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Peprah P, Lloyd J, Harris M. Responding to health literacy of refugees in Australian primary health care settings: a qualitative study of barriers and potential solutions. BMC Health Serv Res 2024; 24:757. [PMID: 38907354 PMCID: PMC11193211 DOI: 10.1186/s12913-024-11192-9] [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: 11/24/2023] [Accepted: 06/11/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Organisational health literacy is a promising area of research that enables a focus on how systems and services can be designed in ways that are responsive to populations with varying states and levels of health literacy, knowledge, and practices, including African refugees. The challenge is how organisations and professionals do this in practice, and research in this area is in its early stages. This qualitative study examined barriers to implementing health literacy responsive care practices in primary health care settings in Australia. It also offered suggestions to potentially address the barriers to improving organisational health literacy. METHODS Refugees (n = 19), primary health care professionals (n = 14), and other key stakeholders (n = 19) were recruited through convenience and snowball strategies from three states in Australia: New South Wales, Victoria, and Queensland. All but one participant was interviewed face-to-face via Zoom. Semi-structured interview guides were used to guide the conversations. Transcriptions from audio recordings were analysed using directed content analysis. RESULTS Thirteen themes were extracted from the data. Themes were organised into the following categories: structural and systemic, organisational context, individual professional level, individual patient level, and socio-community level. Major structural and system-level factors affecting organisational health literacy included rigid systems and structures and limited time. Key organisation-level factors included inflexible organisational processes and policies, institutionalised othering, discrimination and racism, and lack of interpreters. Individual professional factors were poor communication with patients and cultural knowledge gaps. Linguistic issues and service mistrust were key individual patient-level factors. Socio-community factors included limited community engagement. Participants identified potential solutions to help services navigate out of the barriers and improve their response to health literacy. CONCLUSION The findings suggest that mainstream services and organisations could improve timely and appropriate health care access and utilisation for refugees through strategies such as designing services and health literacy programs with refugee communities, promoting health literacy champions in the workforce, integrating health literacy and culturally responsive care plans and strategies into organisational priorities.
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Affiliation(s)
- Prince Peprah
- Social Policy Research Centre, University of New South Wales, Sydney, NSW, 2052, Australia.
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Jane Lloyd
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2052, Australia
- Australia's National Research Organisation for Women's Safety, Sydney, NSW, 1230, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2052, Australia
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Robles G, Lee JJ, Yu M, Starks TJ. Multilevel Analysis of Sociopolitical Contexts, Social Support, Mental Health, and Alcohol Use Among Partnered Sexual Minority Latino Men in the U.S. J Racial Ethn Health Disparities 2024; 11:1618-1627. [PMID: 37222939 DOI: 10.1007/s40615-023-01637-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: 07/08/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The objective of this paper is to examine how state-level characteristics relate to social support and mental health outcomes among Latino sexual minority men in the U.S. METHODS Multilevel linear regression analyses were used to estimate the effect of social support and contextual-level characteristics on mental health and alcohol use among Latino sexual minority men (n = 612). Individual-level data were collected via a national, online survey between November 2018 and May 2019. State-level data were drawn from the 2019 American Community Survey and the Human Rights Campaign's 2018 State Equality Index score cards. RESULTS The interaction between friend support and supportive LGBTQ+ policies was associated with anxiety (B = 1.77; 95% CI 0.69, 2.85; p = 0.001) and depression (B = 2.25; 95% CI 0.99, 3.50; p<0.001). The interaction between friend support and Latino population size was associated with greater problematic alcohol use (B = 0.06; 95% CI 0.03, 0.10; p<0.001). The interaction between partner support and supportive LGBTQ+ policies were also associated problematic drinking (B = -1.72; 95% CI -3.05, -0.38; p<0.012). CONCLUSIONS Contextual factors can affect the everyday experiences of Latino sexual minority men. The effect of social support on mental health outcomes may depend on state-level factors. Public health efforts that seek to address the mental health and problematic drinking behaviors of Latino sexual minority men must consider the impact of macro-level policies on program and intervention development.
