selected. Dental status was clinically recorded, families and children answered questionnaires about oral health determinants. The methodology (sampling, study variables…) was similar to the one used in the 2012 study. Multivariate mixed-models were conducted to compare 2012 and 2019 dental status and to explore the determinants of caries experience in 2019. Results indicated that caries prevalence and experience decreased between 2012 and 2019, with nonetheless various trends depending on the province or type of indexes. The number of carious lesions (d3t + D3T) in 2019 was used as an outcome variable in four models. Model 1 integrated social variables; ethnicity was found to be the only significant determinant. Model 2 was related to oral health care; participation in the program & and access to oral health care was found to be significant. For oral health behaviours (model 3), tooth brushing frequency and consumption of sugary snacks were significant risk factors. In a final model with significant variables from the previous models, ethnicity, accessibility of oral health care, number of sealed molars, consumption of sugary snacks remained explanatory factors. Five years after the implementation of the oral health promotion program, positive changes in oral health have been observed. However, health equity is still an issue with varying health status depending on ethnicity, behavioural factors and accessibility to oral health care.
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Affiliation(s)
- Amal Skandrani
- Université Clermont Auvergne, CROC, F-63000, Clermont-Ferrand, France
| | - Helene Pichot
- Health and Social Agency of New Caledonia (ASS-NC), Nouméa, New Caledonia, France
| | | | - Bruno Pereira
- CHU of Clermont-Ferrand, Clinical Research and Innovation Direction (DRCI), F-63003, Clermont-Ferrand, France
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Gallegos D, Booth S, Pollard CM, Chilton M, Kleve S. Food security definition, measures and advocacy priorities in high-income countries: a Delphi consensus study. Public Health Nutr 2023; 26:1986-1996. [PMID: 37144401 PMCID: PMC10564592 DOI: 10.1017/s1368980023000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/06/2023] [Accepted: 04/26/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To establish an international consensus on the definition of food security, measures and advocacy priorities in high-income countries. DESIGN A two-round online Delphi survey with closing in March 2020 and December 2021. Consensus was set a priori at 75 %. Qualitative data were synthesised and priorities were ranked. SETTING High-income countries. PARTICIPANTS Household food security experts in academia, government and non-government organisations who had published in the last 5 years. RESULTS Up to thirty-two participants from fourteen high-income countries responded to the Delphi with a 25 % response rate in Round 1 and a 38 % response rate in Round 2. Consensus was reached on the technical food security definition and its dimensions. Consensus was not reached on a definition suitable for the general public. All participants agreed that food security monitoring systems provide valuable data for in-country decision-making. Favoured interventions were those that focused on upstream social policy influencing income. Respondents agreed that both national and local community level strategies were required to ameliorate food insecurity, reinforcing the complexity of the problem. CONCLUSIONS This study furthers the conceptual understanding of the commonly used definition of food security and its constituent dimensions. Strong advocacy is needed to ensure food security monitoring, policy and mitigation strategies are implemented. The consensus on the importance of prioritising actions that address the underlying determinants of household food security by experts in the field from across wealthy nations provides evidence to focus advocacy efforts and generate public debate.
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Affiliation(s)
- Danielle Gallegos
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia
- Woolworths Centre for Childhood Nutrition Research, Queensland University of Technology, Brisbane, Australia
| | - Sue Booth
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
- School of Population Health, Curtin University, Perth, Australia
| | - Christina Mary Pollard
- School of Population Health, Curtin University, Perth, Australia
- Enable Institute, Curtin University, Perth, Australia
| | - Mariana Chilton
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Sue Kleve
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Australia
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Wang T, Codling D, Bhugra D, Msosa Y, Broadbent M, Patel R, Roberts A, McGuire P, Stewart R, Dobson R, Harland R. Unraveling ethnic disparities in antipsychotic prescribing among patients with psychosis: A retrospective cohort study based on electronic clinical records. Schizophr Res 2023; 260:168-179. [PMID: 37669576 PMCID: PMC10881407 DOI: 10.1016/j.schres.2023.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/11/2023] [Accepted: 08/27/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Previous studies have shown mixed evidence on ethnic disparities in antipsychotic prescribing among patients with psychosis in the UK, partly due to small sample sizes. This study aimed to examine the current state of antipsychotic prescription with respect to patient ethnicity among the entire population known to a large UK mental health trust with non-affective psychosis, adjusting for multiple potential risk factors. METHODS This retrospective cohort study included all patients (N = 19,291) who were aged 18 years or over at their first diagnoses of non-affective psychosis (identified with the ICD-10 codes of F20-F29) recorded in electronic health records (EHRs) at the South London and Maudsley NHS Trust until March 2021. The most recently recorded antipsychotic treatments and patient attributes were extracted from EHRs, including both structured fields and free-text fields processed using natural language processing applications. Multivariable logistic regression models were used to calculate the odds ratios (OR) for antipsychotic prescription according to patient ethnicity, adjusted for multiple potential contributing factors, including demographic (age and gender), clinical (diagnoses, duration of illness, service use and history of cannabis use), socioeconomic factors (level of deprivation and own-group ethnic density in the area of residence) and temporal changes in clinical guidelines (date of prescription). RESULTS The cohort consisted of 43.10 % White, 8.31 % Asian, 40.80 % Black, 2.64 % Mixed, and 5.14 % of patients from Other ethnicity. Among them, 92.62 % had recorded antipsychotic receipt, where 24.05 % for depot antipsychotics and 81.72 % for second-generation antipsychotic (SGA) medications. Most ethnic minority groups were not significantly different from White patients in receiving any antipsychotic. Among those receiving antipsychotic prescribing, Black patients were more likely to be prescribed depot (adjusted OR 1.29, 95 % confidence interval (CI) 1.14-1.47), but less likely to receive SGA (adjusted OR 0.85, 95 % CI 0.74-0.97), olanzapine (OR 0.82, 95 % CI 0.73-0.92) and clozapine (adjusted OR 0.71, 95 % CI 0.6-0.85) than White patients. All the ethnic minority groups were less likely to be prescribed olanzapine than the White group. CONCLUSIONS Black patients with psychosis had a distinct pattern in antipsychotic prescription, with less use of SGA, including olanzapine and clozapine, but more use of depot antipsychotics, even when adjusting for the effects of multiple demographic, clinical and socioeconomic factors. Further research is required to understand the sources of these ethnic disparities and eliminate care inequalities.
