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Alderwick H, Hutchings A, Mays N. Solving poverty or tackling healthcare inequalities? Qualitative study exploring local interpretations of national policy on health inequalities under new NHS reforms in England. BMJ Open 2024; 14:e081954. [PMID: 38589267 PMCID: PMC11015303 DOI: 10.1136/bmjopen-2023-081954] [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: 11/10/2023] [Accepted: 03/15/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVES Major reforms to the organisation of the National Health Service (NHS) in England established 42 integrated care systems (ICSs) to plan and coordinate local services. The changes are based on the idea that cross-sector collaboration is needed to improve health and reduce health inequalities-and similar policy changes are happening elsewhere in the UK and internationally. We explored local interpretations of national policy objectives on reducing health inequalities among senior leaders working in three ICSs. DESIGN We carried out qualitative research based on semistructured interviews with NHS, public health, social care and other leaders in three ICSs in England. SETTING AND PARTICIPANTS We selected three ICSs with varied characteristics all experiencing high levels of socioeconomic deprivation. We conducted 32 in-depth interviews with senior leaders of NHS, local government and other organisations involved in the ICS's work on health inequalities. Our interviewees comprised 17 leaders from NHS organisations and 15 leaders from other sectors. RESULTS Local interpretations of national policy objectives on health inequalities varied, and local leaders had contrasting-sometimes conflicting-perceptions of the boundaries of ICS action on reducing health inequalities. Translating national objectives into local priorities was often a challenge, and clarity from national policy-makers was frequently perceived as limited or lacking. Across the three ICSs, local leaders worried that objectives on tackling health inequalities were being crowded out by other short-term policy priorities, such as reducing pressures on NHS hospitals. The behaviour of national policy-makers appeared to undermine their stated priorities to reduce health inequalities. CONCLUSIONS Varied and vague interpretations of NHS policy on health inequalities are not new, but lack of clarity among local health leaders brings major risks-including interventions being poorly targeted or inadvertently widening inequalities. Greater conceptual clarity is likely needed to guide ICS action in future.
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Affiliation(s)
- Hugh Alderwick
- Health Foundation, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Nicholas Mays
- London School of Hygiene and Tropical Medicine, London, UK
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Gkiouleka A, Wong G, Sowden S, Kuhn I, Moseley A, Manji S, Harmston RR, Siersbaek R, Bambra C, Ford JA. Reducing health inequalities through general practice: a realist review and action framework. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-104. [PMID: 38551093 DOI: 10.3310/ytww7032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Background Socio-economic inequalities in health have been in the public agenda for decades. General practice has an influential role to play in mitigating the impact of inequalities especially regarding chronic conditions. At the moment, general practice is dealing with serious challenges in relation to workforce shortages, increasing workload and the impact of the COVID-19 pandemic. It is important to identify effective ways so that general practice can play its role in reducing health inequalities. Objectives We explored what types of interventions and aspects of routine care in general practice decrease or increase inequalities in health and care-related outcomes. We focused on cardiovascular disease, cancer, diabetes and/or chronic obstructive pulmonary disease. We explored for whom these interventions and aspects of care work best, why, and in what circumstances. Our main objective was to synthesise this evidence into specific guidance for healthcare professionals and decision-makers about how best to achieve equitable general practice. Design Realist review. Main outcome measures Clinical or care-related outcomes by socio-economic group, or other PROGRESS-Plus criteria. Review methods Realist review based on Pawson's five steps: (1) locating existing theories, (2) searching for evidence, (3) selecting articles, (4) extracting and organising data and (5) synthesising the evidence. Results Three hundred and twenty-five studies met the inclusion criteria and 159 of them were selected for the evidence synthesis. Evidence about the impact of general practice interventions on health inequalities is limited. To reduce health inequalities, general practice needs to be: • connected so that interventions are linked and coordinated across the sector; • intersectional to account for the fact that people's experience