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Affiliation(s)
- Gabriel Robles
- School of Social Work, Rutgers University, New Brunswick, NJ, USA.
| | - Jane J Lee
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Melanie Yu
- School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
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Hendriks JRH, Baker RJ, de Groot TM, Lans A, Waryasz GR, Kerkhoffs GMMJ, Ashkani-Esfahani S, DiGiovanni CW, Guss D. The Influence of Patient Characteristics and Social Determinants of Health on Postoperative Complications Following Achilles Tendon Rupture. Foot Ankle Int 2024:10711007241250021. [PMID: 38798118 DOI: 10.1177/10711007241250021] [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] [Indexed: 05/29/2024]
Abstract
BACKGROUND The influence of social determinants of health (SDH) on postoperative complications has been investigated in several studies, although correlation with Achilles tendon rupture (ATR) repair remains uninvestigated. SDH encompasses several factors, including insurance status and area-based measurements, including the Area Deprivation Index (ADI) and Social Vulnerability Index (SVI), which ranks neighborhoods by social disadvantage. This study investigated the correlation between patient demographics, SDH, and complications following ATR repair. METHODS A retrospective cohort study was conducted on 521 patients who presented with acute ATR and met the inclusion criteria, including age ≥18 years, a minimum of 30-day follow-up, and repair within 28 days of rupture. We reviewed patient demographics, time to surgery (TTS), and postoperative complications, including venous thromboembolism (VTE), rerupture, surgical site infection (SSI), wound dehiscence, and sural nerve injury. SDH variables included race, smoking status, insurance status, level of education, ADI, and SVI. Univariate regression tested the correlation between complications and SDH indicators. Significant variables (P < .05) were included in a multivariate regression. RESULTS Sixty-eight complications occurred in 59 patients (11.3%). Multivariate regression showed that a higher ADI, that is, socially deprived individuals, was associated with lower rates of VTE (OR = 0.41, P = .04). Higher body mass index (BMI) was associated with rerupture (OR = 8.73, P < .01). Male patients had lower rates of wound dehiscence (OR = 0.31, P = .03) and VTE (OR = 0.32, P = .02) compared with women. Longer TTS correlated with sural nerve injuries (OR = 2.23, P < .01) and shorter TTS with reruptures (OR = 0.02, P = .02). CONCLUSION Some measures of SDH were associated with postoperative complications. Gender also may have an effect, with male sex associated with lower rates of wound dehiscence and VTE. BMI was associated with higher rates of reruptures and overall general complications. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Joris R H Hendriks
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Riley J Baker
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Tom M de Groot
- Department of Orthopaedic Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Amanda Lans
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory R Waryasz
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Foot and Ankle Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Newton-Wellesley Hospital, Boston, MA, USA
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Sports, Musculoskeletal Health, Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, the Netherlands
| | - Soheil Ashkani-Esfahani
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Foot and Ankle Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Newton-Wellesley Hospital, Boston, MA, USA
| | - Christopher W DiGiovanni
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Foot and Ankle Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Newton-Wellesley Hospital, Boston, MA, USA
| | - Daniel Guss
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Foot and Ankle Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Newton-Wellesley Hospital, Boston, MA, USA
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Fang Z, Lin Y, Chen C, Jiang J, Dong L. Mental health in China: exploring the impacts of built environment, work environment, and subjective perception. Front Psychol 2024; 15:1352609. [PMID: 38455120 PMCID: PMC10918749 DOI: 10.3389/fpsyg.2024.1352609] [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: 12/08/2023] [Accepted: 02/08/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction The shifting living and working conditions have profound impacts on the residents' mental health. However, current research in this field has not remarkable investigated. Methods This study used the China Labor-force Dynamic Survey (CLDS) dataset from 2018 and relied on a regression model to examine the effects of the built environment, work environment, and subjective perception on the mental health of Chinese citizens. It also considers the circumstances of both migrants and local residents. Results This study revealed significant correlations between mental health and greening space rate, road network density, commuting time, work feelings, community trust, economic satisfaction, and other factors. Additionally, the mental health of local residents was shown to be significantly affected by community security, while it shows no significance in migrants. Furthermore, a significant spatial autocorrelation was found in terms of mental health within the central and eastern regions of China. Discussion The findings of this study offer valuable insights that can be used to facilitate measures aimed at improving the mental health of residents and promoting the development of healthy cities.