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Affiliation(s)
- Tao Wang
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London SE5 8AF, United Kingdom.
| | - David Codling
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London SE5 8AF, United Kingdom; South London and Maudsley National Health Service (NHS) Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
| | - Dinesh Bhugra
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London SE5 8AF, United Kingdom
| | - Yamiko Msosa
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London SE5 8AF, United Kingdom
| | - Matthew Broadbent
- South London and Maudsley National Health Service (NHS) Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
| | - Rashmi Patel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London SE5 8AF, United Kingdom; South London and Maudsley National Health Service (NHS) Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
| | - Angus Roberts
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London SE5 8AF, United Kingdom; South London and Maudsley National Health Service (NHS) Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
| | - Philip McGuire
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; Oxford Health, Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London SE5 8AF, United Kingdom; South London and Maudsley National Health Service (NHS) Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
| | - Richard Dobson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London SE5 8AF, United Kingdom; South London and Maudsley National Health Service (NHS) Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Institute of Health Informatics, University College London, Euston Road, London NW1 2DA, United Kingdom; Health Data Research UK London, University College London, Euston Road, London NW1 2DA, United Kingdom
| | - Robert Harland
- South London and Maudsley National Health Service (NHS) Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
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Ojo-Aromokudu O, Suffel A, Bell S, Mounier-Jack S. Views and experiences of primary care among Black communities in the United Kingdom: a qualitative systematic review. ETHNICITY & HEALTH 2023; 28:1006-1025. [PMID: 37160684 DOI: 10.1080/13557858.2023.2208313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 04/24/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND In the United Kingdom, people with non-white ethnicities are more likely to report being in worse health conditions and have poorer experiences of healthcare services than white counterparts. The voices of those of Black ethnicities are often merged in literature among other non-white ethnicities. This literature review aims to analyse studies that investigate Black participant experiences of primary care in the UK. METHODS We conducted a systematic literature review searching Medline, Web of Science, EMBASE, SCOPUS, Social Policy and Practice, CINAHL plus, Psych INFO and Global Health with specific search terms for appropriate studies. No publish date limit was applied. RESULTS 40 papers (39 articles and 1 thesis) were deemed eligible for inclusion in the review. A number of major themes emerged. Patient expectations of healthcare and the health seeking behaviour impacted their interactions with health systems in the UK. Both language and finances emerged as barriers through which some Black participants interacted with primary care services. (Mis)trust of clinicians and the health system was a common theme that often negatively impacted views of UK primary care services. The social context of the primary care service and instances of a cultural disconnect also impacted views of primary care services. Some papers detail patients recognising differential treatment based on ethnicity. The review included the voices of primary care professionals where descriptions of Black patients were overwhelmingly negative. CONCLUSION Views and experiences of Black groups may be radically different to other ethnic minorities and thus, should be teased out of broader umbrella terms like Black and Asian Minority Ethnic (BAME) and Black Minority Ethnic (BME). To address ethnicity-based health inequalities, culturally sensitive interventions that engage with the impacted community including co-designed interventions should be considered while acknowledging the implications of being racialised as Black in the UK.
