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Hengelaar AH, Verdonk P, van Hartingsveldt M, Abma T. A sense of injustice in care networks: An intersectional exploration of the collaboration between professionals and carers with a migration background. Soc Sci Med 2024; 356:117169. [PMID: 39096534 DOI: 10.1016/j.socscimed.2024.117169] [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: 11/01/2023] [Revised: 07/24/2024] [Accepted: 07/29/2024] [Indexed: 08/05/2024]
Abstract
This study tries to understand the power of knowledge within collaborative care networks to provide insights for designing successful collaboration within care networks by combining intersectionality and epistemic (in)justice. Becoming an informal carer for someone with an acquired brain injury (ABI) causes a dramatic disruption of daily life. Collaboration between professionals and carers with a migration background may result in unjust and unfair situations within care networks. Carer experiences are shaped by aspects of diversity which are subject to power structures and processes of social (in)justice in care networks. In this study, intersectionality was used to both generate complex in-depth insights into the different active layers of carer experiences and focus on within-group differences. Intersectionality was combined with the theoretical concept of epistemic (in)justice to unravel underlying dynamics in collaborative care networks contributing to the understanding that carers with a migration background are often not seen as 'knowers of reality.' This qualitative study conducted in the Netherlands between 2019 and 2022 incorporated three informal group conversations (N = 32), semi-structured interviews (N = 21), and three dialogue sessions (N = 7) with carers caring for someone with an ABI. A critical friend and a community of practice, with carers, professionals, and care recipients (N = 8), contributed to the analysis. Three interrelated themes were identified as constituting different layers of the carer experience: (a) I need to keep going, focusing on carers' personal experiences and how experiences were related to carers social positioning; (b) the struggle of caring together, showing how expectations of family members towards carers added to carer burden; and (c) trust is a balancing act, centering on how support from professionals shaped carers' experiences, in which trusting professionals' support proved challenging for carers, and how this trust was influenced by contextual factors at organizational and policy levels. Overall, the need for diversity-responsive policies within care organizations is apparent. Carers with a migration background need to feel heard so they can meaningfully tailor care to meet recipients' needs.
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Affiliation(s)
- Aldiene Henrieke Hengelaar
- Department Ethics, Law and Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUmc and Department of Occupational Therapy, Faculty of Health, Amsterdam University of Applied Science, Tafelbergweg 51, 1000CN Amsterdam, the Netherlands.
| | - Petra Verdonk
- Department Ethics, Law and Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUmc, de Boelelaan 1105, 1081 HV Amsterdam, the Netherlands.
| | - Margo van Hartingsveldt
- Department of Occupational Therapy, Faculty of Health, Amsterdam University of Applied Science, Tafelbergweg 51, 1000CN Amsterdam, the Netherlands.
| | - Tineke Abma
- Department Public Health and Primary Care, Leiden University Medical Centre, Leiden University and Leyden Academy on Vitality and Ageing, Rijnsburgerweg 10, 2333 AA Leiden, the Netherlands.
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Estupiñán Fdez de Mesa M, Marcu A, Ream E, Whitaker KL. Understanding and tackling cancer inequities: What opportunities does intersectionality offer researchers, policymakers, and providers? A scoping review. J Psychosoc Oncol 2024:1-28. [PMID: 39120128 DOI: 10.1080/07347332.2024.2361642] [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: 08/10/2024]
Abstract
PROBLEM IDENTIFICATION We summarised the international evidence relating to the role of intersectionality in patients' lived experience of inequities along the cancer care pathway. We produced guidance to use intersectionality in future research. LITERATURE SEARCH We included 42 articles published between 1989 to 2023 that used intersectionality to guide the study and interpretation of inequities in cancer care. DATA EVALUATION/SYNTHESIS Articles predominantly comprised North American (n = 37), followed by European (n = 4) and Asian (n = 1) studies. Similar compounding effects of racism, homophobia, and discrimination across countries exacerbated inequities in cancer care experience and cancer outcomes particularly for women of color and sexual/gender minority groups. Professionals' knowledge, attitudes, and behaviors toward minoritised groups affected patient-provider relationships and influenced cancer patients' psychosocial responses. CONCLUSION Intersectionality provides a framework to assess the personal, interpersonal, and structural processes through which cancer inequities manifest within and across countries.
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Affiliation(s)
| | - Afrodita Marcu
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Emma Ream
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
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Robles EH, Castro Y, Najera S, Cardoso J, Gonzales R, Mallonee J, Segovia J, Salazar-Hinojosa L, De Vargas C, Field C. Men of Mexican ethnicity, alcohol use, and help-seeking: "I can quit on my own.". JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209359. [PMID: 38677598 DOI: 10.1016/j.josat.2024.209359] [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: 08/21/2022] [Revised: 03/25/2024] [Accepted: 04/07/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Hispanics report higher rates of problematic alcohol use compared to non-Hispanic Whites while also reporting lower rates of alcohol treatment utilization compared to non-Hispanics. The study employs Anderson's Behavioral Model of Healthcare Utilization Model to guide the exploration of alcohol use, help-seeking and healthcare utilization. METHODS The present qualitative study explored help-seeking and alcohol treatment utilization for Hispanic men of Mexican ethnicity. A total of 27 participants (Mage = 35.7, SD = 10.82) completed a semi-structured interview that explored the treatment experiences and underlying psychological mechanisms that shaped their help-seeking. RESULTS Through a thematic content analysis, the following themes emerged: 1) perceiving need with subthemes of familismo, role as protector and provider, and positive face; 2) predisposing beliefs on help-seeking; and 3) treatment experiences and elements of patient satisfaction with subthemes of monetized treatment, respect, and perceiving professional stigma. CONCLUSIONS The findings in this article may assist in improving strategies for increasing alcohol treatment utilization among men of Mexican ethnicity. By exploring beliefs, values, and experiences health researchers can develop culturally informed intervention strategies.
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Affiliation(s)
- Eden Hernandez Robles
- Worden School of Social Service, Our Lady of the Lake University, United States of America.
| | - Yessenia Castro
- Steve Hicks School of Social Work, The University of Texas at Austin, United States of America
| | - Sarah Najera
- Department of Psychology, The University of Texas at El Paso, United States of America
| | - Juliana Cardoso
- Department of Psychology, Hastings College, United States of America
| | - Rubi Gonzales
- St. Louis School of Medicine, Washington University, United States of America
| | - Jason Mallonee
- Department of Social Work, The University of Texas at El Paso, United States of America
| | - Javier Segovia
- Worden School of Social Service, Our Lady of the Lake University, United States of America
| | | | - Cecilia De Vargas
- Department of Psychiatry, Texas Tech University Health Sciences Center El Paso, United States of America
| | - Craig Field
- Department of Psychology, The University of Texas at El Paso, United States of America
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O'Donnell S, Scott-Storey K, Malcolm J, Vincent CD, Wuest J. Cumulative lifetime violence, social determinants of health, and cannabis use disorder post-cannabis legalization in a community sample of men: An intersectional perspective. Res Nurs Health 2024; 47:460-474. [PMID: 38722053 DOI: 10.1002/nur.22389] [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: 10/30/2023] [Revised: 01/30/2024] [Accepted: 04/27/2024] [Indexed: 07/11/2024]
Abstract
Despite Canada having the highest disease burden globally for cannabis use disorder (CUD) and violence being ubiquitous in men's lives, little is known about how intersections among social determinants of health (SDOH) and cumulative lifetime violence severity (CLVS) influence CUD in men post-cannabis legalization. Using data collected in a survey with a national community sample of 597 men who self-identified as having experienced violence, we conducted a latent profile analysis using 11 subscales of the CLVS-44 scale and explored differential associations between CLVS profiles and CUD considering SDOH covariates. Four profiles were distinguished by intersections among CLVS-44 subscale severity and roles as target and perpetrator. CLVS profiles were significantly associated with CUD in the unadjusted model and in the adjusted model where age, adverse housing, and education were significant covariate controls. In the adjusted model, CUD was differentially associated with CLVS profiles and significantly higher in Profile 4 (highest severity target and perpetrator) than in Profile 1 (lowest severity target, no perpetration). Chi-square tests showed significant intersection between adverse housing, younger age, Profile 4 CLVS, and moderate to severe CUD among cannabis users. These results reveal the importance of understanding simultaneous intersections among indicators of CLVS in determining profiles of lifetime violence. Also critical are intersections among CLVS profiles and significant covariates as a basis for trauma- and violence-informed care for CUD that prioritizes men most disadvantaged by this convergence and attends to individual and structural health disparities at practice and policy levels.
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Affiliation(s)
- Sue O'Donnell
- Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Kelly Scott-Storey
- Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Jeannie Malcolm
- Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Charlene D Vincent
- Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Judith Wuest
- Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada
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Ruvalcaba Y, Ruíz E, Berenstain N. A Study on Economic Stressors During the COVID-19 Pandemic Among Intimate Partner and Sexual Violence Survivors in the United States. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02090-1. [PMID: 38992204 DOI: 10.1007/s40615-024-02090-1] [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: 11/21/2023] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024]
Abstract
Systemic racism and racialized poverty are socially produced structural determinants that shape health outcomes during infectious disease outbreaks. Public health emergencies compound vulnerabilities for survivors of intimate partner violence (IPV) and sexual violence (SV) and those who self-identify as people from racial and ethnic minority groups. We describe findings from an online survey designed to collect data on financial conditions faced by survivors of IPV and SV to understand these conditions during the COVID-19 pandemic. Our analyses were limited to a sample of women in the United States (91.4%, n = 523) who reported IPV or SV to whom we refer as survivors. We characterize the differences of economic stressors across White and aggregated categories of self-identified race, i.e., Black and Brown Latinx women and non-Black or non-Brown Latinx women of color, to highlight disparities between White and non-White populations in our sample. Logistic regressions were used to examine the relationships among racial categories, food insecurity, housing insecurity, and economic insecurity during the COVID-19 pandemic. Black and Brown Latinx women survivors were twice as likely as White women to report housing, financial, and economic insecurity during the COVID-19 pandemic. Approximately one-third of all survivors anticipated taking on more debt than they would want to cover their expenses due to COVID-19. The results of this study have implications for public health responses that involve coordinating economic relief measures among populations disparately affected by public health crises and disasters to ensure that the economic needs of the most impacted are addressed.
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Affiliation(s)
- Yanet Ruvalcaba
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Elena Ruíz
- Research Institute for Structural Change, Michigan State University, 479 W. Circle Dr., East Lansing, MI, 48824, USA
| | - Nora Berenstain
- Department of Philosophy, The University of Tennessee, 801 McClung Tower, Knoxville, TN, 37996, USA
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Sexton MB, Cochran HM, Schubert JR, Gorin HM, Paulson JL, Boyd MR, Porter KE, Smith ER. Trauma-focused therapy retention among military sexual trauma survivors: relationship with veterans' sexual or gender minority identification. Cogn Behav Ther 2024; 53:351-363. [PMID: 38317621 DOI: 10.1080/16506073.2024.2313740] [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: 10/19/2022] [Accepted: 01/26/2024] [Indexed: 02/07/2024]
Abstract
Military servicemembers identifying as sexual and gender minorities (SGM) are at increased risk for military sexual trauma (MST) exposure and Post-traumatic Stress Disorder (PTSD). Although evidence-based treatments can reduce symptoms of PTSD, treatment attrition is concerning. Unfortunately, evaluations of such approaches with veterans identifying as SGM are currently restricted to case studies offering limited information regarding treatment completion. Both historic and current contextual factors related to military and mental health practices may uniquely influence minority veterans' treatment engagement in veteran healthcare settings. We explored associations between SGM identification and treatment of MST-focused therapy completion patterns (finishing the full protocol [FP] or receiving minimally adequate care [MAC; defined as attending eight or more sessions]). Veterans (N = 271, 12.5% SGM) enrolled in individual Prolonged Exposure or Cognitive Processing Therapies at a Midwestern veterans hospital system. Those identifying as SGM were more likely than non-identifying peers to complete FP treatment and, even when attrition occurred, they were retained longer. For MAC, the SGM group was as likely as non-SGM peers to be retained. This research suggests SGM veterans represent a notable minority of those seeking treatment in association with MST and do not appear at greater risk for discontinuation from trauma-focused treatment.
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Affiliation(s)
- Minden B Sexton
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Heather M Cochran
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jessica R Schubert
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Hillary M Gorin
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Julia L Paulson
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Psychology, University of Notre Dame, South Bend, IN, USA
| | - Meredith R Boyd
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Katherine E Porter
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Erin R Smith
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
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Saia T, Yaghmaian R, Cuesta R, Mueller C, Pebdani RN. A call to action for disability and rehabilitation research using a DisCrit and Disability Justice framework. Disabil Rehabil 2024; 46:3189-3195. [PMID: 37605564 DOI: 10.1080/09638288.2023.2242780] [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: 02/27/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Disability and ableism exist within a societal context that does not ignore the many facets of a person's identity, however often our disability research does not recognize how experiences vary based on the intersecting identities individuals hold. This article utilizes Intersectionality, Dis/ability Critical Race Studies (DisCrit), and Disability Justice to identify ways for rehabilitation researchers to adapt their research practices for maximum inclusivity and representation. MATERIALS AND METHODS Using these three frameworks, we have developed a call to action including recommendations for rehabilitation researchers to consider as they design and implement research projects. RESULTS Incorporating these frameworks provides an opportunity to reimagine current research practices. CONCLUSIONS An accessible approach can help researchers better understand and report on the nuances of intersecting identities on the lives of disabled people.