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Affiliation(s)
- Zhou Fang
- Guangzhou Transport Planning Research Institute Co., Ltd., Guangzhou, China
| | - Yu Lin
- School of Architecture and Urban Planning, Guangdong University of Technology, Guangzhou, Guangdong, China
| | - Chuangyuan Chen
- School of Architecture and Urban Planning, Guangdong University of Technology, Guangzhou, Guangdong, China
| | - Jian Jiang
- School of Architecture and Urban Planning, Guangdong University of Technology, Guangzhou, Guangdong, China
| | - Letian Dong
- School of Architecture and Urban Planning, Guangdong University of Technology, Guangzhou, Guangdong, China
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Forcadell-Díez L, Juárez Martínez O, Abiétar DG, López MJ, Sánchez-Martínez F, Perez G. Healthy and Equitable Interpersonal Relationships, Health Inequalities and Socio-Educational Interventions: A Conceptual Framework for Action. THE JOURNAL OF SCHOOL HEALTH 2023; 93:521-532. [PMID: 36917972 DOI: 10.1111/josh.13318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Interpersonal relationships undoubtedly have a bidirectional connection with the health of individuals and communities. Relational models based on equity contribute to well-being, while asymmetrical relationships based on hierarchies and differences of power negatively impact mental, physical, and social health. METHODS A conceptual framework for understanding the determinants of interpersonal relational models was developed. RESULTS Structural determinants were identified as the combined action of systems of oppression, the socio-historical context that normalizes violence, and social stratification and segregation, consequences which included inequitable access to power, resources, and opportunities. Intermediate determinants include individual, psychosocial, behavioral, and community aspects. Structural and intermediate determinants impact health and health inequalities through multiple relational patterns that are simultaneously established and sustained by individuals and communities. The health impact of inequitable relational patterns includes: Reduced self-esteem; anxiety, stress, and depression; acceptance of violence; physical and sexual harm; suicide; and murder. CONCLUSIONS This conceptual framework allows for the modification of relational models by influencing structural and intermediate determinants. Six areas of intervention have been identified: educative policies, school governance, physical and symbolic space, school curriculum, school-community relations, and socio-educative interventions to promote healthy and equitable relationships. Healthy and equitable relationships are associated with improved subjective well-being, health status and protection from violence. Socio-educational interventions that consider the elements of this conceptual framework may be effective in promoting healthy and equitable relational models.
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Affiliation(s)
- Lluís Forcadell-Díez
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Associate Professor, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Daniel G Abiétar
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Associate Professor, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - María José López
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Associate Professor, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Researcher in CIBER de Epidemiología y Salud Pública, Madrid, Spain; Researcher in Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Francesca Sánchez-Martínez
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Researcher in Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Gloria Perez
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Associate Professor, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Researcher in CIBER de Epidemiología y Salud Pública, Madrid, Spain; Researcher in Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
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De Anda-Duran I, Woltz SG, Bell CN, Bazzano LA. Hypertension and cognitive function: a review of life-course factors and disparities. Curr Opin Cardiol 2022; 37:326-333. [PMID: 35731677 PMCID: PMC9354652 DOI: 10.1097/hco.0000000000000975] [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] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Dementia is a life-course condition with modifiable risk factors many from cardiovascular (CV) origin, and disproportionally affects some race/ethnic groups and underserved communities in the USA. Hypertension (HTN) is the most common preventable and treatable condition that increases the risk for dementia and exacerbates dementia pathology. Epidemiological studies beginning in midlife provide strong evidence for this association. This study provides an overview of the differences in the associations across the lifespan, and the role of social determinants of health (SDoH). RECENT FINDINGS Clinical trials support HTN management in midlife as an avenue to lower the risk for late-life cognitive decline. However, the association between HTN and cognition differs over the life course. SDoH including higher education modify the association between HTN and cognition which may differ by race and ethnicity. The role of blood pressure (BP) variability, interactions among CV risk factors, and cognitive assessment modalities may provide information to better understand the relationship between HTN and cognition. SUMMARY Adopting a life-course approach that considers SDoH, may help develop tailored interventions to manage HTN and prevent dementia syndromes. Where clinical trials to assess BP management from childhood to late-life are not feasible, observational studies remain the best available evidence.