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Affiliation(s)
- Oyinkansola Ojo-Aromokudu
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Anne Suffel
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Sadie Bell
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandra Mounier-Jack
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Macgregor C, Walumbe J, Tulle E, Seenan C, Blane DN. Intersectionality as a theoretical framework for researching health inequities in chronic pain. Br J Pain 2023; 17:479-490. [PMID: 38107758 PMCID: PMC10722103 DOI: 10.1177/20494637231188583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Chronic pain is experienced unequally by different population groups; we outline examples from the pain literature of inequities related to gender, ethnicity, socioeconomic and migration status. Health inequities are systematic, avoidable and unfair differences in health outcomes between groups of people, with the fundamental 'causes of causes' recognised as unequal distribution of income, power and wealth. Intersectionality can add further theory to health inequities literature; collective social identities including class/socioeconomic status, race/ethnicity, gender, migration status, age, sexuality and disabled status intersect in multiple interconnected systems of power leading to differing experiences of privilege and oppression which can be understood as axes of health inequities. The process of knowledge creation in pain research is shaped by these interconnected systems of power, and may perpetuate inequities in pain care as it is largely based on majority white, middle class, Eurocentric populations. Intersectionality can inform research epistemology (ways of knowing), priorities, methodology and methods. We give examples from the literature where intersectionality has informed a justice oriented approach across different research methods and we offer suggestions for further development. The use of a reductionist frame can force unachievable objectivity on to complex health concepts, and we note increasing realisation in the field of the need to understand the individuals within their social world, and recognise the fluid and contextual nature of this.
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Affiliation(s)
- Cassandra Macgregor
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- NHS Lanarkshire Chronic Pain Service, Buchanan Centre, Coatbridge, UK
| | - Jackie Walumbe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Emmanuelle Tulle
- Department of Social Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Christopher Seenan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - David N Blane
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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van der Vlegel-Brouwer W, Eelderink M, Bussemaker J. Participatory Action Research as a Driver for Health Promotion and Prevention: A Co-creation Process Between Professionals and Citizens in a Deprived Neighbourhood in the Hague. Int J Integr Care 2023; 23:13. [PMID: 38047119 PMCID: PMC10691282 DOI: 10.5334/ijic.7560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 11/13/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Ignited by the persistent health inequalities many cities and neighbourhoods, the 'Healthy and Happy The Hague' network in the Netherlands wanted to gain insight in how prevention and health promotion could become successful in one deprived neighbourhood, Moerwijk. Methods The cycle of Look-Think-Act of Participatory Action Research was used in which both citizens and professionals got involved from the start. Besides interviews, field notes were analysed, visualised and discussed in several rounds of focus groups. Results Thematic analysis yielded seven themes: Healthy Eating and Exercise, Healthy Money, Healthy Mind, Healthy Relationships, Growing up healthy, Healthy Environment and Healthy Collaboration. During sessions around combination of themes, eight initiatives were co-created by citizens and professionals together, improving the feeling of ownership and interconnectedness. Discussion and conclusion This PAR sheds a light on the mismatch between the system world's solutions for individuals and the living world's needs for solutions for the collective. Findings provides a better insight into the social, political, and cultural mechanisms and processes that influence clustering and interaction of health conditions. PAR is a promising process of citizens and professionals working together is an excellent way to learn about the conditions under which people experience health inequalities, and how to combat these inequalities.
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Affiliation(s)
| | - Madelon Eelderink
- Seven Senses Institute, Nieuwegein, The Netherlands
- Utrecht University, The Netherlands
| | - Jet Bussemaker
- Institute of Public Administration, Health Campus The Hague, The Netherlands
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Jafari H, Varaei S, Brand S, Dehghan Nayeri N, Fazeli N, Khoshnavay Fomani F, Nasrabadi AN. Living with Mental Distress, Social Anger, and In-Group Commitment among Working Children: A Qualitative Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2023; 28:528-535. [PMID: 37869703 PMCID: PMC10588915 DOI: 10.4103/ijnmr.ijnmr_209_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 10/24/2023]
Abstract
Background Working as a child can have various effects on all aspects of children's health. Investigating and identifying issues related to the health of working children can be useful in promoting their health. Therefore, in this qualitative study, we examined issues related to the mental health and behavior of working children. Materials and Methods This qualitative study was conducted in Tehran, Iran, in 2021 with the contractual content analysis approach. The main participants (N = 32) in this study were working children aged 10 to 18 years. To collect data, in-depth and semi-structured interviews were conducted with working children, their parents, and the center officials. In addition to the interview, some field notes were also taken from interactions between working children. After each interview, they were transcribed and coded. After 27 interviews, the data were saturated, no new code was extracted, and further interviews were conducted to ensure data saturation. Data analysis was performed based on the proposed method of Lundman and Graneheim. Results The results revealed the three main categories of mental distress (fear and anxiety, depression, loneliness and isolation, decreased self-confidence, and decentralized mind), social anger (negative social role modeling, harassment and harm of others, reprehensible and antisocial behavior, disregard for the property of others, disrupted relationships, and violence), and in-group commitment (self-censorship outside the group, individual independence and group cohesion, and caring for the group). Conclusions Most working children suffer from various forms of mental and behavioral issues, which, if not taken care of, can have irreparable consequences.