is affected by many of their characteristics; • flexible to meet patients' different needs and preferences; • inclusive so that it does not exclude people because of who they are; • community-centred so that people who receive care engage with its design and delivery. These qualities should inform action across four domains: structures like funding and workforce distribution, organisational culture, everyday regulated procedures involved in care delivery, interpersonal and community relationships. Limitations The reviewed evidence offers limited detail about the ways and the extent to which specific interventions increase or decrease inequalities in general practice. Therefore, we focused on the underpinning principles that were common across interventions to produce higher-level, transferrable conclusions about ways to achieve equitable care. Conclusions Inequalities in general practice result from complex processes across four different domains that include structures, ideas, regulated everyday procedures, and relationships among individuals and communities. To achieve equity, general practice needs to be connected, intersectional, flexible, inclusive and community-centred. Future work Future work should focus on how these five essential qualities can be better used to shape the organisational development of future general practice. Study registration This trial is registered as PROSPERO CRD42020217871. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130694) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 7. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Anna Gkiouleka
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences and Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
| | - Sarah Sowden
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Isla Kuhn
- University of Cambridge Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Annie Moseley
- Patient and Public Involvement Representative, Norwich, UK
| | - Sukaina Manji
- Department of Educational Research, Lancaster University, Lancaster, UK
| | | | - Rikke Siersbaek
- Health System Foundations for Sláintecare Implementation, Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John A Ford
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Young-Silva Y, Berenguera A, Jacques-Aviñó C, Gil-Girbau M, Arroyo-Uriarte P, Chela-Alvarez X, Ripoll J, Martí-Lluch R, Ramos R, Elizondo-Alzola U, Garcia-Martinez S, Méndez-López F, Tamayo-Morales O, Martínez-Andrés M, Motrico E, Gómez-Gómez I, Fernández-Alvarez R, Juvinyà-Canal D. Role of personal aptitudes as determinants of incident morbidity, lifestyles, quality of life, use of the health services and mortality (DESVELA cohort): qualitative study protocol for a prospective cohort study in a hybrid analysis. Front Public Health 2023; 11:1069957. [PMID: 37361167 PMCID: PMC10289184 DOI: 10.3389/fpubh.2023.1069957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/16/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Maintaining or acquiring healthier health-oriented behaviours and promoting physical and mental health amongst the Spanish population is a significant challenge for Primary Health Care. Although the role of personal aptitudes (characteristics of each individual) in influencing health behaviours is not yet clear, these factors, in conjunction with social determinants such as gender and social class, can create axes of social inequity that affect individuals' opportunities to engage in health-oriented behaviours. Additionally, lack of access to health-related resources and opportunities can further exacerbate the issue for individuals with healthy personal aptitudes. Therefore, it is crucial to investigate the relationship between personal aptitudes and health behaviours, as well as their impact on health equity. Objectives This paper outlines the development, design and rationale of a descriptive qualitative study that explores in a novel way the views and experiences on the relationship between personal aptitudes (activation, health literacy and personality traits) and their perception of health, health-oriented behaviours, quality of life and current health status. Method and analysis This qualitative research is carried out from a phenomenological perspective. Participants will be between 35 and 74 years of age, will be recruited in Primary Health Care Centres throughout Spain from a more extensive study called DESVELA Cohort. Theoretical sampling will be carried out. Data will be collected through video and audio recording of 16 focus groups in total, which are planned to be held in 8 different Autonomous Communities, and finally transcribed for a triangulated thematic analysis supported by the Atlas-ti program. Discussion We consider it essential to understand the interaction between health-related behaviours as predictors of lifestyles in the population, so this study will delve into a subset of issues related to personality traits, activation and health literacy.Clinical trial registration: ClinicalTrials.gov, identifier NCT04386135.