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Affiliation(s)
- Toni Saia
- San Diego State University, San Diego, CA, USA
| | | | | | | | - Roxanna N Pebdani
- Centre for Disability Research and Policy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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Turnbull M, Yu C, Tay D. "We Need to Go Back Home (to) the Philippines Healthy": An Interpretive Phenomenological Analysis of Migrant Domestic Workers' Experiences of Having Breast Cancer in Hong Kong. QUALITATIVE HEALTH RESEARCH 2024; 34:865-877. [PMID: 38311814 PMCID: PMC11323434 DOI: 10.1177/10497323241228789] [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] [Indexed: 02/06/2024]
Abstract
Diagnoses of breast cancer are continuing to increase in the Philippines, but little is known about incidence rates among the significant number of Filipino women working abroad as migrant domestic workers (MDWs). These women are often the main income providers for their families, and their ability to work depends upon their physical health and strength. In this article, we use interpretive phenomenological analysis to explore the experiences of 10 MDWs from the Philippines who were diagnosed with breast cancer during a period of employment in Hong Kong. Analysis of these narratives revealed numerous points at which their status as temporary, transnational migrant workers intersected with their experiences of breast cancer detection, diagnosis, and treatment. We argue that these women's experiences of breast cancer were shaped by the structures of migration that link the Philippines with host destinations like Hong Kong. These structures create a unique context in which these women had to constantly renegotiate their identities as migrants, financial providers, and breast cancer patients.
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Affiliation(s)
- Margo Turnbull
- Department of English and Communication, The Hong Kong Polytechnic University, Hong Kong, China
| | - Carol Yu
- Department of English and Communication, The Hong Kong Polytechnic University, Hong Kong, China
| | - Dennis Tay
- Department of English and Communication, The Hong Kong Polytechnic University, Hong Kong, China
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Hafleen N, D'Silva C, Mansfield E, Fierheller D, Chaze F, Parikh A, Martel S, Malhotra G, Mutta B, Hasan Z, Zenlea I. "I Am the Last Priority": Factors Influencing Diabetes Management Among South Asian Caregivers in Peel Region, Ontario. Can J Diabetes 2024; 48:312-321. [PMID: 38583768 DOI: 10.1016/j.jcjd.2024.03.006] [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: 04/24/2023] [Revised: 03/22/2024] [Accepted: 03/30/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE In this study, we aimed to identify sociocultural and systemic factors influencing diabetes management among South Asian (SA) caregivers in Peel Region, Ontario. METHODS Twenty-one semistructured interviews were conducted with SA caregivers using a qualitative descriptive design. Data were analyzed using thematic analysis and intersectionality analysis. RESULTS Themes identified included 1) prioritizing family caregiving over diabetes self-management; 2) labour market impacts on diabetes self-management; and 3) challenges navigating Canadian health and social service systems. SA caregivers described social, economic, and systemic challenges impacting type 2 diabetes management. Systemic factors influencing diabetes management included discrimination and inequities in labour policies and lack of social and health resources funding. Recommendations by caregivers included whole-family, community-based, culturally tailored approaches to diabetes prevention and management strategies. CONCLUSIONS Providing support with system navigation, encouraging family-based approaches, and addressing the social determinants of health could be beneficial for supporting SA families with diabetes management and prevention.
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Affiliation(s)
- Nuzha Hafleen
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Chelsea D'Silva
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Elizabeth Mansfield
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; Department of Occupational Health, University of Toronto, Toronto, Ontario, Canada
| | - Dianne Fierheller
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; School of Social Work, McMaster University, Hamilton, Ontario, Canada
| | - Ferzana Chaze
- Faculty of Applied Health and Community Studies, Sheridan College, Brampton, Ontario, Canada
| | - Amish Parikh
- Department of Medicine, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Sara Martel
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; Institute of Communication, Culture, Information, and Technology, University of Toronto Mississauga, Mississauga, Ontario, Canada
| | | | - Baldev Mutta
- Punjabi Community Health Services, Mississauga, Ontario, Canada
| | | | - Ian Zenlea
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Hempeler C, Schneider-Reuter L, Windel AS, Carlet J, Philipsen L, Juckel G, Gather J, Yeboah A, Faissner M. Intersectional Discrimination in Mental Health Care: A Systematic Review With Qualitative Evidence Synthesis. Psychiatr Serv 2024:appips20230252. [PMID: 38938095 DOI: 10.1176/appi.ps.20230252] [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: 06/29/2024]
Abstract
OBJECTIVE Discriminatory practices in mental health care undermine the right to health of marginalized service users. Intersectional approaches enable consideration of multiple forms of discrimination that occur simultaneously and remain invisible in single-axis analyses. The authors reviewed intersectionality-informed qualitative literature on discriminatory practices in mental health care to better understand the experiences of marginalized service users and their evaluation and navigation of mental health care. METHODS The authors searched EBSCO, PubMed, MEDLINE, and JSTOR for studies published January 1, 1989-December 14, 2022. Qualitative and mixed-methods studies were eligible if they used an intersectional approach to examine discrimination (experiences, mechanisms, and coping strategies) in mental health care settings from the perspective of service users and providers. A qualitative evidence synthesis with thematic analysis was performed. RESULTS Fifteen studies were included in the qualitative evidence synthesis. These studies represented the experiences of 383 service users and 114 providers. Most studies considered the intersections of mental illness with race, sexual and gender diversity, or both and were performed in the United States or Canada. Four themes were identified: the relevance of social identity in mental health care settings, knowledge-related concerns in mental health care, microaggressions in clinical practice, and service users' responses to discriminatory practices. CONCLUSIONS Discriminatory practices in mental health care lead to specific barriers to care for multiply marginalized service users. Universities and hospitals may improve care by building competencies in recognizing and preventing discrimination through institutionalized training.
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Affiliation(s)
- Christin Hempeler
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Lydia Schneider-Reuter
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Anne-Sophie Windel
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Jona Carlet
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Lea Philipsen
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Georg Juckel
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Jakov Gather
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Amma Yeboah
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Mirjam Faissner
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
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Lindsay S, Dain N. Applying an intersectional ecological framework to understand ableism and racism in employment among youth and young adults with disabilities. Disabil Rehabil 2024:1-14. [PMID: 38907587 DOI: 10.1080/09638288.2024.2363956] [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: 02/12/2024] [Accepted: 05/30/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE Youth with disabilities often face many barriers in finding employment. A knowledge gap exists surrounding the experiences of racially minoritized youth with disabilities who arguably encounter multiple and complex forms of discrimination. The purpose of this study was to understand the experiences of ableism and racism in employment among racially minoritized youth and young adults with non-apparent disabilities. METHODS Individual semi-structured interviews were conducted with 19 racially minoritized participants aged 17-30 with non-apparent disabilities. Data were analyzed using a deductive thematic analysis approach informed by an intersectional ecological framework. RESULTS Themes that affected racially minoritized youth's employment included: (1) microsystems (i.e., individual barriers and facilitators to employment); (2) mesosystems (i.e., peers, family, disability, race/ethnicity, and work); (3) exosystems (i.e., workplace policies, healthcare system, educational institutions, community organizations); (4) macrosystems (i.e., ableism, racism, gendered discrimination and intersectional forms of discrimination); (5) the chronosystem (i.e., timing of obtaining employment, diagnosis and discrimination); and (6) ecological niche, which involved the extent to which work environments were safe and inclusive. CONCLUSION Applying an intersectional ecological framework facilitates our understanding of ableism and racism in employment among youth and young adults with disabilities. Further attention is urgently needed to minimize discrimination and enhance supportive, inclusive and psychologically safe, work environments for minoritized youth with disabilities.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Natanela Dain
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
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12
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Fontaine G, Presseau J, Bruneau J, Etherington C, Thomas IM, Hung JHC, van Allen Z, Patey AM, Kareem A, Mortazhejri S, Høj SB, Boyer-Legault G, Grimshaw JM. Using an intersectionality lens to explore barriers and enablers to hepatitis C point-of-care testing: a qualitative study among people who inject drugs and service providers. Int J Equity Health 2024; 23:124. [PMID: 38886803 PMCID: PMC11184812 DOI: 10.1186/s12939-024-02209-0] [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: 04/23/2024] [Accepted: 05/31/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is a significant global health burden, particularly among people who inject drugs. Rapid point-of-care HCV testing has emerged as a promising approach to improve HCV detection and linkage to care in harm reduction organizations such as needle and syringe programs. The objective of this study was to use an intersectionality lens to explore the barriers and enablers to point-of-care HCV testing in a needle and syringe program. METHODS A qualitative study was conducted using semi-structured interviews with clients (people who inject drugs) and service providers in a large community organization focused on the prevention of sexually transmitted and blood borne infections and harm reduction in Montreal, Canada. An intersectionality lens was used alongside the Theoretical Domains Framework to guide the formulation of research questions as well as data collection, analysis, and interpretation. RESULTS We interviewed 27 participants (15 clients, 12 providers). For clients, four themes emerged: (1) understanding and perceptions of HCV testing, (2) the role of an accessible and inclusive environment, (3) the interplay of emotions and motivations in decision-making, and (4) the impact of intersectional stigma related to HCV, behaviors, and identities. For providers, five themes emerged: (1) knowledge, skills, and confidence for HCV testing, (2) professional roles and their intersection with identity and lived experience, (3) resources and integration of services, (4) social and emotional factors, and (5) behavioral regulation and incentives for HCV testing. Intersectional stigma amplified access, emotional and informational barriers to HCV care for clients. In contrast, identity and lived experience acted as powerful enablers for providers in the provision of HCV care. CONCLUSION The application of an intersectionality lens provides a nuanced understanding of multilevel barriers and enablers to point-of-care HCV testing. Findings underscore the need for tailored strategies that address stigma, improve provider roles and communication, and foster an inclusive environment for equitable HCV care. Using an intersectionality lens in implementation research can offer valuable insights, guiding the design of equity-focused implementation strategies.
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Affiliation(s)
- Guillaume Fontaine
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Rue Sherbrooke O #1800, Montréal, QC, H3A 2M7, Canada.
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, CIUSSS West-Central Montreal, 3755 Chem. de La Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada.
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, UNSW, Wallace Wurth Building (C27), Cnr High St & Botany St, Kensington, NSW, 2052, Australia.
| | - Justin Presseau
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, ON, K1N 6N5, Canada
| | - Julie Bruneau
- Research Centre, Université de Montréal Hospital Centre, 900 Saint Denis St, Montreal, QC, H2X 0A9, Canada
- Department of Family and Emergency Medicine, Université de Montréal, 2900, Boulevard Édouard-Montpetit, Montréal, QC, H3T 1J4, Canada
| | - Cole Etherington
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Isabella M Thomas
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Jui-Hsia Cleo Hung
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Zack van Allen
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, ON, K1N 6N5, Canada
| | - Andrea M Patey
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
- School of Rehabilitation Therapy, Queen's University, Louise D Acton Building, 31 George St, Kingston, ON, K7L 3N6, Canada
| | - Ayesha Kareem
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Sameh Mortazhejri
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Stine Bordier Høj
- Research Centre, Université de Montréal Hospital Centre, 900 Saint Denis St, Montreal, QC, H2X 0A9, Canada
| | - Geneviève Boyer-Legault
- Direction of Community Services, CACTUS Montréal, 1300 Rue Sanguinet, Montréal, QC, H2X 3E7, Canada
| | - Jeremy M Grimshaw
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
- Department of Medicine, University of Ottawa, 45 Smyth Road, Ottawa, ON, K1H8M5, Canada
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Lindsay S, Li Y, Joneja S, Hsu S. Experiences of racism and racial disparities in health care among children and youth with autism and their caregivers: a systematic review. Disabil Rehabil 2024:1-20. [PMID: 38864302 DOI: 10.1080/09638288.2024.2364823] [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: 11/15/2023] [Accepted: 06/02/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE Although the health benefits of early diagnosis and therapeutic approaches for children and youth with autism spectrum disorder (ASD), racial disparities persist. This systematic review explored the experiences of racism and racial disparities in health care among children and youth with ASD and their caregivers. METHODS We conducted a systematic review, drawing on six international databases. Two reviewers screened titles, abstracts, and full texts. Thirty-seven studies met our inclusion criteria and we applied a narrative synthesis to develop themes. RESULTS Four themes were identified: (1) experiences and aspects of racism and racial disparities (i.e., language and cultural barriers, poor quality health care interactions, stereotypes and discrimination, family and community stigma, and indirect barriers); (2) racial disparities in health care (i.e., screening and referral, diagnosis, health care services, and care coordination and medication); (3) facilitators to accessing health care services; and (4) recommendations from caregivers. CONCLUSIONS This review highlights the extensive racial disparities experienced by children with autism. More research is needed to explore youth's perspectives on racism in addition to exploring potential interventions to address racial disparities and improve health equity for youth with ASD.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Yiyan Li
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Simran Joneja
- Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Shaelynn Hsu
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Faculty of Science, York University, Toronto, Canada
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Cho HE, Shepherd WS, Colombo GM, Wiese AD, Rork WC, Kostick KM, Nguyen D, Murali CN, Robinson ME, Schneider SC, Qian JH, Lee B, Sutton VR, Storch EA. Resilience and coping: a qualitative analysis of cognitive and behavioral factors in adults with osteogenesis Imperfecta. Disabil Rehabil 2024:1-10. [PMID: 38841844 DOI: 10.1080/09638288.2024.2358903] [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: 10/16/2023] [Accepted: 05/20/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE The aim of this qualitative study was to investigate resilience among adults with Osteogenesis Imperfecta (OI). MATERIALS AND METHODS Semi-structured interviews were conducted with 15 adults with OI. Transcripts were coded and subsequently abstracted, yielding themes specific to resilience and coping. Interview guides covered broad topics including pain challenges specific to OI, mental health issues related to OI, and priorities for future interventions for individuals with OI. RESULTS Participants described resilience in the context of OI as the ability to grow from adversity, adapt to challenges resulting from OI-related injuries, and find identities apart from their condition. Psychological coping strategies included acceptance, self-efficacy, cognitive reframing, perspective-taking, and positivity. Behavioral factors that helped participants develop resilience included developing new skills, pursuing meaningful goals, practicing spirituality, and seeking external resources such as psychotherapy, education, and connection with community. CONCLUSION Having identified how adults with OI define resilience and the strategies they use to cope, we can now develop interventions and guide healthcare providers in improving psychological wellbeing in this population.