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Affiliation(s)
- Haleh Jafari
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Shokoh Varaei
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Serge Brand
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran, Center for Affective, Stress and Sleep Disorders (ZASS), Psychiatric University Hospital Basel, Basel, Switzerland, Department of Clinical Research, University of Basel, Basel, Switzerland, Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland, Substance Abuse Prevention Research Center Health, Kermanshah University of Medical Sciences, Kermanshah, Iran, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nahid Dehghan Nayeri
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Nematollah Fazeli
- Anthropology, Institute for Humanities and Cultural Studies, Tehran, Iran
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Kleineberg-Massuthe H, Papst L, Bassler M, Köllner V. Milieu-specific differences in symptom severity and treatment outcome in psychosomatic rehabilitation in Germany. Front Psychiatry 2023; 14:1198146. [PMID: 37654992 PMCID: PMC10465793 DOI: 10.3389/fpsyt.2023.1198146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/11/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction Previous studies that focused on socioeconomic differences did not comprehensively explain existing inequalities in psychosomatic rehabilitation in Germany. We applied a social milieu approach, which additionally includes sociocultural factors such as lifestyles, attitudes and values, to investigate differences among patients in symptom severity, psychosocial impairment and improvement over the course of the intervention. Methods As a model for social milieus, the empirical Sinus milieus were used. 2,000 patients of two psychosomatic rehabilitation clinics in Germany were included and their milieu was assessed with the Sinus milieu indicator for Germany 10/2018 questionnaire. BDI-II (N = 1,832) and HEALTH-49 (N = 1,829) questionnaires were used to measure depressiveness and psychosocial impairment at admission (T0) and discharge after 5 weeks of treatment (T1). Milieu differences in severity and improvement were analyzed by mixed-model ANOVAs. Results Milieu distribution was not representative of the overall population of Germany. We found significant differences between patients from different milieus in both BDI-II and HEALTH-49 (p < 0.001). Patients from the Precarious Milieu had the highest burden of depressive symptoms in BDI-II and the highest impairment on all HEALTH-49 scales at T0 and T1. Over the course of rehabilitation, patients from all milieus improved significantly in all domains (p < 0.001). Significant interaction effects showed milieu-dependent differences in improvement for depressiveness on the BDI-II [F(9, 1822) = 2.50, p = 0.008] and for three HEALTH-49 scales, namely Psychological well-being [F(9, 1819) = 3.30, padj = 0.005], Interactional difficulties [F(9, 1819) = 2.74, padj = 0.036] and Activity and Participation [F(9, 1819) = 4.94, padj < 0.001], while post-hoc tests only revealed two significant group differences for the last scale. In all domains, patients from the Precarious Milieu retained higher symptoms and impairment at T1 than patients from better-off milieus had at T0. Discussion Social milieu was associated with symptom severity, treatment access and outcome of psychosomatic rehabilitation patients. Milieu-specific sociocultural habits, psychosocial needs and therapeutic demands may help describe differences and should be considered in therapy planning and implementation, to improve equal access, quality and effectiveness of rehabilitation. Therefore, further research on milieu-specific differences and needs is necessary.
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Affiliation(s)
- Henrika Kleineberg-Massuthe
- Psychosomatic Rehabilitation Research Group, Department of Psychosomatic Medicine, Centrum für Innere Medizin und Dermatologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Lilia Papst
- Psychosomatic Rehabilitation Research Group, Department of Psychosomatic Medicine, Centrum für Innere Medizin und Dermatologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Bassler
- Institute for Social Medicine, Rehabilitation Sciences and Health Services Research (ISRV), Hochschule Nordhausen, Nordhausen, Germany
- Center for Oncology and Psychosomatics, Rehazentrum Oberharz, Clausthal-Zellerfeld, Germany
| | - Volker Köllner
- Psychosomatic Rehabilitation Research Group, Department of Psychosomatic Medicine, Centrum für Innere Medizin und Dermatologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychosomatics and Behavioral Psychotherapy, Reha-Zentrum Seehof, Teltow, Germany
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40
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Levison A, Harrison J, Hill J. Is a lower socio-economic position associated with poorer outcomes for end-of-life care? Int J Palliat Nurs 2023; 29:370-373. [PMID: 37620145 DOI: 10.12968/ijpn.2023.29.8.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Affiliation(s)
| | - Joanna Harrison
- Synthesis, Economic Evaluation and Decision Science Group, Health Technology Assessment Unit, University of Central Lancashire
| | - James Hill
- Synthesis, Economic Evaluation and Decision Science Group, Health Technology Assessment Unit, University of Central Lancashire
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Johnston JC, Sartwelle TP, Zebenigus M, Arda B, Beran RG. Global Neurology: The Good, the Bad, and the Ugly. Neurol Clin 2023; 41:549-568. [PMID: 37407107 DOI: 10.1016/j.ncl.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Global health programs engaging in isolated or short-term medical missions can and do cause harm, reinforce health care disparities, and impede medical care in the regions where it is so desperately needed. Related ethical, medical, and legal concerns are reviewed in this article. The authors recommend abandoning these ill-considered missions and focusing attention and resources on advancing neurology through ethically congruent, multisectoral, collaborative partnerships to establish sustainable, self-sufficient training programs within low- and middle-income countries.