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Affiliation(s)
- Ileana De Anda-Duran
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Sara G. Woltz
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Caryn N. Bell
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Lydia A. Bazzano
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
- Tulane University School of Medicine, New Orleans, LA
- Ochsner Clinic Foundation, New Orleans, LA
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Villanueva K, Alderton A, Higgs C, Badland H, Goldfeld S. Data to Decisions: Methods to Create Neighbourhood Built Environment Indicators Relevant for Early Childhood Development. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095549. [PMID: 35564944 PMCID: PMC9102076 DOI: 10.3390/ijerph19095549] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/07/2022] [Accepted: 04/29/2022] [Indexed: 02/01/2023]
Abstract
Healthy development in the early years lays the foundations for children’s ongoing physical, emotional, and social development. Children develop in multiple contexts, including their local neighbourhood. Neighbourhood-built environment characteristics, such as housing, walkability, traffic exposure, availability of services, facilities, and parks, are associated with a range of health and wellbeing outcomes across the life course, but evidence with early years’ outcomes is still emerging. Data linkage techniques were used to assemble a dataset of spatial (objectively-measured) neighbourhood-built environment (BE) measures linked to participant addresses in the 2015 Australian Early Development Census (AEDC) for children living in the 21 most populous urban and regional Australian cities (n = 235,655) to help address this gap. This paper describes the methods used to develop this dataset. This linked dataset (AEDC-BE) is the first of its kind worldwide, enabling opportunities for identifying which features of the built environment are associated with ECD across Australia at scale, allow comparisons between diverse contexts, and the identification of where best to intervene. National data coverage provides statistical power to model real-world complexities, such as differences by city, state/territory, and remoteness. The neighbourhood-built environment can be modified by policy and practice at scale, and has been identified as a way to help reduce inequitable early childhood development outcomes.
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Affiliation(s)
- Karen Villanueva
- Centre for Urban Research, Royal Melbourne Institute of Technology (RMIT) University, Melbourne, VIC 3000, Australia; (A.A.); (C.H.); (H.B.)
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
- Correspondence: or
| | - Amanda Alderton
- Centre for Urban Research, Royal Melbourne Institute of Technology (RMIT) University, Melbourne, VIC 3000, Australia; (A.A.); (C.H.); (H.B.)
| | - Carl Higgs
- Centre for Urban Research, Royal Melbourne Institute of Technology (RMIT) University, Melbourne, VIC 3000, Australia; (A.A.); (C.H.); (H.B.)
| | - Hannah Badland
- Centre for Urban Research, Royal Melbourne Institute of Technology (RMIT) University, Melbourne, VIC 3000, Australia; (A.A.); (C.H.); (H.B.)
| | - Sharon Goldfeld
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
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Brownson RC, Shelton RC, Geng EH, Glasgow RE. Revisiting concepts of evidence in implementation science. Implement Sci 2022; 17:26. [PMID: 35413917 PMCID: PMC9004065 DOI: 10.1186/s13012-022-01201-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 04/04/2022] [Indexed: 11/20/2022] Open
Abstract
Background Evidence, in multiple forms, is a foundation of implementation science. For public health and clinical practice, evidence includes the following: type 1 evidence on etiology and burden; type 2 evidence on effectiveness of interventions; and type 3: evidence on dissemination and implementation (D&I) within context. To support a vision for development and use of evidence in D&I science that is more comprehensive and equitable (particularly for type 3 evidence), this article aims to clarify concepts of evidence, summarize ongoing debates about evidence, and provide a set of recommendations and tools/resources for addressing the “how-to” in filling evidence gaps most critical to advancing implementation science. Main text Because current conceptualizations of evidence have been relatively narrow and insufficiently characterized in our opinion, we identify and discuss challenges and debates about the uses, usefulness, and gaps in evidence for implementation science. A set of questions is proposed to assist in determining when evidence is sufficient for dissemination and implementation. Intersecting gaps include the need to (1) reconsider how the evidence base is determined, (2) improve understanding of contextual effects on implementation, (3) sharpen the focus on health equity in how we approach and build the evidence-base, (4) conduct more policy implementation research and evaluation, and (5) learn from audience and stakeholder perspectives. We offer 15 recommendations to assist in filling these gaps and describe a set of tools for enhancing the evidence most needed in implementation science. Conclusions To address our recommendations, we see capacity as a necessary ingredient to shift the field’s approach to evidence. Capacity includes the “push” for implementation science where researchers are trained to develop and evaluate evidence which should be useful and feasible for implementers and reflect community or stakeholder priorities. Equally important, there has been inadequate training and too little emphasis on the “pull” for implementation science (e.g., training implementers, practice-based research). We suggest that funders and reviewers of research should adopt and support a more robust definition of evidence. By critically examining the evolving nature of evidence, implementation science can better fulfill its vision of facilitating widespread and equitable adoption, delivery, and sustainment of scientific advances.