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Affiliation(s)
- Yudy Young-Silva
- Unitat de Suport a la recerca Girona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Goli Gurina (IDIAPJGol), Girona, Spain
- Facultat d’Infermeria, Universitat de Girona, Girona, Spain
| | - Anna Berenguera
- Facultat d’Infermeria, Universitat de Girona, Girona, Spain
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Goli Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Network on Chronicity, Primary Care, and Health Prevention and Promotion(RICAPPS), Spain
| | - Constanza Jacques-Aviñó
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Goli Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Network on Chronicity, Primary Care, and Health Prevention and Promotion(RICAPPS), Spain
| | - Montserrat Gil-Girbau
- Network on Chronicity, Primary Care, and Health Prevention and Promotion(RICAPPS), Spain
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de LLobregat, Spain
- Parc Sanitari Sant Joan de Déu, San Boi de Llobregat, Spain
| | - Paula Arroyo-Uriarte
- Network on Chronicity, Primary Care, and Health Prevention and Promotion(RICAPPS), Spain
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de LLobregat, Spain
| | - Xenia Chela-Alvarez
- Network on Chronicity, Primary Care, and Health Prevention and Promotion(RICAPPS), Spain
- Primary Care Research Unit of Mallorca (IB-Salut), Balearic Health Service, Palma de Mallorca, Spain
- Research Group in Primary Care and Promotion-Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Joana Ripoll
- Network on Chronicity, Primary Care, and Health Prevention and Promotion(RICAPPS), Spain
- Primary Care Research Unit of Mallorca (IB-Salut), Balearic Health Service, Palma de Mallorca, Spain
- Research Group in Primary Care and Promotion-Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Ruth Martí-Lluch
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Network on Chronicity, Primary Care, and Health Prevention and Promotion(RICAPPS), Spain
- Vascular Health Research Group of Girona, Institut Universitari per a la Recerca a l'Atenció Primària Jordi Gol I Gurina (IDIAPJGol), Girona, Catalonia, Spain
- Girona Biomedical Research Institute, Girona, Catalonia, Spain
| | - Rafel Ramos
- Network on Chronicity, Primary Care, and Health Prevention and Promotion(RICAPPS), Spain
- Vascular Health Research Group of Girona, Institut Universitari per a la Recerca a l'Atenció Primària Jordi Gol I Gurina (IDIAPJGol), Girona, Catalonia, Spain
- Girona Biomedical Research Institute, Girona, Catalonia, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
- Primary Care Services, Catalan Institute of Health, Girona, Catalonia, Spain
| | - Usue Elizondo-Alzola
- Grupo de Investigación en Ciencias de la Diseminación e Implementación en Servicios Sanitarios, Instituto Investigación de Biocruces, Barakaldo, Spain
| | - Sandra Garcia-Martinez
- Grupo de Investigación en Ciencias de la Diseminación e Implementación en Servicios Sanitarios, Instituto Investigación de Biocruces, Barakaldo, Spain
| | - Fátima Méndez-López
- Network on Chronicity, Primary Care, and Health Prevention and Promotion(RICAPPS), Spain
- Aragonese Primary Care Research Group (GAIAP), Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
| | - Olaya Tamayo-Morales
- Network on Chronicity, Primary Care, and Health Prevention and Promotion(RICAPPS), Spain
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL) Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Mária Martínez-Andrés
- Network on Chronicity, Primary Care, and Health Prevention and Promotion(RICAPPS), Spain
- Faculty of Nursing, Universidad de Castilla La Mancha, Albacete, Spain
- Social and Health Research Center, Universidad de Castilla La Mancha, Cuenca, Spain
| | - Emma Motrico
- Network on Chronicity, Primary Care, and Health Prevention and Promotion(RICAPPS), Spain
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain
| | - Irene Gómez-Gómez
- Network on Chronicity, Primary Care, and Health Prevention and Promotion(RICAPPS), Spain
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain
| | - Roberto Fernández-Alvarez
- Ourense Health Area, SERGAS, Ourence, Spain
- Centro de Saúde de Allariz, SERGAS, Allariz, Spain
- I-Saúde Grup, South Galicia Health Research Institute, Vigo, Spain
| | - Dolors Juvinyà-Canal
- Facultat d’Infermeria, Universitat de Girona, Girona, Spain
- Grup de recerca Salut i Atenció sanitària Universitat de Girona, Girona, Spain
- Càtedra de Promoció de la Salut Universitat de Girona, Girona, Spain