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Affiliation(s)
- James C Johnston
- Auckland, New Zealand and San Antonio, TX, USA; Department of Neurology, Addis Ababa University School of Medicine, Ethiopia.
| | | | - Mehila Zebenigus
- Department of Neurology, Addis Ababa University School of Medicine, Ethiopia; Yehuleshet Higher Clinic, Addis Ababa, Ethiopia
| | - Berna Arda
- Department of Medical Ethics, Faculty of Medicine, Ankara University, Turkey
| | - Roy G Beran
- University of New South Wales, Sydney, Australia; Western Sydney University, Sydney, Australia; School of Medicine, Griffith University, Queensland, Australia
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42
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Andrade CAS, Mahrouseh N, Gabrani J, Charalampous P, Cuschieri S, Grad DA, Unim B, Mechili EA, Chen-Xu J, Devleesschauwer B, Isola G, von der Lippe E, Baravelli CM, Fischer F, Weye N, Balaj M, Haneef R, Economou M, Haagsma JA, Varga O. Inequalities in the burden of non-communicable diseases across European countries: a systematic analysis of the Global Burden of Disease 2019 study. Int J Equity Health 2023; 22:140. [PMID: 37507733 PMCID: PMC10375608 DOI: 10.1186/s12939-023-01958-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Although overall health status in the last decades improved, health inequalities due to non-communicable diseases (NCDs) persist between and within European countries. There is a lack of studies giving insights into health inequalities related to NCDs in the European Economic Area (EEA) countries. Therefore, the aim of the present study was to quantify health inequalities in age-standardized disability adjusted life years (DALY) rates for NCDs overall and 12 specific NCDs across 30 EEA countries between 1990 and 2019. Also, this study aimed to determine trends in health inequalities and to identify those NCDs where the inequalities were the highest. METHODS DALY rate ratios were calculated to determine and compare inequalities between the 30 EEA countries, by sex, and across time. Annual rate of change was used to determine the differences in DALY rate between 1990 and 2019 for males and females. The Gini Coefficient (GC) was used to measure the DALY rate inequalities across countries, and the Slope Index of Inequality (SII) to estimate the average absolute difference in DALY rate across countries. RESULTS Between 1990 and 2019, there was an overall declining trend in DALY rate, with larger declines among females compared to males. Among EEA countries, in 2019 the highest NCD DALY rate for both sexes were observed for Bulgaria. For the whole period, the highest DALY rate ratios were identified for digestive diseases, diabetes and kidney diseases, substance use disorders, cardiovascular diseases (CVD), and chronic respiratory diseases - representing the highest inequality between countries. In 2019, the highest DALY rate ratio was found between Bulgaria and Iceland for males. GC and SII indicated that the highest inequalities were due to CVD for most of the study period - however, overall levels of inequality were low. CONCLUSIONS The inequality in level 1 NCDs DALYs rate is relatively low among all the countries. CVDs, digestive diseases, diabetes and kidney diseases, substance use disorders, and chronic respiratory diseases are the NCDs that exhibit higher levels of inequality across countries in the EEA. This might be mitigated by applying tailored preventive measures and enabling healthcare access.
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Affiliation(s)
- Carlos Alexandre Soares Andrade
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26 Kassai Street, 4028, Debrecen, Hungary
| | - Nour Mahrouseh
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26 Kassai Street, 4028, Debrecen, Hungary
| | - Jonila Gabrani
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Periklis Charalampous
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sarah Cuschieri
- Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Diana Alecsandra Grad
- Department of Public Health, Babes-Bolyai University, Cluj-Napoca-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca-Napoca, Romania
| | - Brigid Unim
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore Di Sanità, Rome, Italy
| | - Enkeleint A Mechili
- Department of Healthcare, Faculty of Health, University of Vlora, Vlora, Albania
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Crete, Greece
| | - José Chen-Xu
- Public Health Unit, Primary Healthcare Cluster Baixo Mondego, Coimbra, Portugal
- National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Gaetano Isola
- Department of General Surgery and Surgical Medical Specialties, University of Catania, Catania, Italy
| | - Elena von der Lippe
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | | | - Florian Fischer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nanna Weye
- Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Mirza Balaj
- Department of Sociology and Political Science, Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Romana Haneef
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, Saint-Maurice, France
| | - Mary Economou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Juanita A Haagsma
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Orsolya Varga
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26 Kassai Street, 4028, Debrecen, Hungary.
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McCartney G, Hoggett R, Walsh D, Lee D. How important is it to avoid indices of deprivation that include health variables in analyses of health inequalities? Public Health 2023; 221:175-180. [PMID: 37473649 DOI: 10.1016/j.puhe.2023.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES This study aimed to quantify the difference in mortality inequalities using the Scottish Index of Multiple Deprivation (SIMD) and the Income and Employment Index (IEI; a subindex of SIMD, which excludes health) as ranking measures in Scotland. STUDY DESIGN This ecological study was a cross-sectional analysis of routine administrative data. METHODS Data from the 2020 SIMD and the subindex using data from only the Income and Employment domains, the IEI, were obtained. The correlation between data zones, percentage of data zones that changed deprivation tenth and differences in the Slope Index of Inequality (SII) and Relative Index of Inequality (RII) for Standardised Mortality Ratios (SMRs) across tenths were compared when data zones were ranked by SIMD and IEI. RESULTS There was a close correlation between data zones ranked by SIMD and IEI (R2 = 0.96). When data zones were ranked by IEI, 18.7% of data zones moved to a lower deprivation tenth, and 20.8% of data zones moved to a higher deprivation tenth, compared with SIMD. However, only a negligible number of data zones moved two or more tenths. The SMRs across deprivation tenths were very similar between the SIMD and IEI, as were the summary health inequality measures of SII (87.3 compared with 85.7) and RII (0.88 and 0.86). CONCLUSION Although there is a logical problem in using deprivation indices that include health outcomes to rank areas to calculate the scale of health inequalities, the impact of using an alternative subindex containing only data from the income and employment domains is minimal. For population-wide analyses of health inequalities in Scotland, the SIMD does not introduce a substantial bias in the health inequalities summary measures despite substantial movement of small areas between ranked population tenths. Although not examined here, this is likely to be relevant to other similar indices across the United Kingdom.