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Laymon BP, Chudgar R, Huang T, Kulkarni M, Holtgrave PL, Gore K. Partnering on the Social Determinants of Health With the Community Health Improvement Matrix. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:459-463. [PMID: 32890253 DOI: 10.1097/phh.0000000000001245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The research goal was to describe local health department community health improvement plans and hospital implementation strategies, assessing the extent to which they address the social determinants of health. In 2014, we used a grounded theory approach to conceptualize the extent of social determinant efforts in a purposive sample of improvement plans and implementation strategies (N = 12) taken from the community health assessment database pilot project (N = 502). We developed the Community Health Improvement Matrix (CHIM), categorizing public health activities according to target and prevention levels. In 2016, we surveyed NACCHO's Performance Improvement Workgroup (N = 9) using CHIM categories. In 2017, we tested the interrater reliability of the CHIM through an analysis of stories in 30 states (N = 101). We shared the CHIM in conferences, trainings, and focused conversations. The CHIM provides a framework for local public health partners to work together to address social determinants.
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Affiliation(s)
- Barbara P Laymon
- Public Health Infrastructure and Systems Team, National Association of County and City Health Officials, Washington, District of Columbia
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Abstract
Metrics are an important part of the assessment of public health. They include traditional measures of mortality and newly described summary measures to describe the disability engendered by diseases. Epidemiology has transformed the understanding of risk factors for disease; however, a holistic approach includes recognition of social determinants and the neighborhood and communities where the people most at risk reside.
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Siddiqi A, Jones MK, Bruce DJ, Erwin PC. Do racial inequities in infant mortality correspond to variations in societal conditions? A study of state-level income inequality in the U.S., 1992-2007. Soc Sci Med 2016; 164:49-58. [PMID: 27471130 DOI: 10.1016/j.socscimed.2016.07.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 07/11/2016] [Accepted: 07/15/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prior studies have examined the association between income inequality and overall infant mortality rates (IMR). We examine effects of income inequality on racial inequities in IMR over the period 1992-2007 in the U.S. METHODS Race-specific state IMR data were obtained from 1992 to 2007, from which absolute and relative IMR inequities were calculated. Fixed and random effects models, adjusted for state-level median income, percent poverty, percent high school graduates, and unemployment rate, were used to determine contemporaneous and lagged state-level associations between income inequality and racial IMR inequities. RESULTS Racial IMR inequities varied significantly across the U.S. Contemporaneous income inequality was negatively associated with white IMR only. Two-year lagged income inequality was negatively associated with black IMR and had the most pronounced effect on racial inequities in IMR. DISCUSSION Future studies should consider lagged effects of income inequality on IMR and other health outcomes, and should examine other potential societal conditions that may account for state-level variations in racial IMR inequities.