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Affiliation(s)
- Hannah E Cho
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Whitney S Shepherd
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Gianna M Colombo
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Andrew D Wiese
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - W Conor Rork
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Kristin M Kostick
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Dianne Nguyen
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Chaya N Murali
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
| | | | - Sophie C Schneider
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Justin H Qian
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Brendan Lee
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
| | - V Reid Sutton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Barr E, Belaunzarán-Zamudio PF, Clayton JA, Gerald MS, Greenwood GL, Highsmith K, Jaworski BK, Karraker A, Kobrin S, Lachowicz-Scroggins M, Maric-Bilkan C, Popkin R, Roodzant E, Sankar CA, Senn TE, Siskind R, Temkin SM. Workshop summary: National Institutes of Health (NIH) 2022 scientific workshop on gender and health. Soc Sci Med 2024; 351 Suppl 1:116435. [PMID: 38825375 DOI: 10.1016/j.socscimed.2023.116435] [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: 05/12/2023] [Revised: 11/06/2023] [Accepted: 11/13/2023] [Indexed: 06/04/2024]
Abstract
In this manuscript, we summarize the goals, content, and impact of the Gender and Health: Impacts of Structural Sexism, Gender Norms, Relational Power Dynamics, and Gender Inequities workshop held by the National Institutes of Health (NIH) Office of Research on Women's Health (ORWH) in collaboration with 10 NIH Institutes, Centers, and Offices. Specifically, we outline the key points emerging from the workshop presentations, which are the focus of the collection of articles in this supplement. The overarching goals of the workshop were to convene NIH staff, the external scientific community, and the public to discuss methods, measurement, modifiable factors, interventions, and best practices in health research on gender as a social and cultural variable and to identify opportunities to advance research and foster collaborations on these key topics. Themes emerging from the workshop include the need for intersectional measures in research on gender and health, the role of multilevel interventions and analyses, and the importance of considering gender as a social and structural determinant of health. Careful, nuanced, and rigorous integration of gender in health research can contribute to knowledge about and interventions to change the social and structural forces that lead to disparate health outcomes and perpetuate inequities.
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Affiliation(s)
- Elizabeth Barr
- National Institutes of Health, Office of Research on Women's Health, Bethesda, MD, USA.
| | - Pablo F Belaunzarán-Zamudio
- National Institutes of Health, National Institute of Allergy and Infectious Diseases [Contractor], Bethesda, MD, USA
| | - Janine Austin Clayton
- National Institutes of Health, Office of Research on Women's Health, Bethesda, MD, USA
| | - Melissa S Gerald
- National Institutes of Health, National Institute on Aging, Bethesda, MD, USA
| | - Gregory L Greenwood
- National Institutes of Health, National Institute of Mental Health, Bethesda, MD, USA
| | - Keisher Highsmith
- United States Public Health Service, National Institutes of Health, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Beth K Jaworski
- National Institutes of Health, Office of Behavioral and Social Sciences Research, Bethesda, MD, USA
| | - Amelia Karraker
- National Institutes of Health, National Institute on Aging, Bethesda, MD, USA
| | - Sarah Kobrin
- National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | | | - Christine Maric-Bilkan
- National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Ronna Popkin
- National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Erik Roodzant
- Booz Allen Hamilton, McLean, VA, USA; National Institutes of Health, Office of Research on Women's Health [Contractor], Bethesda, MD, USA
| | - Cheryse A Sankar
- National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Theresa E Senn
- National Institutes of Health, National Institute of Mental Health, Bethesda, MD, USA
| | - Rona Siskind
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Sarah M Temkin
- National Institutes of Health, Office of Research on Women's Health, Bethesda, MD, USA
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16
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Woods SB, Udezi V, Roberson PNE, Arnold EM, Nesbitt S, Hiefner A. "A cuff is not enough": A community-based participatory research approach to soliciting perspectives of African Americans with hypertension and their family members on self-management intervention features. FAMILY PROCESS 2024; 63:731-748. [PMID: 37718711 PMCID: PMC10947536 DOI: 10.1111/famp.12935] [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: 02/09/2023] [Revised: 06/20/2023] [Accepted: 08/07/2023] [Indexed: 09/19/2023]
Abstract
We aimed to solicit the perspectives of African Americans with hypertension and their family members on the desired features of a behavioral hypertension self-management intervention. Using a community-based participatory approach to intervention design, we conducted four dyadic focus groups, including African American community members with hypertension (n = 23) and their family members (n = 23), recruited from African American-serving Christian churches in a large, southern metropolitan area. We used open-ended questions to elicit participants' perspectives regarding program features they would recommend, intervention delivery, and barriers necessary to address. Our grounded theory analysis identified themes reflecting participants' recommendations for hypertension self-management interventions to enhance health literacy and provide communication training via an accessible, population-tailored, family-based approach, which they believed has the potential to create family-level impact on health across generations. Participants also recommended intervention researchers engage in advocacy (i.e., via physician education and policy change) as part of a broader impact on structural inequities driving worse hypertension and health outcomes for African Americans. The perceptions and recommendations of African Americans with a lived experience of hypertension, as well as their family members, aid in shaping acceptable and efficacious behavioral interventions aiming to promote hypertension self-management behavior while leveraging the unique power of family relationships to create sustained behavior change.
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Affiliation(s)
- Sarah B. Woods
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, Dallas TX, USA
| | - Victoria Udezi
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, Dallas TX, USA
| | | | - Elizabeth Mayfield Arnold
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, Dallas TX, USA
| | - Shawna Nesbitt
- University of Texas Southwestern Medical Center, Departments of Internal Medicine and Cardiology, Dallas TX, USA
| | - Angela Hiefner
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, Dallas TX, USA
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17
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Bond KT, Chen WT, Crespo-Fierro M, Randolph S, Ramos SR. Ending the HIV Epidemic: Disrupting Inequities Through HIV Research Centered on Women and Girls. J Assoc Nurses AIDS Care 2024; 35:173-174. [PMID: 38949900 DOI: 10.1097/jnc.0000000000000475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Affiliation(s)
- Keosha T Bond
- Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor in Community Health and Social Medicine at the CUNY School of Medicine, New York, New York, USA
- Wei-Ti Chen, PhD, CNM, RN, FAAN, is Professor at the UCLA School of Nursing, Los Angeles, California, USA
- Michele Crespo-Fiero, PhD, MPH, RN, AACRN, CNE, FNYAM, FAAN, is a Clinical Associate Professor and Director of the LEAD Honors Program at the Rory Meyers College of Nursing, New York University, New York, New York, USA
- Schenita Randolph, PhD, MPH, RN, FAAN, is an Associate Professor at the Duke University School of Nursing, Durham, North Carolina, USA
- S. Raquel Ramos, PhD, MSN, MBA, FNYAM, FAHA, is an Associate Professor at the Yale University School of Nursing, Orange, Connecticut, USA
| | - Wei-Ti Chen
- Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor in Community Health and Social Medicine at the CUNY School of Medicine, New York, New York, USA
- Wei-Ti Chen, PhD, CNM, RN, FAAN, is Professor at the UCLA School of Nursing, Los Angeles, California, USA
- Michele Crespo-Fiero, PhD, MPH, RN, AACRN, CNE, FNYAM, FAAN, is a Clinical Associate Professor and Director of the LEAD Honors Program at the Rory Meyers College of Nursing, New York University, New York, New York, USA
- Schenita Randolph, PhD, MPH, RN, FAAN, is an Associate Professor at the Duke University School of Nursing, Durham, North Carolina, USA
- S. Raquel Ramos, PhD, MSN, MBA, FNYAM, FAHA, is an Associate Professor at the Yale University School of Nursing, Orange, Connecticut, USA
| | - Michele Crespo-Fierro
- Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor in Community Health and Social Medicine at the CUNY School of Medicine, New York, New York, USA
- Wei-Ti Chen, PhD, CNM, RN, FAAN, is Professor at the UCLA School of Nursing, Los Angeles, California, USA
- Michele Crespo-Fiero, PhD, MPH, RN, AACRN, CNE, FNYAM, FAAN, is a Clinical Associate Professor and Director of the LEAD Honors Program at the Rory Meyers College of Nursing, New York University, New York, New York, USA
- Schenita Randolph, PhD, MPH, RN, FAAN, is an Associate Professor at the Duke University School of Nursing, Durham, North Carolina, USA
- S. Raquel Ramos, PhD, MSN, MBA, FNYAM, FAHA, is an Associate Professor at the Yale University School of Nursing, Orange, Connecticut, USA
| | - Schenita Randolph
- Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor in Community Health and Social Medicine at the CUNY School of Medicine, New York, New York, USA
- Wei-Ti Chen, PhD, CNM, RN, FAAN, is Professor at the UCLA School of Nursing, Los Angeles, California, USA
- Michele Crespo-Fiero, PhD, MPH, RN, AACRN, CNE, FNYAM, FAAN, is a Clinical Associate Professor and Director of the LEAD Honors Program at the Rory Meyers College of Nursing, New York University, New York, New York, USA
- Schenita Randolph, PhD, MPH, RN, FAAN, is an Associate Professor at the Duke University School of Nursing, Durham, North Carolina, USA
- S. Raquel Ramos, PhD, MSN, MBA, FNYAM, FAHA, is an Associate Professor at the Yale University School of Nursing, Orange, Connecticut, USA
| | - S Raquel Ramos
- Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor in Community Health and Social Medicine at the CUNY School of Medicine, New York, New York, USA
- Wei-Ti Chen, PhD, CNM, RN, FAAN, is Professor at the UCLA School of Nursing, Los Angeles, California, USA
- Michele Crespo-Fiero, PhD, MPH, RN, AACRN, CNE, FNYAM, FAAN, is a Clinical Associate Professor and Director of the LEAD Honors Program at the Rory Meyers College of Nursing, New York University, New York, New York, USA
- Schenita Randolph, PhD, MPH, RN, FAAN, is an Associate Professor at the Duke University School of Nursing, Durham, North Carolina, USA
- S. Raquel Ramos, PhD, MSN, MBA, FNYAM, FAHA, is an Associate Professor at the Yale University School of Nursing, Orange, Connecticut, USA
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Eschliman EL, Choe K, DeLucia A, Addison E, Jackson VW, Murray SM, German D, Genberg BL, Kaufman MR. First-hand accounts of structural stigma toward people who use opioids on Reddit. Soc Sci Med 2024; 347:116772. [PMID: 38502980 PMCID: PMC11031276 DOI: 10.1016/j.socscimed.2024.116772] [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: 01/25/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 03/21/2024]
Abstract
People who use opioids face multilevel stigma that negatively affects their health and well-being and drives opioid-related overdose. Little research has focused on lived experience of the structural levels of stigma toward opioid use. This study identified and qualitatively analyzed Reddit content about structural stigma toward opioid use. Iterative, human-in-the-loop natural language processing methods were used to identify relevant posts and comments from an opioid-related subforum. Ultimately, 273 posts and comments were qualitatively analyzed via directed content analysis guided by a prominent conceptualization of stigma. Redditors described how structures-including governmental programs and policies, the pharmaceutical industry, and healthcare systems-stigmatize people who use opioids. Structures were reported to stigmatize through labeling (i.e., particularly in medical settings), perpetuating negative stereotypes, separating people who use opioids into those who use opioids "legitimately" versus "illegitimately," and engendering status loss and discrimination (e.g., denial of healthcare, loss of employment). Redditors also posted robust formulations of structural stigma, mostly describing how it manifests in the criminalization of substance use, is often driven by profit motive, and leads to the pervasiveness of fentanyl in the drug supply and the current state of the overdose crisis. Some posts and comments highlighted interpersonal and structural resources (e.g., other people who use opioids, harm reduction programs, telemedicine) leveraged to navigate structural stigma and its effects. These findings reveal key ways by which structural stigma can pervade the lives of people who use opioids and show the value of social media data for investigating complex social processes. Particularly, this study's findings related to structural separation may help encourage efforts to promote solidarity among people who use opioids. Attending to first-hand accounts of structural stigma can help interventions aiming to reduce opioid-related stigma be more responsive to these stigmatizing structural forces and their felt effects.