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Affiliation(s)
- G McCartney
- College of Social Sciences, University of Glasgow, 40 Bute Gardens, Glasgow, G12 8RT, UK.
| | - R Hoggett
- NHS Education for Scotland, 89 Hydepark St, Glasgow, G3 8BW, UK
| | - D Walsh
- Glasgow Centre for Population Health, Olympia Building, Bridgeton Cross, Glasgow, UK
| | - D Lee
- School of Mathematics and Statistics, Mathematics and Statistics Building, Glasgow, G12 8SQT, UK
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Black L, Humphrey N, Marquez J. The influence of minority stress-related experiences on mental wellbeing for trans/gender-diverse and cisgender youth: a comparative longitudinal analysis. ROYAL SOCIETY OPEN SCIENCE 2023; 10:221230. [PMID: 37501657 PMCID: PMC10369031 DOI: 10.1098/rsos.221230] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 06/28/2023] [Indexed: 07/29/2023]
Abstract
Trans and gender-diverse (TGD) adolescents are likely to experience poorer mental health and wellbeing than their cisgender peers. Minority stress theory has developed as a possible explanation for some of this disadvantage: factors such as increased bullying and discrimination lead to excess stress and reduced wellbeing. However, the evidence base remains limited. This study drew on secondary data analysis of the #BeeWell longitudinal cohort over 2 years (N = 26 042, aged 12-13 at time one, T1). We report two unregistered hypotheses relating to T1 (autumn 2021) data which was available at the time of stage-one submission: H1, mean differences in T1 wellbeing; H2, mean differences in T1 minority-related stressors. These are followed by two registered hypotheses relating to T2 (autumn 2022) data: H3, replication of T1 mean differences in T2 wellbeing; H4, predictions were made about the strength of the association between T1 minority-related stressors, controlling for sexuality and T2 wellbeing across T1 gender identity groups. At both time points cis-females, TGD and those who preferred not to say their gender had lower wellbeing than cis-males (CM), with the largest effect evident for the TGD group. TGD adolescents also showed the largest disadvantage (mean difference) compared with CM for minority stressors. Counter to H4 and minority stress theory, gender was not found to moderate the effect of minority stressors on later wellbeing. Our findings highlight the vulnerability of the TGD group in terms of wellbeing and minority stressors and are discussed with relevance for policy and future research.
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Affiliation(s)
- Louise Black
- Manchester Institute of Education, University of Manchester, Manchester M13 9PL, UK
| | - Neil Humphrey
- Manchester Institute of Education, University of Manchester, Manchester M13 9PL, UK
| | - Jose Marquez
- Manchester Institute of Education, University of Manchester, Manchester M13 9PL, UK
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Ford J, Black M, Morling J. Health inequality: Time to get smart about our language. PUBLIC HEALTH IN PRACTICE 2023; 5:100369. [PMID: 36923962 PMCID: PMC10009285 DOI: 10.1016/j.puhip.2023.100369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Affiliation(s)
- John Ford
- Wolfson Institute, Queen Mary University London, London, UK
| | - Michelle Black
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Jo Morling
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
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Baral S, McCartney G. Health inequalities: responding to the challenge. Public Health 2023; 219:165-166. [PMID: 37248159 DOI: 10.1016/j.puhe.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- S Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, 21205, USA
| | - G McCartney
- School of Social and Political Sciences, University, of Glasgow, Glasgow, G12 8QQ, UK.