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Gkiouleka A, Wong G, Sowden S, Bambra C, Siersbaek R, Manji S, Moseley A, Harmston R, Kuhn I, Ford J. Reducing health inequalities through general practice. Lancet Public Health 2023; 8:e463-e472. [PMID: 37244675 DOI: 10.1016/s2468-2667(23)00093-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/30/2023] [Accepted: 04/18/2023] [Indexed: 05/29/2023]
Abstract
Although general practice can contribute to reducing health inequalities, existing evidence provides little guidance on how this reduction can be achieved. We reviewed interventions influencing health and care inequalities in general practice and developed an action framework for health professionals and decision makers. We conducted a realist review by searching MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Cochrane Library for systematic reviews of interventions into health inequality in general practice. We then screened the studies in the included systematic reviews for those that reported their outcomes by socioeconomic status or other PROGRESS-Plus (Cochrane Equity Methods Group) categories. 159 studies were included in the evidence synthesis. Robust evidence on the effect of general practice on health inequalities is scarce. Focusing on common qualities of interventions, we found that to reduce health inequalities, general practice needs to be informed by five key principles: involving coordinated services across the system (ie, connected), accounting for differences within patient groups (ie, intersectional), making allowances for different patient needs and preferences (ie, flexible), integrating patient worldviews and cultural references (ie, inclusive), and engaging communities with service design and delivery (ie, community-centred). Future work should explore how these principles can inform the organisational development of general practice.
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Affiliation(s)
- Anna Gkiouleka
- Department of Public Health and Primary Care, Cambridge, UK
| | - Geoff Wong
- University of Cambridge, Cambridge, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah Sowden
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Rikke Siersbaek
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Sukaina Manji
- Department of Educational Research, Lancaster University, Lancaster, UK
| | | | | | - Isla Kuhn
- University of Cambridge Medical Library, School of Clinical Medicine, Cambridge, UK
| | - John Ford
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
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French M, Keegan T, Preston N. Facilitating equitable access to hospice care in socially deprived areas: A mixed methods multiple case study. Palliat Med 2022; 37:508-519. [PMID: 36380483 PMCID: PMC10074748 DOI: 10.1177/02692163221133977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is uncertainty about the factors influencing inequities in access to palliative care in socially deprived areas, including the role of service models and professional perceptions. AIM To explore the relationship between social deprivation and access to hospice care, including factors influencing access and professional experiences of providing care. DESIGN A mixed-methods multiple case study approach was used. Hospice referrals data were analysed using generalised linear mixed models and other regression analyses. Qualitative interviews with healthcare professionals were analysed using thematic analysis. Findings from different areas (cases) were compared in a cross-case analysis. SETTING The study took place in North West England, using data from three hospices (8699 hospice patients) and interviews with 42 healthcare professionals. RESULTS Social deprivation was not statistically significantly, or consistently, associated with hospice referrals in the three cases (Case 1, Incidence Rate Ratio 1.04, p = 0.75; Case 2, Incidence Rate Ratio 1.09, p = 0.15, Case 3, Incidence Rate Ratio 0.88, p = 0.35). Hospice data and interviews suggest the model of hospice care, including working relationship with hospitals, and the local nature of social deprivation influenced access. Circumstances associated with social deprivation can conflict with professional expectations within palliative care. CONCLUSION Hospice care in the UK can be organised in ways that facilitate referrals of patients from socially deprived areas, although uncertainty about what constitutes need limits conclusions about equity. Grounding professional narratives around expectations, responsibility, and choice in frameworks that recognise the sociostructural influences on end-of-life circumstances may help to foster more equitable palliative care.