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Affiliation(s)
- Arjumand Siddiqi
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Canada; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | | | - Donald J Bruce
- Department of Economics, University of Tennessee Knoxville, USA
| | - Paul C Erwin
- Department of Public Health, College of Education, Health, and Human Sciences, University of Tennessee Knoxville, USA
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Nay O, Béjean S, Benamouzig D, Bergeron H, Castel P, Ventelou B. Achieving universal health coverage in France: policy reforms and the challenge of inequalities. Lancet 2016; 387:2236-49. [PMID: 27145707 DOI: 10.1016/s0140-6736(16)00580-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Since 1945, the provision of health care in France has been grounded in a social conception promoting universalism and equality. The French health-care system is based on compulsory social insurance funded by social contributions, co-administered by workers' and employers' organisations under State control and driven by highly redistributive financial transfers. This system is described frequently as the French model. In this paper, the first in The Lancet's Series on France, we challenge conventional wisdom about health care in France. First, we focus on policy and institutional transformations that have affected deeply the governance of health care over past decades. We argue that the health system rests on a diversity of institutions, policy mechanisms, and health actors, while its governance has been marked by the reinforcement of national regulation under the aegis of the State. Second, we suggest the redistributive mechanisms of the health insurance system are impeded by social inequalities in health, which remain major hindrances to achieving objectives of justice and solidarity associated with the conception of health care in France.
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Affiliation(s)
- Olivier Nay
- University of Paris 1 Panthéon-Sorbonne, Paris, France.
| | | | - Daniel Benamouzig
- Centre National de la Recherche Scientifique (CNRS), Paris, France; Sciences Po, Paris, France
| | - Henri Bergeron
- Centre National de la Recherche Scientifique (CNRS), Paris, France; Sciences Po, Paris, France
| | | | - Bruno Ventelou
- Aix-Marseille University, School of Economics, Marseille, France; Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
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Santos Salas A, Fuentes Contreras J, Armijo-Olivo S, Saltaji H, Watanabe S, Chambers T, Walter L, Cummings GG. Non-pharmacological cancer pain interventions in populations with social disparities: a systematic review and meta-analysis. SUPPORTIVE CARE IN CANCER : OFFICIAL JOURNAL OF THE MULTINATIONAL ASSOCIATION OF SUPPORTIVE CARE IN CANCER 2015. [PMID: 26556211 DOI: 10.1007/s00520‐015‐2998‐9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Global advances in pain relief have improved the quality of life of cancer populations. Yet, variation in cancer pain outcomes has been found in populations with social disparities compared to mainstream groups. Populations with social disparities bear an inequitable distribution of resources such as ethnic minorities, low income individuals, and women in vulnerable circumstances. RESEARCH PURPOSE A systematic review and meta-analysis of the effect of non-pharmacological cancer pain interventions in cancer populations with social disparities of income, ethnicity, or gender. METHODS Randomized controlled trials, controlled trials, and before and after studies were targeted through comprehensive multidatabase searches. Two reviewers independently screened titles/abstracts for potentially relevant studies and reviewed the full text of relevant articles for inclusion. Data were extracted from included studies by one reviewer and verified by another reviewer. Four reviewers independently completed quality assessment. Studies were grouped by intervention. Effects were evaluated for heterogeneity and pooled. RESULTS The search found 5219 potential records. Full text of 26 reports was evaluated. Three randomized controlled trials (RCTs) met inclusion criteria, targeting ethnic minorities and underserved populations and/or women. Interventions included education, coaching, and online support groups. Studies found no significant differences in pain reduction between intervention and control groups or between ethnic minorities and their counterparts. A high risk of bias was found in all studies. Meta-analysis found no statistically significant difference on pain intensity among underserved groups, ethnic minorities, or between ethnic minorities and white counterparts. CONCLUSION Results show the need to examine supportive care interventions particularly in populations with social disparities.
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Affiliation(s)
- Anna Santos Salas
- Faculty of Nursing University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada.