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Mabetha D, Ojewola T, van der Merwe M, Mabika R, Goosen G, Sigudla J, Hove J, Witter S, D'Ambruoso L. Realising radical potential: building community power in primary health care through Participatory Action Research. Int J Equity Health 2023; 22:94. [PMID: 37198678 DOI: 10.1186/s12939-023-01894-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 04/14/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND While community participation is an established pro-equity approach in Primary Health Care (PHC), it can take many forms, and the central category of power is under-theorised. The objectives were to (a) conduct theory-informed analysis of community power-building in PHC in a setting of structural deprivation and (b) develop practical guidance to support participation as a sustainable PHC component. METHODS Stakeholders representing rural communities, government departments and non-governmental organisations engaged through a participatory action research (PAR) process in a rural sub-district in South Africa. Three reiterative cycles of evidence generation, analysis, action, and reflection were progressed. Local health concerns were raised and framed by community stakeholders, who generated new data and evidence with researchers. Dialogue was then initiated between communities and the authorities, with local action plans coproduced, implemented, and monitored. Throughout, efforts were made to shift and share power, and to adapt the process to improve practical, local relevance. We analysed participant and researcher reflections, project documents, and other project data using power-building and power-limiting frameworks. RESULTS Co-constructing evidence among community stakeholders in safe spaces for dialogue and cooperative action-learning built collective capabilities. The authorities embraced the platform as a space to safely engage with communities and the process was taken up in the district health system. Responding to COVID-19, the process was collectively re-designed to include a training package for community health workers (CHWs) in rapid PAR. New skills and competencies, new community and facility-based alliances and explicit recognition of CHW roles, value, and contribution at higher levels of the system were reported following the adaptations. The process was subsequently scaled across the sub-district. CONCLUSIONS Community power-building in rural PHC was multidimensional, non-linear, and deeply relational. Collective mindsets and capabilities for joint action and learning were built through a pragmatic, cooperative, adaptive process, creating spaces where people could produce and use evidence to make decisions. Impacts were seen in demand for implementation outside the study setting. We offer a practice framework to expand community power in PHC: (1) prioritising community capability-building, (2) navigating social and institutional contexts, and (3) developing and sustaining authentic learning spaces.
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Affiliation(s)
- Denny Mabetha
- Cochrane South Africa, South African Medical Research Council (MRC), Cape Town, South Africa
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, and Centre for Global Development, School of Education, University of Aberdeen, Aberdeen, Scotland, UK
| | - Temitope Ojewola
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, and Centre for Global Development, School of Education, University of Aberdeen, Aberdeen, Scotland, UK
- Health Education England, Northwest, Manchester, England, UK
| | - Maria van der Merwe
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, and Centre for Global Development, School of Education, University of Aberdeen, Aberdeen, Scotland, UK
- Maria Van Der Merwe Consulting, White River, South Africa
| | | | | | - Jerry Sigudla
- Mpumalanga Department of Health, Mbombela, South Africa
| | - Jennifer Hove
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, and Centre for Global Development, School of Education, University of Aberdeen, Aberdeen, Scotland, UK
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland, UK
| | - Lucia D'Ambruoso
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, and Centre for Global Development, School of Education, University of Aberdeen, Aberdeen, Scotland, UK.
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland, UK.
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
- Public Health, National Health Service (NHS) Grampian, Aberdeen, Scotland, UK.
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa.
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Naït Salem R, Rotily M, Apostolidis T, Odena S, Lamouroux A, Chischportich C, Persico N, Auquier P. Health mediation: an intervention mode for improving emergency department care and support for patients living in precarious conditions. BMC Health Serv Res 2023; 23:495. [PMID: 37194100 PMCID: PMC10186303 DOI: 10.1186/s12913-023-09522-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/09/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Severe overcrowding of emergency departments (EDs) impacts the quality of healthcare. One factor of this overcrowding is precariousness, but it has rarely been considered a key factor in designing interventions to improve ED care. Health mediation (HM) aims to facilitate access to rights, prevention, and care for the most vulnerable persons and to raise awareness among healthcare providers about obstacles in accessing healthcare. We here present the results of an ancillary qualitative study to explore the prospects regarding a health mediation intervention implemented in EDs for deprived persons who are frequent ED users, from professionals' and patients' perspectives. METHODS Design, data collection, and data analysis were done according to a psychosocial approach, based on thematic content analysis and semi-structured interviews of 16 frequent ED users and deprived patients exposed to HM and of 14 professionals in 4 EDs of South-eastern France. RESULTS All patients reported multifactorial distress. Most of them expressed experiencing isolation and powerlessness, and lacking personal resources to cope with healthcare. They mentioned the use of ED as a way of quickly meeting a professional to respond to their suffering, and recognized the trustworthy alliance with health mediators (HMrs) as a means to put them back in a healthcare pathway. The presence of HMrs in EDs was appreciated by ED professionals because HMrs responded to requests they were not able to access and were perceived as an efficient support for caring for deprived persons in emergency contexts. CONCLUSIONS Our results are in favour of health mediation in EDs as a promising solution, requested by patients and ED professionals, to cope with frequent ED users and deprived patients. Our results could also be used to adapt other strategies for the most vulnerable populations to reduce the frequency of ED readmissions. At the interface of the patients' health experience and the medico-social sector, HM could complete the immediate responses to medical needs given in EDs and contribute in alleviating the social inequalities of health.
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Affiliation(s)
- Riwan Naït Salem
- Laboratoire de Psychologie Sociale (LPS), Aix Marseille Université, Aix-en-Provence, France
| | - Michel Rotily
- Centre de Santé Universitaire - Espace Santé Aygalades - Assistance Publique Hopitaux de Marseille, Marseille, France.