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Affiliation(s)
- Maddy French
- Division of Health Research, Lancaster University, UK
| | | | - Nancy Preston
- Division of Health Research, Lancaster University, UK
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Why don't general dental practitioners test for diabetes in periodontitis patients? How infrastructure, role identity and self-efficacy can prevent effective shared care. Br Dent J 2022; 232:798-803. [PMID: 35689063 PMCID: PMC9185712 DOI: 10.1038/s41415-022-4294-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022]
Abstract
Aim To explore the attitudes of general dental practitioners (GDPs) towards testing for diabetes in periodontitis patients amid recommendations from professional organisations that dentists and oral health professionals are well-positioned to support the diagnosis of diabetes in primary dental care. Method GDPs were selected based on purposeful sampling. The number of GDPs recruited was dependent on thematic saturation. Semi-structured telephone interviews were conducted with all recruited GDPs. Interviews were audio recorded and transcribed verbatim. Thematic analysis was utilised to generate initial codes and subsequent themes. Results Fifteen GDPs participated in this qualitative study. Three main interrelated themes emerged: 1) there is an inadequate infrastructure within the current NHS; 2) the difference in the definition and threshold of the social and professional roles and identities of GDPs; and 3) there is a low self-efficacy to testing due to a perceived lack of knowledge. Conclusions This qualitative study has identified the barriers to and enablers for testing for diabetes in patients with periodontitis attending general dental practices in England. The findings have the potential to influence interventions and policies going forward to improve the co-management of diabetes and periodontitis within primary healthcare. NHS-practising GDPs perceived the current infrastructure of the health service to be their biggest barrier to implementation of such testing. All GDPs, whether NHS or private, had varied perspectives on their social and professional role and identity in relation to such testing. Self-efficacy in the realm of testing was generally low due to a lack of perceived knowledge, training and competence.
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McMahon NE. What shapes local health system actors' thinking and action on social inequalities in health? A meta-ethnography. SOCIAL THEORY & HEALTH 2022; 21:119-139. [PMID: 35125968 PMCID: PMC8801929 DOI: 10.1057/s41285-022-00176-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 12/14/2022]
Abstract
Local health systems are increasingly tasked to play a more central role in driving action to reduce social inequalities in health. Past experience, however, has demonstrated the challenge of reorienting health system actions towards prevention and the wider determinants of health. In this review, I use meta-ethnographic methods to synthesise findings from eleven qualitative research studies that have examined how ambitions to tackle social inequalities in health take shape within local health systems. The resulting line-of-argument illustrates how such inequalities continue to be problematised in narrow and reductionist ways to fit both with pre-existing conceptions of health, and the institutional practices which shape thinking and action. Instances of health system actors adopting a more social view of inequalities, and taking a more active role in influencing the social and structural determinants of health, were attributed to the beliefs and values of system leaders, and their ability to push-back against dominant discourses and institutional norms. This synthesised account provides an additional layer of understanding about the specific challenges experienced by health workforces when tasked to address this complex and enduring problem, and provides essential insights for understanding the success and shortcomings of future cross-sectoral efforts to tackle social inequalities in health. Supplementary Information The online version contains supplementary material available at 10.1057/s41285-022-00176-6.
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Affiliation(s)
- Naoimh E. McMahon
- Division of Health Research, National Institute for Health Research School for Public Health Research (NIHR SPHR), Lancaster University, Lancaster, LA1 4YW UK
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Brown CL, Raza D, Pinto AD. Voting, health and interventions in healthcare settings: a scoping review. Public Health Rev 2020; 41:16. [PMID: 32626605 PMCID: PMC7329475 DOI: 10.1186/s40985-020-00133-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/27/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In democracies, voting is an important action through which citizens engage in the political process. Although elections are only one aspect of political engagement, voting sends a signal of support or dissent for policies that ultimately shape the social determinants of health. Social determinants subsequently influence who votes and who does not. Our objective is to examine the existing research on voting and health and on interventions to increase voter participation through healthcare organizations. METHODS We conducted a scoping review to examine the existing research on voting, health, and interventions to increase voter participation through healthcare organizations. We carried out a search of the indexed, peer-reviewed literature using Ovid MEDLINE (1946-present), PsychINFO (1806-present), Ebsco CINAHL, Embase (1947-present), Web of Science, ProQuest Sociological Abstracts, and Worldwide Political Science Abstracts. We limited our search to articles published in English. Titles and abstracts were reviewed, followed by a full-text review of eligible articles and data extraction. Articles were required to focus on the connection between voting and health, or report on interventions that occurred within healthcare organizations that aimed to improve voter engagement. RESULTS Our search identified 2041 citations, of which 40 articles met our inclusion criteria. Selected articles dated from 1991-2018 and were conducted primarily in Europe, the USA, and Canada. We identified four interrelated areas explored in the literature: (1) there is a consistency in the association between voting and health; (2) differences in voter participation are associated with health conditions; (3) gaps in voter participation may be associated with electoral outcomes; and (4) interventions in healthcare organizations can increase voter participation. CONCLUSION Voting and health are associated, namely people with worse health tend to be less likely to engage in voting. Differences in voter participation due to social, economic, and health inequities have been shown to have large effects on electoral outcomes. Research gaps were identified in the following areas: long-term effects of voting on health, the effects of other forms of democratic engagement on health, and the broader impact that health providers and organizations can have on voting through interventions in their communities.