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Affiliation(s)
- Evan L Eschliman
- Department of Epidemiology, Columbia University Mailman School of Public Health, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA.
| | - Karen Choe
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, USA
| | - Alexandra DeLucia
- Center for Language and Speech Processing, Johns Hopkins University, USA
| | | | - Valerie W Jackson
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, USA
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA
| | - Becky L Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Michelle R Kaufman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, USA
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Closson K, Lee GY, Osborne Z, Hangle C, Nemutambwe T, Raj A, Leonce I, Kaida A. "Nobody has written the book about what non-binary people should put forward in relationships": Exploring gender equity in relationships of queer, trans, and non-monogamous young women and non-binary youth in British Columbia, Canada. Soc Sci Med 2024; 347:116759. [PMID: 38513562 DOI: 10.1016/j.socscimed.2024.116759] [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: 07/27/2023] [Revised: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 03/23/2024]
Abstract
Understanding the unique ways in which queer, trans, and non-monogamous young women and non-binary youth navigate and negotiate equitable intimate relationships is a first step toward strong research, programs/resources, and policies to support healthy relationship dynamics across the life course. Using a youth-engaged collaborative Reflexive Thematic Analysis, we aimed to explore how youth of diverse genders and relationship experiences understand gender equity in their relationships. Thirty cis- and transgender inclusive young women (46.7%) and non-binary youth (53.3%) aged 17-29 who were in a current (76.6%) or recent (in past 12 months, 23.4%) non-heterosexual and/or non-monogamous intimate relationship and residing in British Columbia, Canada, completed qualitative interviews between August and November 2022. Of the 30 youth, 53.3% reported having experience living as a trans person, 33.3% identified only as bisexual and 10% identified as only lesbian or gay, whereas the remaining 56.7% identified with ≥1 of: queer, pansexual, and demisexual. Participants identified that relationship equity requires: 1) Moving away from cis-heteronormative conceptualizations of gender roles and norms; 2) Actively working to dismantle hierarchal power structures by sharing power, responsibility, labour, and decision-making; and 3) Accommodating and affirming each person's unique needs and identities in a relationship. For theme one, youth further described the ways in which they re-imagined relationship norms and discussed the various challenges to resisting ingrained hierarchical cis-heteronormativity. This research contributes a greater understanding of how to create equitable and healthy relationships and has important implications for healthcare providers, educators, and policymakers working with queer, transgender, and non-monogamous youth.
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Affiliation(s)
- Kalysha Closson
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, USA; Faculty of Health Sciences, Simon Fraser University, BC, Canada.
| | - Gem Y Lee
- Faculty of Health Sciences, Simon Fraser University, BC, Canada
| | - Zoë Osborne
- Faculty of Health Sciences, Simon Fraser University, BC, Canada
| | - Colby Hangle
- Faculty of Health Sciences, Simon Fraser University, BC, Canada; Department of Psychology, University of Northern British Columbia, BC, Canada
| | | | - Anita Raj
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, USA; Newcomb Institute, Tulane University, LA, USA; Tulane School of Public Health and Tropical Medicine, LA, USA
| | | | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, BC, Canada
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Shatto JA, Stickland MK, Soril LJJ. Variations in COPD Health Care Access and Outcomes: A Rapid Review. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2024; 11:229-246. [PMID: 38241509 DOI: 10.15326/jcopdf.2023.0441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
Background Health inequities among individuals with chronic obstructive pulmonary disease (COPD) are often associated with differential access to health care and health outcomes. A greater understanding of the literature concerning such variation is necessary to determine where gaps or inequities exist along the continuum of COPD care. Methods A rapid review of the published and grey literature reporting variations in health care access and/or health outcomes for individuals with COPD was completed. Variation was defined as differential patterns in access indicators or outcome measures within sociodemographic categories, including age, ethnicity, geography, race, sex, and socioeconomic status. Emergent themes were identified from the included literature and synthesized narratively. Results Thirty-five articles were included for final review; the majority were retrospective cohort studies. Twenty-five studies assessed variation in access to health care. Key indicators included: access to spirometry testing, medication adherence, participation in pulmonary rehabilitation, and contact with general practitioners and/or respiratory specialists. Twenty-one studies assessed variation in health outcomes in COPD and key metrics included: hospital-based resource utilization (length of stay and admissions/readmissions), COPD exacerbations, and mortality. Patients who live in rural environments and those of lower socioeconomic status had both poorer access to care and outcomes at the system and patient level. Other sociodemographic variables, including ethnicity, race, age, and sex were associated with variation in health care access and outcomes, although these findings were less consistent. Conclusion The results of this rapid review suggest that substantial variation in access and outcomes exists for individuals with COPD, highlighting opportunities for targeted interventions and policies.
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Affiliation(s)
- Julie A Shatto
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Alberta, Canada
| | - Michael K Stickland
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Alberta, Canada
- Medicine Strategic Clinical Network-Respiratory Health Section, Alberta Health Services, Alberta, Canada
- G.F. MacDonald Centre for Lung Health, Covenant Health, Alberta, Canada
| | - Leslie J J Soril
- Medicine Strategic Clinical Network-Respiratory Health Section, Alberta Health Services, Alberta, Canada
- Division of General Internal Medicine, Department of Medicine, University of Alberta, Alberta, Canada
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21
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Bruder R, Mason R, Williams CC, Du Mont J. Exploring the experiences of wellbeing, health, and healthcare among women who have been domestically sex trafficked in Ontario, Canada: A qualitative study protocol. PLoS One 2024; 19:e0299500. [PMID: 38446788 PMCID: PMC10917261 DOI: 10.1371/journal.pone.0299500] [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] [Received: 10/05/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Although there is a growing body of evidence to suggest that persons who have been sex trafficked can suffer devastating health consequences and often face challenges accessing suitable care that addresses their health and overall well-being, little existing research has adopted a survivor-informed approach. Centering the voices of sex-trafficked women in this research will provide valuable insights into their health-related experiences and can help lay the foundation for survivor-centric healthcare responses. METHODS AND ANALYSIS Using a semi-structured interview guide, we will interview women who have been domestically sex trafficked in Ontario; recruitment will continue until data saturation is reached. Interview questions and prompts will elicit information about women's experiences prior to, during, and after their trafficking ordeal, with particular attention paid to their encounters with healthcare providers. Intersectionality theory will inform strategies for recruitment, data collection, and data analysis. Data will be analyzed deductively as well as inductively using Braun and Clarke's six phases of reflexive thematic analysis. The study's design was informed by the consolidated criteria for reporting qualitative research (COREQ), which ensures a comprehensive and robust reporting of interview data. We will continue to adhere to the COREQ checklist throughout the data collection, analysis, and findings write-up phases, helping to ensure methodological accuracy and transparency. DISCUSSION To our knowledge, this will be the first Canada-specific investigation to apply intersectionality theory to explore the experiences of well-being, health, and healthcare from the perspectives of women who have been domestically sex trafficked. The results of this study hold the potential to improve responses to trafficking within the healthcare sector. Specifically, the findings could be used to inform the development of education materials and curricula for medical students and continuing professional education for health and allied healthcare providers. They could also inform the creation of patient experience surveys and intake forms for sex trafficked patients.
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Affiliation(s)
- Rhonelle Bruder
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Robin Mason
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Janice Du Mont
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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22
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Thorpe S, Dogan-Dixon J, Malone N, Palomino KA. 'Just be strong and keep going': the influence of Superwoman Schema on Black women's perceived expectations of coping with sexual pain. CULTURE, HEALTH & SEXUALITY 2024; 26:346-361. [PMID: 37226881 PMCID: PMC11214806 DOI: 10.1080/13691058.2023.2210199] [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: 07/19/2022] [Accepted: 05/01/2023] [Indexed: 05/26/2023]
Abstract
Superwoman Schema, a conceptual framework that reflects Black women's ability to overcome gendered racism and stress, affects the way Black women choose to cope with health-related issues. The purpose of this study was to investigate how Black women perceive they should cope with sexual pain using the Superwoman Schema as an analytic and interpretative guide. Data were derived from participants who completed an individual interview on sexual pain and pleasure. Deductive thematic analysis was conducted. Results indicated whereas some Black women endorsed all five components of Superwoman Schema as coping strategies for sexual pain, other Black women resisted SWS completely. Additionally, one participant was an outlier and did not endorse or resist SWS. Implications for generational sexual health interventions for Black women are discussed.
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Affiliation(s)
- Shemeka Thorpe
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, USA
| | - Jardin Dogan-Dixon
- Department of Educational, School & Counseling Psychology, University of Kentucky, Lexington, KY, USA
| | - Natalie Malone
- Department of Educational, School & Counseling Psychology, University of Kentucky, Lexington, KY, USA
| | - Kaylee A. Palomino
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, USA
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23
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Belisle LA, Pinchevsky GM, Ortega G. Examining the prevalence of adverse childhood experiences (ACEs) among justice-involved youth in the U.S.: The importance of accounting for race/ethnicity, gender, and gendered racial/ethnic groups. CHILD ABUSE & NEGLECT 2024; 149:106514. [PMID: 38359774 DOI: 10.1016/j.chiabu.2023.106514] [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: 04/08/2023] [Revised: 10/04/2023] [Accepted: 10/12/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Youth in the U.S. juvenile justice system are exposed to adverse childhood experiences (ACEs) at higher rates than youth in the general public. Additionally, research has demonstrated ACEs can vary by race/ethnicity and gender. However, little is known about how ACEs are experienced across gendered racial/ethnic groups of justice-involved youth. OBJECTIVE To address this gap, this exploratory study is the first to apply an intersectional lens to examine the prevalence of ACEs among a group of justice-involved youth in the U.S. PARTICIPANTS & SETTING Using secondary data, this study examines ACEs by gender, race/ethnicity, and six gendered racial/ethnic groups of justice-involved youth referred to the Division of Youth and Family Services (DYFS) in Milwaukee, Wisconsin. METHODS Descriptive analyses are presented by gender and race/ethnicity separately, followed by gendered racial/ethnic groups to understand differential rates of exposure to ACEs. RESULTS The study's findings align with previous research and reinforce that justice-involved youth experience higher rates of adversity than the general public. The results also support the feminist pathway's perspective within an intersectional context, emphasizing the importance of accounting for race/ethnicity and gender simultaneously to identify the unique experiences of ACEs among justice-involved youth. CONCLUSION Recommendations related to these findings and considerations surrounding ACE measures are discussed. Specifically, findings from this study stress the importance of accounting for gender and race/ethnicity simultaneously when measuring experiences of adversity. This is a critical step to providing equitable treatment and services to address trauma-related needs across gendered racial/ethnic groups of system-involved youth.
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24
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Keogh E, Boerner KE. Challenges with embedding an integrated sex and gender perspective into pain research: Recommendations and opportunities. Brain Behav Immun 2024; 117:112-121. [PMID: 38145854 DOI: 10.1016/j.bbi.2023.12.027] [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] [Revised: 12/01/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023] Open
Abstract
The focus of this article, within this BBI horizons special issue, is on sex, gender, and pain. We summarise what is currently known about sex- and gender-related variations in pain, exploring intersectional biological and psychosocial mechanisms, and highlight gaps in knowledge and understanding. Five key challenges with the exploration of sex and gender in pain research are presented, relating to: conceptual imprecision, research bias, limitations with binary descriptions, integrating sex and gender, and timely adoption/implementation of good research practice. Guidance on how to overcome such challenges is provided. Despite clear evidence for sex and gender differences in pain, there are conceptual and methodological barriers to overcome. Innovation in methods and approach can help develop more effective and tailored treatment approaches for men, women, boys, girls, and gender-diverse people.
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Affiliation(s)
- Edmund Keogh
- Bath Centre for Pain Research & Department of Psychology, University of Bath, UK.
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25
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de Bres J, Morrison-Young I. Intersectional perspectives of parents of transgender children in Aotearoa (New Zealand). INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2024; 25:584-601. [PMID: 39055633 PMCID: PMC11268225 DOI: 10.1080/26895269.2024.2316689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Introduction This article explores the intersectional perspectives of parents of transgender children in Aotearoa (New Zealand). The substantial body of research on parent experiences in this area has largely focused on parents who are white North American middle-class cisgender women. We seek to extend this research by taking an intersectional approach and examining the perspectives of a group of participants of different genders, sexual orientations, and cultural backgrounds. Methods We asked 20 participants in Aotearoa who self-identified as gender-affirming parents to draw their experience of parenting a transgender child and discuss this with us in interview. Results The research resulted in rich visual and verbal depictions of gender-affirming parenting, drawing from the intersectional perspectives of Māori, Pākehā, Pacific, Asian, queer, straight, female, male and non-binary parents. Using visual and verbal discourse analysis, we explore how the participants constructed their experience from their uniquely situated perspectives, both specific and multilayered. Conclusion We argue that the parents' perspectives reveal both challenges and strengths, reflecting the burdens of intersectional oppression, while also fostering the parents' capacity for engaging in discursive resistance to advance their children's interests.