| | - Jorge Fuentes Contreras
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Católica del Maule, Avda. San Miguel 3605, Talca, Chile
| | - Susan Armijo-Olivo
- Research Centre Faculty of Rehabilitation Medicine, 3-62 Corbett Hall, University of Alberta, 8205 114 Street, Edmonton, AB, T6G 2G4, Canada
| | - Humam Saltaji
- School of Dentistry, University of Alberta, 5-476 Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Sharon Watanabe
- Department of Symptom Control and Palliative Care, Cross Cancer Institute and Division of Palliative Care Medicine, Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Room 2001, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Thane Chambers
- John W. Scott Health Sciences Library, University of Alberta Libraries, Edmonton, AB, T6G 2R7, Canada
| | - Lori Walter
- UBC Okanagan Library, The University of British Columbia, Okanagan Campus, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| | - Greta G Cummings
- Faculty of Nursing University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
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Santos Salas A, Fuentes Contreras J, Armijo-Olivo S, Saltaji H, Watanabe S, Chambers T, Walter L, Cummings GG. Non-pharmacological cancer pain interventions in populations with social disparities: a systematic review and meta-analysis. Support Care Cancer 2015; 24:985-1000. [PMID: 26556211 DOI: 10.1007/s00520-015-2998-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 10/26/2015] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Global advances in pain relief have improved the quality of life of cancer populations. Yet, variation in cancer pain outcomes has been found in populations with social disparities compared to mainstream groups. Populations with social disparities bear an inequitable distribution of resources such as ethnic minorities, low income individuals, and women in vulnerable circumstances. RESEARCH PURPOSE A systematic review and meta-analysis of the effect of non-pharmacological cancer pain interventions in cancer populations with social disparities of income, ethnicity, or gender. METHODS Randomized controlled trials, controlled trials, and before and after studies were targeted through comprehensive multidatabase searches. Two reviewers independently screened titles/abstracts for potentially relevant studies and reviewed the full text of relevant articles for inclusion. Data were extracted from included studies by one reviewer and verified by another reviewer. Four reviewers independently completed quality assessment. Studies were grouped by intervention. Effects were evaluated for heterogeneity and pooled. RESULTS The search found 5219 potential records. Full text of 26 reports was evaluated. Three randomized controlled trials (RCTs) met inclusion criteria, targeting ethnic minorities and underserved populations and/or women. Interventions included education, coaching, and online support groups. Studies found no significant differences in pain reduction between intervention and control groups or between ethnic minorities and their counterparts. A high risk of bias was found in all studies. Meta-analysis found no statistically significant difference on pain intensity among underserved groups, ethnic minorities, or between ethnic minorities and white counterparts. CONCLUSION Results show the need to examine supportive care interventions particularly in populations with social disparities.
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Affiliation(s)
- Anna Santos Salas
- Faculty of Nursing University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada.
| | - Jorge Fuentes Contreras
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Católica del Maule, Avda. San Miguel 3605, Talca, Chile
| | - Susan Armijo-Olivo
- Research Centre Faculty of Rehabilitation Medicine, 3-62 Corbett Hall, University of Alberta, 8205 114 Street, Edmonton, AB, T6G 2G4, Canada
| | - Humam Saltaji
- School of Dentistry, University of Alberta, 5-476 Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Sharon Watanabe
- Department of Symptom Control and Palliative Care, Cross Cancer Institute and Division of Palliative Care Medicine, Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Room 2001, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Thane Chambers
- John W. Scott Health Sciences Library, University of Alberta Libraries, Edmonton, AB, T6G 2R7, Canada
| | - Lori Walter
- UBC Okanagan Library, The University of British Columbia, Okanagan Campus, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| | - Greta G Cummings
- Faculty of Nursing University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
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Kaplan RM, Howard VJ, Safford MM, Howard G. Educational attainment and longevity: results from the REGARDS U.S. national cohort study of blacks and whites. Ann Epidemiol 2015; 25:323-8. [PMID: 25791026 PMCID: PMC4631606 DOI: 10.1016/j.annepidem.2015.01.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 01/07/2015] [Accepted: 01/29/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Educational attainment may be an important determinant of life expectancy. However, few studies have prospectively evaluated the relationship between educational attainment and life expectancy using adjustments for other social, behavioral, and biological factors. METHOD The data were from the REasons for Geographic and Racial Differences in Stroke study that enrolled 30,239 black and white adults (≥45 years) between 2003 and 2007. Demographic and cardiovascular risk information was collected and participants were followed for health outcomes. Educational attainment was categorized as less than high school education, high school graduate, some college, or college graduate. Proportional hazards analysis was used to characterize survival by level of education. RESULTS Educational attainment and follow-up data were available on 29,657 (98%) of the participants. Over 6.3 years of follow-up, 3673 participants died. There was a monotonically increasing risk of death with lower levels of educational attainment. The same monotonic relationship held with adjustments for age, race, sex, cardiovascular risk factors, and health behaviors. The unadjusted hazard ratio for those without a high school education in comparison with college graduates was 2.89 (95% CI = 2.64-3.18). Although adjustment for income, health behaviors, and cardiovascular risk factors attenuated the relationship, the same consistent pattern was observed after adjustment. The relationship between educational attainment and longevity was similar for black and white participants. The monotonic relationship between educational attainment and longevity was observed for all age groups, except for those aged 85 years or more. CONCLUSIONS Educational attainment is a significant predictor of longevity. Other factors including age, race, income, health behaviors, and cardiovascular risk factors only partially explain the relationship.