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Affiliation(s)
- Chloe L. Brown
- Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Danyaal Raza
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Andrew D. Pinto
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
- Institute for Health Policy, Management and Evaluation and the Division of Clinical Public Health, Dalla Lana School of Public Health, Toronto, ON Canada
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Eliacin J, Cunningham B, Partin MR, Gravely A, Taylor BC, Gordon HS, Saha S, Burgess DJ. Veterans Affairs Providers' Beliefs About the Contributors to and Responsibility for Reducing Racial and Ethnic Health Care Disparities. Health Equity 2019; 3:436-448. [PMID: 31448354 PMCID: PMC6707034 DOI: 10.1089/heq.2019.0018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: Providers' beliefs about the causes of disparities and the entities responsible for addressing these disparities are important in designing disparity-reduction interventions aimed at providers. This secondary analysis of a larger study is aimed at evaluating perceptions of providers regarding the underlying causes of racial health care disparities and their views of who is responsible for reducing them. Methods: We surveyed 232 providers at 3 Veterans Affairs (VA) Medical Centers. Results: Sixty-nine percent of participants believed that minority patients in the United States receive lower quality health care. Most participants (64%) attributed differences in quality of care for minority patients in the VA health care system primarily to patients' socioeconomic status, followed by patient behavior (43%) and provider behaviors (33%). In contrast, most participants believed that the VA and other health care organizations (75%) and providers (70%) bear the responsibility for reducing disparities, while less than half (45%) believed that patients were responsible. Among provider-level contributors to disparities, providers' poor communication was the most widely endorsed (48%), while differences in prescribing of medications (13%) and in provision of specialty referrals (12%) were the least endorsed. Conclusions: Although most providers in the study did not believe that providers contribute to disparities, they do believe that they, along with health care organizations, have the responsibility to help reduce them. Interventions might focus on directly offering providers concrete ways that they can help reduce disparities, rather than focusing on simply raising awareness about disparities and their contributions to them.
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Affiliation(s)
- Johanne Eliacin
- Center for Health information and Communication, CHIC, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
- Department of Psychology, Indiana University Purdue University at Indianapolis, Indianapolis, Indiana
- Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana
- ACT Center of Indiana, Indianapolis, Indiana
| | - Brooke Cunningham
- Department of Family Medicine and Community Health, Minneapolis, Minnesota
| | - Melissa R. Partin
- Center for Chronic Disease Outcomes Research (a VA HSR&D Center of Excellence), Veterans Affairs Medical Center, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Amy Gravely
- Center for Chronic Disease Outcomes Research (a VA HSR&D Center of Excellence), Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Brent C. Taylor
- Center for Chronic Disease Outcomes Research (a VA HSR&D Center of Excellence), Veterans Affairs Medical Center, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Howard S. Gordon
- Jesse Brown Veterans Affairs Medical Center and Center of Innovation for Complex Chronic Healthcare, Chicago, Illinois
- Section of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Somnath Saha
- Section of General Internal Medicine, VA Portland Health Care System, Portland, Oregon
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, Oregon
| | - Diana J. Burgess
- Center for Chronic Disease Outcomes Research (a VA HSR&D Center of Excellence), Veterans Affairs Medical Center, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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