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Affiliation(s)
- Julia de Bres
- School of Humanities, Media and Creative Communication, Massey University, Wellington, New Zealand
| | - Ia Morrison-Young
- School of Humanities, Media and Creative Communication, Massey University, Wellington, New Zealand
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26
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Fuentes K, Hsu S, Patel S, Lindsay S. More than just double discrimination: a scoping review of the experiences and impact of ableism and racism in employment. Disabil Rehabil 2024; 46:650-671. [PMID: 36724368 DOI: 10.1080/09638288.2023.2173315] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/21/2023] [Indexed: 02/03/2023]
Abstract
PURPOSE Research has shed light on the employment barriers faced by individuals with disabilities, and by racialized people. The challenges faced by people belonging to both marginalized groups are less well-understood. The purpose of this scoping review was to examine existing research on labour market and workplace experiences of racialized people with disabilities, and to identify how ableism and racism intersect to shape employment experiences and outcomes. METHODS Seven international databases were searched, covering the period from 2000 to April 2022. Four reviewers independently conducted the screening, and data extraction and analysis were performed on 44 articles that met our inclusion criteria. RESULTS The findings highlighted rates of workplace ableism and racism (including discrimination allegations and perceived discrimination); types and forms of experiences arising from the intersection of ableism and racism (including unique individual stereotyping and systemic and institutional discrimination); and the role of other demographic variables. The intersection of ableism and racism impacted labour market outcomes, well-being in the workplace, and career/professional advancement. CONCLUSIONS Our review highlights the need for greater in-depth research focusing explicitly on the intersection of ableism and racism (and of other forms of discrimination), to better understand and address the barriers that racialized people with disabilities face in employment.IMPLICATIONS FOR REHABILITATIONThe experiences of racialized people with disabilities have been under explored, and clinicians and rehabilitation specialists should consider incorporating intersectionality into their practices to better understand and serve these populations.Ableism and racism do not operate in isolation, and clinicians and other professionals need to be aware that racialized people with disabilities may face unique challenges and barriers as a result.Service providers should aim to address gaps and inequities in services faced by racialized people with disabilities which may prevent them from finding and/or maintaining meaningful employment.
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Affiliation(s)
- Kristina Fuentes
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Shaelynn Hsu
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Stuti Patel
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Psychology, University of Toronto Mississauga campus, Mississauga, Canada
| | - Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
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Weiss CR, Roberts M, Florell M, Wood R, Johnson-Koenke R, Amura CR, Kissler K, Barton AJ, Jones J. Best Practices for Telehealth in Nurse-Led Care Settings-A Qualitative Study. Policy Polit Nurs Pract 2024; 25:47-57. [PMID: 37750219 PMCID: PMC10841034 DOI: 10.1177/15271544231201417] [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] [Indexed: 09/27/2023]
Abstract
The COVID-19 pandemic in the US prompted a sudden shift to telehealth in nurse-led care sites which provide services to diverse geolocations. Using a lens of intersectionality, this study characterizes provider and patient-perceived best and promising practices emerging from geographical variation. The aim of this study was to identify best practices of implementing telehealth in nurse-led care models in Colorado through patient and provider experiences of the sudden implementation of telehealth that can enhance health equity. In this exploratory/descriptive qualitative study, a purposive sample of 18 providers and 30 patients were interviewed using a guide informed by the RE-AIM implementation and evaluation framework to capture the contextual experiences related to the sudden shift to telehealth. Textual theme analysis and reflexive team strategies guided the interpretation. Four primary themes of perceived best practices were identified: using multiple modalities, tailoring triage and scheduling, cultivating safety through boundaries and expectations, and differentiating established versus new patient relationships. The findings suggest that telehealth is a flexible and powerful tool to enhance the delivery of equitable care through nurse-led care models within diverse communities such as the one represented in this study. Nurse leaders are positioned to participate in innovative research and create policies and protocols to ensure telehealth is a viable resource to deliver equitable, safe, and accessible high-quality healthcare.
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Affiliation(s)
- Charlotte R. Weiss
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Mia Roberts
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Melissa Florell
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Rachel Wood
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Rachel Johnson-Koenke
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Claudia R. Amura
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Katherine Kissler
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Amy J. Barton
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Jacqueline Jones
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
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Garcia M. Intersectional Microaggressions and Implications for Health Inequities and HIV Among Latino/x Sexual Minority Males in Puerto Rico. J Racial Ethn Health Disparities 2024:10.1007/s40615-023-01900-2. [PMID: 38198018 DOI: 10.1007/s40615-023-01900-2] [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: 08/27/2023] [Revised: 11/21/2023] [Accepted: 12/16/2023] [Indexed: 01/11/2024]
Abstract
Latino/x sexual minority males (SMM) continue to be disproportionately impacted by health inequities. This study aims to understand the lived experience of Puerto Rican (PR) SMM related to how intersectional microaggressions influence health-related risk and protective factors. Young adult (ages 21-30) PR SMM from San Juan, Puerto Rico, completed a bilingual in-depth individual interview (14 in Spanish and 1 in English). A thematic analysis based on the original language of the interviews was conducted using NVivo. Six prominent themes were identified through the data analysis: (1) religious microaggressions, being gay is bad because God doesn't like it; (2) gender microaggressions, gay is not good because it's not for men; (3) sexuality microaggressions, this one is a homosexual, coming out as a sexual minority; (4) trans microaggressions, drag queens create an illusion; (5) internalized microaggressions, battling with internalized homophobia; and (6) mitigating microaggressions, establishing a supportive community. Findings suggest that multiple forms of microaggressions based on the intersectionality of sexuality and gender manifest from straight as well as gay communities. PR SMM demonstrated their resiliency by assessing interactions with others to mitigate risks and enhance supportive networks.
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Affiliation(s)
- Moctezuma Garcia
- School of Social Work, San José State University, San Jose, CA, 95112, USA.
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.
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29
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Thompson RA, Lewis KR, Curtis CA, Olanrewaju SA, Squires A. Making the invisible visible: The importance of applying a lens of intersectionality for researching internationally educated nurses. Nurs Outlook 2024; 72:102086. [PMID: 37984020 DOI: 10.1016/j.outlook.2023.102086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Roy A Thompson
- Sinclair School of Nursing, University of Missouri, Columbia, MO.
| | - Kaleea R Lewis
- Department of Public Health, School of Health Professions, Columbia, MO; Department of Women's and Gender Studies, College of Arts and Science, University of Missouri, Columbia, MO
| | - Cedonnie A Curtis
- School of Nursing and Health Sciences, La Salle University, Philadelphia, PA
| | - Sherif A Olanrewaju
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA
| | - Allison Squires
- Rory Meyers College of Nursing, New York University, New York, NY; Department of General Internal Medicine, Grossman School of Medicine, New York, NY
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30
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Dhir P, Maynard M, Drew KJ, Homer CV, Bakhai C, Ells LJ. South Asian individuals' experiences on the NHS low-calorie diet programme: a qualitative study in community settings in England. BMJ Open 2023; 13:e079939. [PMID: 38154908 PMCID: PMC10759119 DOI: 10.1136/bmjopen-2023-079939] [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: 09/18/2023] [Accepted: 11/30/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Existing literature examines barriers to the provision of ethnically diverse dietary advice, however, is not specific to total diet replacement (TDR). There is a lack of literature from the UK, limiting the potential applicability of existing findings and themes to the UK context. This study addresses this gap in research by interviewing participants of South Asian ethnicity who have undertaken the National Health Service (NHS) low-calorie diet programme (LCD) for people with type 2 diabetes living with overweight or obesity. This study explores factors that may affect the uptake and acceptability of its TDR, food reintroduction and weight maintenance stages. This aims to provide rich data that can inform effective tailoring of future programmes with South Asian participants. OBJECTIVE To explore the perspectives of individuals of South Asian ethnicity on an NHS programme using TDR approaches for the management of type 2 diabetes (T2D). DESIGN Qualitative study. SETTING Individuals in the community undertaking the NHS LCD programme. PARTICIPANTS Twelve one-to-one interviews were conducted with individuals from a South Asian ethnicity participating in the NHS LCD. MAIN OUTCOME MEASURES Qualitative semistructured interviews conducted through different stages of the programme. Reflexive thematic analysis was used to analyse the transcripts. RESULTS Key themes highlighted positive and negative experiences of the programme: (1) more work is needed in the programme for person centeredness; (2) it is not the same taste; (3) needing motivation to make changes and feel better; (4) a mixed relationship with the coach; (5) social experiences; (6) culture-related experiences. CONCLUSION This study provides important experience-based evidence of the need for culturally tailored T2D programmes. Action to address these findings and improve the tailoring of the NHS LCD may improve experience, retention and outcomes on the programme for people of South Asian ethnicity and thereby reduce inequalities.
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Affiliation(s)
- Pooja Dhir
- School of Health, Leeds Beckett University, Leeds, UK
| | - Maria Maynard
- School of Health, Leeds Beckett University, Leeds, UK
| | - Kevin J Drew
- School of Health, Leeds Beckett University, Leeds, UK
| | | | - Chirag Bakhai
- Arndale House, Bedfordshire, Luton and Milton Keynes, UK
| | - Louisa Jane Ells
- School of Health, Leeds Beckett University, Leeds, UK
- Obesity Institute, Leeds Beckett University, Leeds, UK
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31
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Chandramohan S, Salinger AP, Wendt AS, Waid JL, Kalam MA, Delea MG, Comeau DL, Sobhan S, Gabrysch S, Sinharoy S. Diagnosing norms and norm change in rural Bangladesh: an exploration of gendered social norms and women's empowerment. BMC Public Health 2023; 23:2337. [PMID: 38001422 PMCID: PMC10675851 DOI: 10.1186/s12889-023-17213-2] [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: 04/29/2023] [Accepted: 11/12/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Gender-transformative public health programs often aim to address power inequities between men and women and promote women's empowerment. However, to achieve transformative change, it is necessary to first identify the underlying norms that perpetuate these power imbalances. The objective of our study was to use Bicchieri's theory of social norms and model of norm change to identify gendered norms and evidence of norm change amongst participants of the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) trial in rural Sylhet Division, Bangladesh. METHODS We conducted ten life history interviews, 16 key informant interviews, and four focus group discussions with women and men in communities within the FAARM study site in rural, north-eastern Bangladesh. We performed a thematic analysis as well as a relational analysis of the data. RESULTS We found that social norms dictated the extent and ways in which women participated in household decisions, the locations they could visit, and their autonomy to use household resources. We also found evidence of changes to gendered social norms over time and the desire amongst some men and women to abandon restrictive norms. Certain intersecting factors, such as education and employment, were identified as facilitators and barriers to women's empowerment and the related gendered expectations. CONCLUSIONS Our findings corroborate existing norms literature, which highlights the strong role social norms play in influencing women's empowerment and behaviour. Our study provides an example of rigorous qualitative methodology that others may follow to assess gendered social norms that can be targeted for transformative change.
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Affiliation(s)
- Shivani Chandramohan
- Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Allison P Salinger
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Mailstop 1518-002-7BB Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Amanda S Wendt
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, P.O. Box 60 12 03, 14412, Potsdam, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Jillian L Waid
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, P.O. Box 60 12 03, 14412, Potsdam, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
- Bangladesh Country Office, Helen Keller International, Rd No 82, Dhaka, 1212, Bangladesh
| | - Md Abul Kalam
- Bangladesh Country Office, Helen Keller International, Rd No 82, Dhaka, 1212, Bangladesh
| | - Maryann G Delea
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Mailstop 1518-002-7BB Clifton Rd NE, Atlanta, GA, 30322, USA
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, USA
| | - Dawn L Comeau
- Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Shafinaz Sobhan
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, P.O. Box 60 12 03, 14412, Potsdam, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Institute of Public Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Sabine Gabrysch
- Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, P.O. Box 60 12 03, 14412, Potsdam, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Institute of Public Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Sheela Sinharoy
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Mailstop 1518-002-7BB Clifton Rd NE, Atlanta, GA, 30322, USA.
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, USA.