- Centre d'Etudes et de Recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université, Marseille, France.
| | | | - Sophie Odena
- Aix Marseille Univ, CNRS, LEST, Aix-en-Provence, France
| | - Aurore Lamouroux
- Centre de Santé Universitaire - Espace Santé Aygalades - Assistance Publique Hopitaux de Marseille, Marseille, France
| | | | - Nicolas Persico
- Service d'Accueil des Urgences Adultes, Hopital Nord, Assistance Publique Hopitaux de Marseille, Marseille, France
| | - Pascal Auquier
- Centre d'Etudes et de Recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université, Marseille, France
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49
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Buhmeida A, Assidi M, Budowle B. Current Healthcare Systems in Light of Hyperendemic NCDs and the COVID-19 Pandemic: Time to Change. Healthcare (Basel) 2023; 11:healthcare11101382. [PMID: 37239667 DOI: 10.3390/healthcare11101382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/01/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Despite the significant achievements of current healthcare systems (CHCSs) in curing or treating several acute conditions, there has been far less success coping with noncommunicable diseases (NCDs), which have complex roots and nonconventional transmission vectors. Owing to the impact of the invisible hyperendemic NCDs and the COVID-19 pandemic, the limitations of CHCSs have been exposed. In contrast, the advent of omics-based technologies and big data science has raised global hope of curing or treating NCDs and improving overall healthcare outcomes. However, challenges related to their use and effectiveness must be addressed. Additionally, while such advancements intend to improve quality of life, they can also contribute the ever-increasing health disparity among vulnerable populations, such as low/middle-income populations, poorly educated people, gender-based violence victims, and minority and indigenous peoples, to name a few. Among five health determinants, the contribution of medical care to individual health does not exceed 11%. Therefore, it is time to implement a new well-being-oriented system complementary or parallel to CHCSs that incorporates all five health determinants to tackle NCDs and unforeseen diseases of the future, as well as to promote cost-effective, accessible, and sustainable healthy lifestyle choices that can reduce the current level of healthcare inequity.
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Affiliation(s)
- Abdelbaset Buhmeida
- Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Mourad Assidi
- Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Bruce Budowle
- Department of Forensic Medicine, University of Helsinki, Universitetsgatan 2, 00100 Helsinki, Finland
- Forensic Science Institute, Radford University, Radford, 24142 VA, USA
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50
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Macassa G, McGrath C, Wijk K, Rashid M, Hiswåls AS, Soares J. The Association between Fear of Crime, Educational Attainment, and Health. EPIDEMIOLOGIA 2023; 4:148-162. [PMID: 37218875 DOI: 10.3390/epidemiologia4020016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/11/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
Fear of crime is an important public health problem that impacts people's quality of life, health, and wellbeing, and causes mental health ailments (e.g., anxiety). This study aimed to determine whether there was an association between fear of crime, educational attainment, and self-rated health and anxiety among women residing in a county in east-central Sweden. A sample (n = 3002) of women aged 18-84 years surveyed in the Health on Equal Terms survey carried out in 2018 was included in the study. Bivariate and multivariate regression analysis was performed on the relationship between the composite variables fear of crime, educational attainment, and self-rated health and anxiety. Women with primary education or similar who reported fear of crime had increased odds of poor health (odds ratio (OR) 3.17; 95% confidence interval (CI) 2.40-4.18) compared with women with primary education/similar and no fear of crime (OR 2.90; CI 1.90-3.20). A statistically significant relationship persisted in the multivariate analysis after controlling for other covariates, although the odds were reduced (OR 1.70; CI 1.14-2.53 and 1.73; CI 1.21-2.48, respectively). Similarly, in the bivariate analysis, women who reported fear of crime and who only had primary education had statistically significant odds of anxiety (OR 2.12; CI 1.64-2.74); the significance was removed, and the odds were reduced (OR 1.30; CI 0.93-1.82) after adjusting for demographic, socioeconomic, and health-related covariates. Women with only primary education or similar who reported fear of crime had higher odds of poor health and anxiety compared with those with university education or similar, with and without fear of crime. Future studies (including longitudinal ones) are warranted-on the one hand, to understand possible mechanisms of the relationship between educational attainment and fear of crime and its consequences to health, and on the other, to explore low-educated women's own perceptions regarding factors underlining their fear of crime (qualitative studies).
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Affiliation(s)
- Gloria Macassa
- Department of Public Health and Sports Science, Faculty of Occupational and Health Sciences, University of Gävle, 80176 Gävle, Sweden
- EPI Unit-Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
| | - Cormac McGrath
- Department of Education, Stockholm University, 10691 Stockholm, Sweden
| | - Katarina Wijk
- Centre for Research and Development, Uppsala University, 80187 Gävle, Sweden
- Department of Occupational Health Sciences and Psychology, University of Gävle, 80176 Gävle, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, 75123 Uppsala, Sweden
| | - Mamunur Rashid
- Department of Public Health and Sports Science, Faculty of Occupational and Health Sciences, University of Gävle, 80176 Gävle, Sweden
| | - Anne-Sofie Hiswåls
- Department of Public Health and Sports Science, Faculty of Occupational and Health Sciences, University of Gävle, 80176 Gävle, Sweden
| | - Joaquim Soares
- Department of Health Sciences, Mid-Sweden University, 85170 Sundsvall, Sweden
- Department of Psychology, Universidade Europeia, 1500-210 Lisbon, Portugal
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