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Affiliation(s)
- Robert M Kaplan
- Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD.
| | - Virginia J Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Monika M Safford
- Department of Medicine, University of Alabama Birmingham, Birmingham, AL
| | - George Howard
- Department of Biostatistics, University of Alabama Birmingham, Birmingham, AL
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Zaboli R, Seyedin SH, Malmoon Z. Macroeconomic policies and increasing social-health inequality in Iran. Int J Health Policy Manag 2014; 3:129-34. [PMID: 25197677 PMCID: PMC4154550 DOI: 10.15171/ijhpm.2014.70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 07/19/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Health is a complex phenomenon that can be studied from different approaches. Despite a growing research in the areas of Social Determinants of Health (SDH) and health equity, effects of macroeconomic policies on the social aspect of health are unknown in developing countries. This study aimed to determine the effect of macroeconomic policies on increasing of the social-health inequality in Iran. METHODS This study was a mixed method research. The study population consisted of experts dealing with social determinants of health. A purposive, stratified and non-random sampling method was used. Semi-structured interviews were conducted to collect the data along with a multiple attribute decision-making method for the quantitative phase of the research in which the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) was employed for prioritization. The NVivo and MATLAB softwares were used for data analysis. RESULTS Seven main themes for the effect of macroeconomic policies on increasing the social-health inequality were identified. The result of TOPSIS approved that the inflation and economic instability exert the greatest impact on social-health inequality, with an index of 0.710 and the government policy in paying the subsidies with a 0.291 index has the lowest impact on social-health inequality in the country. DISCUSSION It is required to invest on the social determinants of health as a priority to reduce health inequality. Also, evaluating the extent to which the future macroeconomic policies impact the health of population is necessary.
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Affiliation(s)
- Rouhollah Zaboli
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyed Hesam Seyedin
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zainab Malmoon
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
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dos Santos Junior VE, de Sousa RMB, Oliveira MC, de Caldas Junior AF, Rosenblatt A. Early childhood caries and its relationship with perinatal, socioeconomic and nutritional risks: a cross-sectional study. BMC Oral Health 2014; 14:47. [PMID: 24885697 PMCID: PMC4019949 DOI: 10.1186/1472-6831-14-47] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 05/01/2014] [Indexed: 11/29/2022] Open
Abstract
Background Socioeconomic, perinatal and other life cycle events can be important determinants of the health status of the individual and populations. This study aimed to assess the prevalence of early childhood caries (ECC), perinatal factors (gestational age, teenage pregnancy and birth weight), family income and nutritional risk in children. Methods A cross-sectional study in which 320 children were examined according to the criteria established by the World Health Organization. A previously validated questionnaire was used to obtain information from parents and guardians about family income, gestational age and birth weight. To check the nutritional risk, we used the criteria provided by the CDC (Center for Disease Control). For Statistics, Pearson’s, chi-square and the multivariate Poisson analyses were used to determine the association among variables. Results Approximately 20% of children had ECC, and the Poisson multivariate analyses indicated that family income (p = 0.009), birth weight (p < 0.001) and infant obesity (p < 0.001) were related to the increase of ECC, and gestational age was not significantly associated with ECC (p = 0.149). Pregnancy in adolescence was not included in the regression analyses model because it was not statistically significant in the chi-square test (p > 0.05). Conclusion The prevalence of ECC was related to low family income, premature birth and infant obesity.
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