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Rodrigues IB, Fahim C, Garad Y, Presseau J, Hoens AM, Braimoh J, Duncan D, Bruyn-Martin L, Straus SE. Developing the intersectionality supplemented Consolidated Framework for Implementation Research (CFIR) and tools for intersectionality considerations. BMC Med Res Methodol 2023; 23:262. [PMID: 37946142 PMCID: PMC10636989 DOI: 10.1186/s12874-023-02083-4] [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: 07/26/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The concept of intersectionality proposes that demographic and social constructs intersect with larger social structures of oppression and privilege to shape experiences. While intersectionality is a widely accepted concept in feminist and gender studies, there has been little attempt to use this lens in implementation science. We aimed to supplement the Consolidated Framework for Implementation Research (CFIR), a commonly used framework in implementation science, to support the incorporation of intersectionality in implementation science projects by (1) integrating an intersectional lens to the CFIR; and (2) developing a tool for researchers to be used alongside the updated framework. METHODS Using a nominal group technique, an interdisciplinary framework committee (n = 17) prioritized the CFIR as one of three implementation science models, theories, and frameworks to supplement with intersectionality considerations; the modification of the other two frameworks are described in other papers. The CFIR subgroup (n = 7) reviewed the five domains and 26 constructs in the CFIR and prioritized domains and constructs for supplementation with intersectional considerations. The subgroup then iteratively developed recommendations and prompts for incorporating an intersectional approach within the prioritized domains and constructs. We developed recommendations and prompts to help researchers consider how personal identities and power structures may affect the facilitators and inhibitors of behavior change and the implementation of subsequent interventions. RESULTS We achieved consensus on how to apply an intersectional lens to CFIR after six rounds of meetings. The final intersectionality supplemented CFIR includes the five original domains, and 28 constructs; the outer systems and structures and the outer cultures constructs were added to the outer setting domain. Intersectionality prompts were added to 13 of the 28 constructs. CONCLUSION Through an expert-consensus approach, we modified the CFIR to include intersectionality considerations and developed a tool with prompts to help implementation users apply an intersectional lens using the updated framework.
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Affiliation(s)
- Isabel B Rodrigues
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Knowledge Translation Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Christine Fahim
- Knowledge Translation Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
| | - Yasmin Garad
- Knowledge Translation Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Justin Presseau
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Jessica Braimoh
- Department of Social Science, York University, Toronto, ON, Canada
| | - Diane Duncan
- Physician Learning Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lora Bruyn-Martin
- Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
| | - Sharon E Straus
- Knowledge Translation Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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Opara I, Weerakoon SM, Stephens JRB, Choe T, Gunn JF, Thrasher SS. Relationship between suicide ideation and attempts, bully victimization, dating violence, and depressive symptoms among Black and Hispanic youth. Suicide Life Threat Behav 2023:10.1111/sltb.13015. [PMID: 37933468 PMCID: PMC11074240 DOI: 10.1111/sltb.13015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 09/18/2023] [Accepted: 10/07/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Suicide rates among Black and Hispanic youth have been increasing over the past decade in the United States. The objective of this study was to identify risk factors for suicide ideation and attempt among Black and Hispanic youth in the United States using intersectionality theory and minority stress theory as a framework. METHODS Data from the CDC Youth Risk Behavior Surveillance System (YRBSS; 2015-2019) were analyzed and delimited to include only Black and Hispanic youth. RESULTS About 37% of the subsample identified as Black and 63% of the subsample identified as Hispanic; mean age was 16 years (SE = 0.02). Weighted multivariate logistic regressions were used to explore associations between suicide ideation and attempt, depressive symptoms, bullying, dating violence, and being threatened with a weapon. Black and Hispanic youth who had depressive symptoms, experienced bullying, dating violence, or threatened with a weapon all had increased odds of having suicide ideation and suicide attempt. Hispanic youth had the higher odds of suicide ideation and attempt than Black youth. Girls in the study also had elevated odds of suicide ideation. CONCLUSION This study adds to the literature on risk factors of suicide in Black and Hispanic youth and bringing to awareness the gender disparities in suicide ideation and attempt among youth.
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Affiliation(s)
- Ijeoma Opara
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Sitara M. Weerakoon
- Yale School of Public Health, New Haven, Connecticut, USA
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Taylor Choe
- Yale School of Public Health, New Haven, Connecticut, USA
| | - John F. Gunn
- Gwynedd Mercy University, Gwynedd Valley, Pennsylvania, USA
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Efird CR, Barrington C, Metzl JM, Muessig KE, Matthews DD, Lightfoot AF. "We grew up in the church": A critical discourse analysis of Black and White rural residents' perceptions of mental health. Soc Sci Med 2023; 336:116245. [PMID: 37793270 DOI: 10.1016/j.socscimed.2023.116245] [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: 11/21/2022] [Revised: 06/02/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023]
Abstract
RATIONALE Known as the "Black-White mental health paradox," Black Americans typically report better mental health than White Americans, despite chronic exposure to the psychologically harmful effects of racism and discrimination. Yet, researchers rarely examine how mental health is experienced across racial groups in economically distressed rural regions where all residents have disproportionately less access to mental healthcare resources. OBJECTIVE The purpose of this study was to explore how the racialized social system potentially contributes to the mental health beliefs and attitudes of racially majoritized and minoritized rural residents. METHODS We conducted a secondary analysis of 29 health-focused oral history interviews from Black American (n = 16) and White American (n = 13) adults in rural North Carolina. Through critical discourse analysis, we found nuanced discourses linked to three mental-health-related topics: mental illness, stressors, and coping. RESULTS White rural residents' condemning discourses illustrated how their beliefs about mental illnesses were rooted in meritocratic notions of individual choice and personal responsibility. Conversely, Black rural residents offered compassionate discourses toward those who experience mental illness, and they described how macro-level mechanisms can affect individual well-being. Stressors also differed along racial lines, such that White residents were primarily concerned about perceived social changes, and Black residents referenced experiences of interpersonal and structural racism. Related to coping, Black and White rural residents characterized the mental health benefits of social support from involvement in their respective religious organizations. Only Black residents signified that a personal relationship with a higher power was an essential positive coping mechanism. CONCLUSIONS Our findings suggest that belief (or disbelief) in meritocratic ideology and specific religious components could be important factors to probe with Black-White patterning in mental health outcomes. This research also suggests that sociocultural factors can disparately contribute to mental health beliefs and attitudes among diverse rural populations.
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Affiliation(s)
- Caroline R Efird
- Racial Justice Institute, Georgetown University, Washington, DC, USA.
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jonathan M Metzl
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN, USA
| | | | - Derrick D Matthews
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alexandra F Lightfoot
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Abboud S, Seal DW, Pachankis JE, Khoshnood K, Khouri D, Fouad FM, Heimer R. Experiences of stigma, mental health, and coping strategies in Lebanon among Lebanese and displaced Syrian men who have sex with men: A qualitative study. Soc Sci Med 2023; 335:116248. [PMID: 37742387 DOI: 10.1016/j.socscimed.2023.116248] [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: 02/09/2022] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND In Lebanon, men who have sex with men (MSM) face high rates of stigma, discrimination, and violence. Minority stress, or the unique stressors related to anti-MSM stigma and discrimination, negatively impacts the mental health of MSM. These stressors are heightened for those with intersectional minority identities such as displaced Syrian MSM in Lebanon. METHODS In this qualitative study conducted in 2020-21, part of a larger study focused on the mental and sexual health risks among MSM, we collected qualitative data from Lebanese and displaced Syrian MSM living in Lebanon and analyzed reports of their experiences with stigma, mental health, and coping strategies. We conducted semi-structured, in-depth interviews with 12 displaced Syrian MSM and 13 Lebanese MSM. RESULTS Our findings highlight how MSM in Lebanon navigate stigma and the mental health risks that result. Common stressors among Lebanese and displaced Syrian MSM were related to finances, sexual orientation discrimination, and social isolation. Comparing the two groups, we found that stressors specific to displaced Syrian MSM were related to adverse childhood experiences, recent exposure to the Syrian war, displacement, and discrimination in Lebanon based on their intersectional identities as MSM and Syrians. For Lebanese participants, the most common stigma coping strategies were avoidance, drinking alcohol, using drugs, or having sex. As for displaced Syrian MSM, the most common stigma coping strategy was seeking the freely available mental health services offered to them through non-governmental organizations. CONCLUSION Our findings suggest that increased targeted mental health and social support interventions, informed by the unique experiences of Lebanese and displaced Syrian MSM, are highly needed to improve the coping and mental health resources of all MSM in Lebanon.
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Affiliation(s)
- Sarah Abboud
- University of Illinois Chicago College of Nursing, 845 S. Damen Ave, Chicago, IL, 60612, USA
| | - David W Seal
- Tulane University School of Public Health & Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, USA.
| | - John E Pachankis
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, 60 College St, New Haven, CT, 06510, USA
| | - Kaveh Khoshnood
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, 60 College St, New Haven, CT, 06510, USA
| | - Danielle Khouri
- American University of Beirut, Faculty of Health Sciences, Bliss Street, Beirut, Lebanon
| | - Fouad M Fouad
- American University of Beirut, Faculty of Health Sciences, Bliss Street, Beirut, Lebanon
| | - Robert Heimer
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, 60 College St, New Haven, CT, 06510, USA
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Shahbaz R, Williams A, Sethi B, Wahoush O. Commonalities and Differences in the Experiences of Visible Minority Transnational Carer-Employees: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6800. [PMID: 37754659 PMCID: PMC10531478 DOI: 10.3390/ijerph20186800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/10/2023] [Accepted: 09/19/2023] [Indexed: 09/28/2023]
Abstract
This qualitative study explored the commonalities and differences among the experiences of visible minority Transnational Carer-Employees (TCEs) before and after COVID-19. TCEs are immigrants who live and work in the country of settlement while providing caregiving across international borders. Purposive and snowball sampling resulted in the participation of 29 TCEs of Pakistani, Syrian, African, and South American origin living in London, Ontario. Thematic analysis of the dataset using the ATLAS.ti software, Version 23.2.1., generated three themes: (1) feelings associated with transnational care; (2) employment experiences of TCEs; and (3) coping strategies for well-being. The results of the secondary analysis conducted herein suggested that there are more similarities than differences across the four cohorts. Many participants felt a sense of satisfaction at being able to fulfill their care obligations; however, a different outlook was observed among some Syrian and African origin respondents, who disclosed that managing care and work is overwhelming. Most TCEs also reported facing limited job options because of language barriers. While various interviewees experienced a lack of paid work and reduced income after COVID-19, a distinct perspective was noted from African descent TCEs as they expressed facing increased work demands after the pandemic. Participants additionally revealed four common coping strategies such as keeping busy, praying, family support, and staying active. Study implications include the promotion of Carer-Friendly Workplace Policies (CFWPs) that can facilitate the welfare of unpaid caregivers. This research is important as it may inform policymakers to create opportunities that may not only foster economic stability of TCEs and the Canadian economy, but also contribute towards a more equitable society.
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Affiliation(s)
- Reemal Shahbaz
- Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Allison Williams
- Faculty of Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Bharati Sethi
- Department of Political Studies, Trent University, Peterborough, ON K9L 0G2, Canada;
| | - Olive Wahoush
- School of Nursing, McMaster University, Hamilton, ON L8S 4L8, Canada;
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Villegas VC, Bosak DL, Salgado Z, Phoenix M, Parde N, Teplicky R, Khetani MA. Diversified caregiver input to upgrade the Young Children's Participation and Environment Measure for equitable pediatric re/habilitation practice. J Patient Rep Outcomes 2023; 7:87. [PMID: 37639038 PMCID: PMC10462549 DOI: 10.1186/s41687-023-00627-2] [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: 04/13/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Practitioner and family experiences of pediatric re/habilitation can be inequitable. The Young Children's Participation and Environment Measure (YC-PEM) is an evidence-based and promising electronic patient-reported outcome measure that was designed with and for caregivers for research and practice. This study examined historically minoritized caregivers' responses to revised YC-PEM content modifications and their perspectives on core intelligent virtual agent functionality needed to improve its reach for equitable service design. METHODS Caregivers were recruited during a routine early intervention (EI) service visit and met five inclusion criteria: (1) were 18 + years old; (2) identified as the parent or legal guardian of a child 0-3 years old enrolled in EI services for 3 + months; (3) read, wrote, and spoke English; (4) had Internet and telephone access; and (5) identified as a parent or legal guardian of a Black, non-Hispanic child or as publicly insured. Three rounds of semi-structured cognitive interviews (55-90 min each) used videoconferencing to gather caregiver feedback on their responses to select content modifications while completing YC-PEM, and their ideas for core intelligent virtual agent functionality. Interviews were transcribed verbatim, cross-checked for accuracy, and deductively and inductively content analyzed by multiple staff in three rounds. RESULTS Eight Black, non-Hispanic caregivers from a single urban EI catchment and with diverse income levels (Mdn = $15,001-20,000) were enrolled, with children (M = 21.2 months, SD = 7.73) enrolled in EI. Caregivers proposed three ways to improve comprehension (clarify item wording, remove or simplify terms, add item examples). Environmental item edits prompted caregivers to share how they relate and respond to experiences with interpersonal and institutional discrimination impacting participation. Caregivers characterized three core functions of a virtual agent to strengthen YC-PEM navigation (read question aloud, visual and verbal prompts, more examples and/or definitions). CONCLUSIONS Results indicate four ways that YC-PEM content will be modified to strengthen how providers screen for unmet participation needs and determinants to design pediatric re/habilitation services that are responsive to family priorities. Results also motivate the need for user-centered design of an intelligent virtual agent to strengthen user navigation, prior to undertaking a community-based pragmatic trial of its implementation for equitable practice.
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Affiliation(s)
- Vivian C Villegas
- Children's Participation in Environment Research Lab, University of Illinois Chicago, Chicago, IL, USA
| | - Dianna L Bosak
- Children's Participation in Environment Research Lab, University of Illinois Chicago, Chicago, IL, USA
| | - Zurisadai Salgado
- Children's Participation in Environment Research Lab, University of Illinois Chicago, Chicago, IL, USA
| | - Michelle Phoenix
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, USA
| | - Natalie Parde
- Department of Computer Science, University of Illinois Chicago, Chicago, IL, USA
| | - Rachel Teplicky
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, USA
| | - Mary A Khetani
- Children's Participation in Environment Research Lab, University of Illinois Chicago, Chicago, IL, USA.
- Department of Occupational Therapy, University of Illinois Chicago, 1919 West Taylor Street, Room 316A, Chicago, IL, 60612-7250, USA.
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Falako S, Okoli N, Boateng MO, Sandoval J, Gumudavelly D, Larsuel S, Opara I. Utilizing Community-Centered Approaches to Address Black Maternal Mortality. HEALTH EDUCATION & BEHAVIOR 2023; 50:500-504. [PMID: 37525982 PMCID: PMC11161891 DOI: 10.1177/10901981231177078] [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] [Indexed: 08/02/2023]
Abstract
The rise of Black maternal mortality rates throughout the country demonstrates a great need to utilize innovative frameworks to craft solutions that improve health outcomes for Black birthing people. Previous research and interventions have examined individual- and policy-level factors to reduce maternal mortality; however, these methods may lack a true community-centered approach to understanding the experiences of Black birthing people in local communities that have been disproportionately impacted. In addition, certain research methods may not recognize other marginalized intersectional identities (e.g., Black transgender men) who experience inequities in Black maternal health. This commentary aims to provide recommendations for utilizing community-centered strategies on Black maternal mortality informed by community-based participatory research principles.
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Affiliation(s)
- Simileoluwa Falako
- Yale University, New Haven, CT, USA
- Columbia University, New York, NY, USA
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Helu-Brown P, Barrio C, Hernandez M. Stigma and the Intersection of Ethnicity, Gender, Romantic Relationships, and Serious Mental Illness: Perspectives from Latinxs with Schizophrenia and Their Family Members. STIGMA AND HEALTH 2023; 8:344-354. [PMID: 37867559 PMCID: PMC10588796 DOI: 10.1037/sah0000439] [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] [Indexed: 10/24/2023]
Abstract
Romantic relationships are a fundamental part of the human experience and contribute to quality of life and recovery of people with serious mental illness (SMI). However, few psychosocial interventions exist to address this issue among people with schizophrenia, and no existing intervention focuses on Latinxs. The intersectionality of being Latinx and having schizophrenia can create a unique experience regarding stigma, romantic relationships, and gender. Guided by intersectionality theory, this study used qualitative content analysis and an intersectionality template analysis to examine data from interviews with 22 participants-11 people with diagnosed schizophrenia and their identified primary family member. Overall, findings illustrate perspectives about romantic relationships in a sample of Latinxs with schizophrenia and highlight the stigma that people with schizophrenia and their families can experience. Five key themes emerged from the data: obstacles to romantic relationships, advantages of romantic relationships, disadvantages of romantic relationships, gender-role issues and satisfaction with life, and hope for the future. Participants reported that stigma related to schizophrenia and the lack of employment were the main obstacles to establishing and maintaining romantic relationships. These findings provide an insider perspective on romantic relationships in a sample of Latinxs with schizophrenia and elucidate the importance of using an intersectionality lens to guide culturally responsive approaches.
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Affiliation(s)
| | - Concepcion Barrio
- Suzanne Dworak-Peck School of Social Work, University of Southern California
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Layland EK, Bränström R, Murchison GR, Pachankis JE. Kept in the Closet: Structural Stigma and the Timing of Sexual Minority Developmental Milestones Across 28 European Countries. J Youth Adolesc 2023:10.1007/s10964-023-01818-2. [PMID: 37410349 DOI: 10.1007/s10964-023-01818-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/25/2023] [Indexed: 07/07/2023]
Abstract
Structural stigma's role in lesbian, gay, and bisexual (LGB) people's attainment of identity development milestones remains unknown. In a sample of 111,498 LGB people (ages 15 to 65+) living across 28 European countries, associations were investigated between structural stigma measured using an objective index of discriminatory country-level laws and policies affecting LGB people and the timing and pacing of LGB self-awareness, coming out, and closet duration, and subgroup differences in these associations. On average, self-awareness occurred at age 14.8 years old (SD = 5.1), coming out occurred at 18.5 years old (SD = 5.7), and the closet was 3.9 years long (SD = 4.9); thereby highlighting adolescence as a key period for sexual identity development and disclosure. Greater structural stigma was associated with higher odds of never coming out, later age of coming out, and longer closet duration. Gender identity, transgender identity, and sexual identity moderated associations between structural stigma and these developmental milestones. Reducing structural stigma can plausibly promote sexual identity development among LGB populations, especially during adolescence when identity related milestones are often attained.
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Affiliation(s)
- E K Layland
- Department of Human Development and Family Sciences, University of Delaware, 111 Alison Hall West, Newark, DE, 19716, USA.
- Yale School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA.
| | - R Bränström
- Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77, Stockholm, Sweden
| | - G R Murchison
- Yale School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA
| | - J E Pachankis
- Yale School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA
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Acuff K, Delavar A, Radha Saseendrakumar B, Wu JH, Weinreb RN, Baxter SL. Associations between Socioeconomic Factors and Visit Adherence among Patients with Glaucoma in the All of Us Research Program. Ophthalmol Glaucoma 2023; 6:405-412. [PMID: 36746242 PMCID: PMC10400726 DOI: 10.1016/j.ogla.2023.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE To identify socioeconomic factors associated with visit adherence among patients with glaucoma in a nationwide cohort. DESIGN Cross-sectional study. SUBJECTS All subjects were participants in the National Institutes of Health All of Us Research Program. This study cohort consists of participants who were diagnosed with glaucoma and who answered the question on the Health Care Access and Utilization Survey regarding whether they have seen an eye care provider in the last 12 months. METHODS Descriptive analyses were conducted based on participant age, gender, race/ethnicity, insurance status, level of education, and income bracket. Multivariable logistic regression adjusting for these factors was used to generate odds ratios (ORs) for the association between socioeconomic factors and visit adherence. MAIN OUTCOME MEASURE Visit adherence, defined as reporting seeing an eye care provider in the last 12 months. RESULTS Among 4517 patients with glaucoma, 730 (16.3%) indicated that they had not seen or spoken to an eye doctor in the last 12 months. In multivariable models, those with some college education (OR: 1.91; 95% confidence interval [CI]: 1.19-3.04) and those with a college degree or advanced degree (OR: 2.25; 95% CI: 1.39-3.60) and those with the highest annual income of ≥ $200 000 (OR: 1.64; 95% CI: 1.10-2.45) were more likely to have seen an eye doctor in the past year compared with those in the lowest education and income categories, respectively. CONCLUSION Lower income and education levels were significantly associated with lower odds of seeing an eye doctor in the past year among all patients with glaucoma in All of Us. This highlights an important health disparity and may inform subsequent interventions to promote improved adherence to clinical guidelines regarding eye care for glaucoma monitoring and management. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Kaela Acuff
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California; Health Sciences Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Arash Delavar
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California; Health Sciences Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Bharanidharan Radha Saseendrakumar
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California; Health Sciences Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Jo-Hsuan Wu
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California; Health Sciences Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Sally L Baxter
- Hamilton Glaucoma Center, Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California; Health Sciences Department of Biomedical Informatics, University of California San Diego, La Jolla, California.
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Zapata JP, Petroll AE, Quinn KG, Zamantakis A, John SA. Implementation determinants of HIV Self-Testing among young sexual minority men. Arch Public Health 2023; 81:113. [PMID: 37344899 DOI: 10.1186/s13690-023-01126-y] [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: 03/23/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND HIV self-testing (HIVST) has shown the potential for reaching people with heightened vulnerability to HIV, including young sexual minority men (YSMM), yet implementation of HIVST among YSMM aged 17-24 is scarce as a prevention method. Moreover, despite the consistent finding that offering HIVST increases HIV testing rates, barriers remain that need to be reduced in order to maximize the potential of this biomedical technology. Such information is necessary to direct implementation efforts to increase HIVST among YSMM, including HIV counseling and linkage to care. The current study was therefore intended to investigate perspectives for HIVST among YSMM and how HIVST can be marketed to increase implementation. METHODS Between March and September 2020, we enrolled 41 YSMM to participate in one of nine online synchronous focus group discussions about their general experience with HIV preventive services. Guided by the Consolidated Framework (CFIR) for Implementation Research, we explored YSMM perspectives on facilitators and barriers to HIVST implementation. Data were analyzed using a deductive thematic content analysis approach. RESULTS Many participants had never used HIVST before their participation in this study (n = 30; 73.2%). Qualitative results exhibited a variety of implementation determinants across the five CFIR 2.0 domains. Barriers included concerns about the format in which the testing materials would be provided (i.e., nature of packaging) and about the method in which the sample would need to be collected, particularly for those who had the testing kit mailed to their home address. These reservations were nested in the fear of unwanted disclosure of their sexual behavior, namely among the respondents who had to cohabitate with family due to the COVID-19 pandemic. Participants also discussed the limited local resources for HIVST. Many participants suggested programs that could be implemented to support HIVST, such as collaborations with trusted community agencies. CONCLUSIONS Understanding YSMM' perspectives of HIVST may help identify implementation deficiencies within the delivery system and aid the development of implementation strategies to promote reach of HIVST.
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Affiliation(s)
- Juan Pablo Zapata
- Institute for Sexual and Gender Minority Health and Wellbeing, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave 14th Floor, Chicago, IL, 60611, USA.
| | - Andrew E Petroll
- Health Intervention Sciences Group, Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Katherine G Quinn
- Health Intervention Sciences Group, Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alithia Zamantakis
- Institute for Sexual and Gender Minority Health and Wellbeing, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave 14th Floor, Chicago, IL, 60611, USA
| | - Steven A John
- Health Intervention Sciences Group, Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Palmer Molina A, Ponting C, Hernandez Y, Traube DE, Pham D, Garcia I, Mennen FE. Pandemic-Related Stress and Resilience Among Latinx Mothers with a History of Depression: Differences by Immigration Status. JOURNAL OF HUMAN RIGHTS AND SOCIAL WORK 2023; 8:1-14. [PMID: 37360667 PMCID: PMC10172054 DOI: 10.1007/s41134-023-00249-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 06/28/2023]
Abstract
This study explores the impact of the COVID-19 pandemic on low-income, Latinx mothers in Southern California with a history of depression, including undocumented mothers and members of mixed status families. Drawing participants from a parent study that provided a maternal depression intervention to Head Start mothers (n = 119), this mixed method study integrates qualitative and quantitative data in a convergent design. Thirty-four mothers completed semi-structured qualitative interviews and standardized questionnaires in the fall of 2020. Mothers shared overwhelming economic difficulties, with the majority reporting that their family income decreased and half reporting that they were unable to pay for housing. Stressors were compounded for undocumented mothers and members of mixed-status families who were excluded from major relief programs. Stress affected maternal mental health, and mothers with precarious status reported differences in functioning. Mothers also identified positive ways that they coped with adversity. Results show that Latinx mothers with a history of depression, particularly mothers with precarious immigration status, continue to suffer considerable economic, social, and emotional impacts of the COVID-19 pandemic. Social workers can support the human rights of this population by advocating for financial relief, food assistance, and the expansion of medical-legal partnerships and physical and mental health services.
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Affiliation(s)
| | - Carolyn Ponting
- Department of Psychology, University of California Los Angeles, Los Angeles, CA USA
| | - Yuliana Hernandez
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA USA
| | - Dorian E. Traube
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA USA
| | - Duyen Pham
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA USA
| | - Iliana Garcia
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA USA
| | - Ferol E. Mennen
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA USA
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Raque TL, Ross KV, Hangge AR, Gaines RC. A Meta-Ethnography on the Impact of Cancer for Lesbian and Queer Women and Their Partners. QUALITATIVE HEALTH RESEARCH 2023; 33:371-387. [PMID: 36802915 DOI: 10.1177/10497323231155403] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Lesbian and queer women face unique experiences navigating cancer care, including challenges in accessing services that incorporate their relational supports. Given the importance of social support for survivorship, this study examines the impact of cancer on lesbian/queer women in romantic relationships. We conducted the seven stages of Noblit and Hare's meta-ethnography. PubMed/MEDLINE, PsycINFO, SocINDEX, and Social Sciences Abstract databases were searched. Two hundred and ninety citations were initially identified, 179 abstracts were reviewed, and 20 articles were coded. Themes were (a) intersectionality of lesbian/queer identity in the cancer context; (b) institutional and systemic supports and barriers; (c) navigation of disclosure; (d) characteristics of affirmative cancer care; (e) survivors' critical reliance on their partner(s); and (f) shifts in connection after cancer. Findings indicate the importance of accounting for intrapersonal, interpersonal, institutional, and socio-cultural-political factors for understanding the impact of cancer for lesbian and queer women and their romantic partners. Affirmative cancer care for sexual minorities fully validates and integrates partners in care, removes heteronormative assumptions in services provided, and offers LGB+ patient and partner support services.
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Affiliation(s)
- Trisha L Raque
- Department of Counseling Psychology, University of Denver, Denver, CO, USA
| | - Kaitlin V Ross
- Department of Counseling Psychology, University of Denver, Denver, CO, USA
| | - Anna R Hangge
- Department of Counseling Psychology, University of Denver, Denver, CO, USA
| | - Rebecca C Gaines
- Department of Counseling Psychology, University of Denver, Denver, CO, USA
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Yang YY, Yang YP, Chen KM, Wang CJ, Chang SH, Wang JJ. A Feasibility Evaluation of the Need-Centered Watch-Assess-Need Intervention-Think Education and Training Program for Behavioral and Psychological Symptoms of Dementia. J Nurs Res 2023; 31:e266. [PMID: 36976538 DOI: 10.1097/jnr.0000000000000548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Despite the high prevalence of dementia among residents living in long-term care facilities in Taiwan, most care providers in these facilities have not received adequate training to deal with the behavioral and psychological symptoms of dementia (BPSD). An original care and management model for BPSD has been developed, and model-based recommendations for an education and training program have been made. However, empirical testing has not yet been conducted to determine the efficacy of this program. PURPOSE This study was designed to evaluate the feasibility of using the Watch-Assess-Need intervention-Think (WANT) education and training program for BPSD in long-term care settings. METHODS A mixed-method design was used. Twenty care providers and 20 corresponding care receivers (residents with dementia) from a nursing home in southern Taiwan were enrolled. Data were collected using a variety of measurement tools, including the Cohen-Mansfield Agitation Inventory, Cornell Scale for Depression in Dementia, Attitude towards Dementia Care Scale, and Dementia Behavior Disturbance Self-efficacy Scale. Qualitative data, including care-provider perspectives on the efficacy of the WANT education and training program, were also collected. Repeated measures were conducted on the results of quantitative data analysis, whereas content analysis was performed on the results of qualitative data analysis. RESULTS Findings indicate that the program relieves agitated behavior (p = .01), alleviates depression in those with dementia (p < .001), and enhances care-provider attitudes toward dementia care (p = .01). However, no significant improvement was found in self-efficacy among the care providers (p = .11). In terms of qualitative outcomes, care providers indicated they perceived improved self-efficacy in managing BPSD, improved ability to view problems from a more need-centered perspective, improved attitudes toward dementia and patients' BPSD, and decreased care burden and stress. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The study found the WANT education and training program to be feasible in clinical practice. Because of this program's simple and easy-to-remember characteristics, it is recommended that it be vigorously promoted to care providers in both long-term institutional and home care settings to help them effectively address the BPSD.
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Affiliation(s)
- Yueh-Ying Yang
- PhD, RN, Assistant Professor, Department of Nursing, Fooyin University, Taiwan
| | - Ya-Ping Yang
- PhD, RN, Associate Professor, Department of Nursing, National Tainan Junior College of Nursing, Taiwan
| | - Kuei-Min Chen
- PhD, RN, Professor, Department of Nursing, School of Nursing, Kaohsiung Medical University, Taiwan
| | - Chi-Jane Wang
- PhD, RN, Associate Professor, Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan
| | - Su-Hsien Chang
- PhD, RN, Associate Professor, Department of Nursing, National Tainan Junior College of Nursing, Taiwan
| | - Jing-Jy Wang
- PhD, RN, Professor, Department of Nursing, College of Medicine, National Cheng Kung University, and Alzheimer Disease Research Center, National Cheng Kung University Hospital, Taiwan
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Göttgens I, Modderkolk L, Jansen C, Darweesh SKL, Bloem BR, Oertelt-Prigione S. The salience of gender in the illness experiences and care preferences of people with Parkinson's disease. Soc Sci Med 2023; 320:115757. [PMID: 36738652 DOI: 10.1016/j.socscimed.2023.115757] [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: 08/01/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023]
Abstract
RATIONALE In recent years, interest in sex characteristics and gender dimensions of Parkinson's disease (PD) has increased. Yet, much remains to be understood about how gender-related aspects specifically impact the illness and experiences of care in persons living with PD. OBJECTIVE The purpose of this study was to explore the salience of gender-related aspects in the illness experiences and care provision preferences of people with PD. METHODS A descriptive qualitative study including semi-structured life story interviews was conducted with men and women living with PD in the Netherlands. Between September 2020 and February 2021, forty people with PD (20 men and 20 women) participated in digital interviews of which thirty-one (18 men and 13 women) were included in the thematic analyses for this specific study. RESULTS Overall, most participants did not consider gender-related aspects salient towards their illness experiences. However, when prompted, a number of participants described several stereotypical views about gender as related to the visibility of PD, emotional experiences, help seeking, role patterns and physical appearance. While most men and women with PD did not express specific gender-related preferences for their healthcare providers, those that did, all preferred women as healthcare providers. These preferences were generally related to attributed feminine traits which are considered relevant in routine, particularly sensitive, physical examinations of people with PD. CONCLUSION This study demonstrates that although every person has a gender identity, the salience attributed to gender varies with illness experiences and in care provision preferences between people with PD. These findings highlight the need for precise and personalized methodologies to capture more nuanced insights into the impact of gender dimensions on PD. Furthermore, drivers behind gender-related preferences in care provision are multifactorial and warrant further investigation among people with PD.
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Affiliation(s)
- Irene Göttgens
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Linda Modderkolk
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Sirwan K L Darweesh
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands; AG 10 Sex- and Gender-sensitive Medicine, Medical Faculty OWL, University of Bielefeld, Bielefeld, Germany.
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Estupiñán Fdez de Mesa M, Marcu A, Ream E, Whitaker KL. Relationship between intersectionality and cancer inequalities: a scoping review protocol. BMJ Open 2023; 13:e066637. [PMID: 36707112 PMCID: PMC9884887 DOI: 10.1136/bmjopen-2022-066637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Persistent inequalities in cancer care and cancer outcomes exist within and between countries. However, the evidence pertaining to the root causes driving cancer inequalities is mixed. This may be explained by the inadequate attention paid to experiences of patients with cancer living at the intersection of multiple social categories (eg, social class, ethnicity). This is supported by the intersectionality framework. This framework offers an alternative lens through which to analyse and understand how these interlocking systems of oppression uniquely shape the experiences of patients with cancer and drive inequalities. In this protocol, we outline a scoping review that will systematically map what is known about the relationship between intersectionality and inequalities in care experience and cancer outcomes of patients with cancer; and to determine how the intersectionality framework has been applied in studies across the cancer care pathway and across countries. METHODS AND ANALYSIS This study will be guided by Arksey and O'Malley's, and Levac et al's frameworks for scoping reviews. We will identify and map the evidence on cancer inequalities and intersectionality from 1989 to present date. Electronic databases (EMBASE, PsychINFO, CINAHL, Medline, Web of Science, ProQuest) and a systematic search strategy using a combination of keywords and Boolean operators AND/OR will be used to identify relevant studies. Screening of eligible papers and data extraction will be conducted by two independent reviewers, and disagreements resolved by discussion with the research team. We will use an iterative process to data charting using a piloted form. Findings will be collated into a narrative report. ETHICS AND DISSEMINATION Ethical approval is not required since data used are from publicly available secondary sources. Findings will be disseminated through peer-reviewed journals, conferences and stakeholder meetings. Further, findings will inform the next phases of a multistage research project aimed at understanding inequalities among patients with breast cancer.
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Affiliation(s)
| | - Afrodita Marcu
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Emma Ream
- School of Health Sciences, University of Surrey, Guildford, UK
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Hasemann Lara JE. Health Sector Reform in Honduras: Privatization as Institutional Bad Faith. Med Anthropol 2023; 42:62-75. [PMID: 36174649 DOI: 10.1080/01459740.2022.2125388] [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: 02/04/2023]
Abstract
I address the privatization of public health care services in Honduras by focusing on one family's experiences using both private and public health services. I juxtapose their increasing use of private health care services, over public services, against sustained and consistent episodes of health sector reform culminating in protests against decrees that sought to further restructure the Ministry of Health during early 2019. By complementing the concept of "privatization by attrition" with "institutional bad faith," I argue that the increased use of private health care may be understood as privatization by coercion.
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Santos LAD, Unsain RF, Brasil SA, Silva LAVD, Duarte FM, Couto MT. PrEP perception and experiences of adolescent and young gay and bisexual men: an intersectional analysis. CAD SAUDE PUBLICA 2023; 39Suppl 1:e00134421. [PMID: 36995863 DOI: 10.1590/0102-311xen134421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/11/2021] [Indexed: 03/29/2023] Open
Abstract
Studies indicate gaps in knowledge about the barriers to access and adhere to HIV pre-exposure prophylaxis (PrEP) in adolescents. In this article, we explore the perceptions and experiences of young gay, bisexual, and other men who have sex with men (YGBMSM) of the search, use and adherence to PrEP, considering their positions according to social markers of difference such as race/skin color, gender, sexuality, and social status. Intersectionality provides theoretical and methodological tools to interpret how the interlinking of these social markers of difference constitutes barriers and facilitators in the PrEP care continuum. The analyzed material is part of the PrEP1519 study and is comprised of 35 semi-structured interviews with YGBMSM from two Brazilian capitals (Salvador and São Paulo). The analyses suggest connections between social markers of difference, sexual cultures, and the social meanings of PrEP. Subjective, relational and symbolic aspects permeate the awareness of PrEP in the range of prevention tools. Willingness to use and adhere to PrEP is part of a learning process, production of meaning, and negotiation in the face of getting HIV and other sexually transmittable infections and the possibilities of pleasure. Thus, accessing and using PrEP makes several adolescents more informed about their vulnerabilities, leading to more informed decision-making. Interlinking the PrEP continuum of care among YGBMSM with the intersections of the social markers of difference may provide a conceptual framework to problematize the conditions and effects of implementing this prevention strategy, which could bring advantages to HIV prevention programs.
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Murphy N, Azzopardi P, Bowen K, Quinn P, Rarama T, Dawainavesi A, Bohren MA. Using social capital to address youth sexual and reproductive health and rights in disaster preparedness and response: A qualitative study highlighting the strengths of Pacific community organisations and networks. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001624. [PMID: 37146000 PMCID: PMC10162552 DOI: 10.1371/journal.pgph.0001624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/12/2023] [Indexed: 05/07/2023]
Abstract
In the Pacific region, youth sexual and reproductive health and rights (SRHR) are strongly influenced by sociocultural and structural factors, which limit access to SRHR information and services for youth. As climate-related disasters intensify in the Pacific, existing challenges to youth SRHR may increase the risk of worse SRHR experiences and outcomes for youth before, during and after disasters. Community-based models of SRHR service provision models increase accessibility for youth in non-disaster times, but there is limited evidence of how community organisations address youth SRHR in disaster contexts. We conducted qualitative interviews with 16 participants from community organisations and networks in Fiji, Vanuatu, and Tonga following the 2020 Tropical Cyclone (TC) Harold. Guided by the Recovery Capitals Framework (natural, built, political, cultural, human, social, and financial capitals), we explored how community organisations addressed challenges to facilitate access to youth SRHR information and services. Social capital in the form of peer networks and virtual safe spaces was used to navigate challenges in political, financial, and natural capitals. Existing relationships and trusted collaborations were crucial to address cultural taboos related to youth SRHR. Previous experiences of disasters and knowledge of contexts enabled participants to provide sustainable solutions to identified SRHR needs. The work conducted by community organisations and networks pre-disaster made it easier to identify and address youth SRHR risks following disasters. Our research offers a unique perspective into how social capitals were used to mitigate challenges to youth SRHR across natural, human, financial, cultural, built, and political capitals. Findings offer important opportunities to invest in existing community strengths, for transformative action to advance the SRHR of Pacific youth.
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Affiliation(s)
- Nabreesa Murphy
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Melbourne Climate Futures, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Institute for Advanced Sustainability Studies, Potsdam, Germany
| | - Peter Azzopardi
- Department of Paediatrics, Burnet Institute, South Australian Health and Medical Research Institute, Global Adolescent Health Group, Maternal Child and Adolescent Health Program, AND Adolescent Health and Wellbeing Program, Aboriginal Health Equity Theme, University of Melbourne, Melbourne, Australia
| | - Kathryn Bowen
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Melbourne Climate Futures, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Institute for Advanced Sustainability Studies, Potsdam, Germany
| | - Phoebe Quinn
- Melbourne Climate Futures, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Institute for Advanced Sustainability Studies, Potsdam, Germany
- Child & Community Wellbeing Unit, Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Tamani Rarama
- Fiji Youth Sexual and Reproductive Health and Rights Alliance (FYSA), Suva, Fiji
| | - Akanisi Dawainavesi
- Pacific Sub-Regional Office for International Planned Parenthood Federation (IPPF), Suva, Fiji
| | - Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
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