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Mulawa MI, Docherty SL, Bailey DE, Gonzalez-Guarda RM, Lipkus IM, Randolph SD, Yang Q, Pan W. A Hybrid Pragmatic and Factorial Cluster Randomized Controlled Trial for an Anti-racist, Multilevel Intervention to Improve Mental Health Equity in High Schools. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:486-496. [PMID: 38175459 DOI: 10.1007/s11121-023-01626-x] [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] [Accepted: 12/10/2023] [Indexed: 01/05/2024]
Abstract
Systemic racism is pervasive in US society and disproportionately limits opportunities for education, work, and health for historically marginalized and minoritized racial and ethnic groups, making it an urgent issue of social justice. Because systemic racism is a social determinant of health prevalent across multiple social and institutional structures, it requires multilevel intervention approaches using effective designs and analytic methods to measure and evaluate outcomes. Racism is a fundamental cause of poor health outcomes, including mental health outcomes; thus, mental health services and programs that address racism and discrimination are key to promoting positive mental health of racial and ethnic minority youth. While multilevel interventions are well-suited for improving outcomes like youth mental health disparities, their evaluation poses unique methodological challenges, requiring specialized design and analytic approaches. There has been limited methodological guidance provided to researchers on how to test multilevel interventions using approaches that balance methodological rigor, practicality, and acceptability across stakeholder groups, especially within communities most affected by systemic racism. This paper addresses this gap by providing an example of how to rigorously evaluate a hypothetical, theoretically based, multilevel intervention promoting mental health equity in three US school systems using an anti-racist approach intervening at the macro- (i.e., school system), meso- (i.e., school), and micro- (i.e., family and student) levels to improve mental health in adolescents. We describe the design, sample size considerations, and analytic methods to comprehensively evaluate its effectiveness while exploring the extent to which the components interact synergistically to improve outcomes. The methodological approach proposed can be adapted to other multilevel interventions that include strategies addressing macro-, meso-, and micro-levels of influence.
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Affiliation(s)
- Marta I Mulawa
- Duke University School of Nursing, Duke University, Durham, NC, USA.
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Sharron L Docherty
- Duke University School of Nursing, Duke University, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Donald E Bailey
- Duke University School of Nursing, Duke University, Durham, NC, USA
| | | | - Isaac M Lipkus
- Duke University School of Nursing, Duke University, Durham, NC, USA
| | | | - Qing Yang
- Duke University School of Nursing, Duke University, Durham, NC, USA
| | - Wei Pan
- Duke University School of Nursing, Duke University, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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Guilamo-Ramos V, Thimm-Kaiser M, Benzekri A, Johnson C, Williams D, Wilhelm-Hilkey N, Goodman M, Hagan H. Application of a Heuristic Framework for Multilevel Interventions to Eliminate the Impact of Unjust Social Processes and Other Harmful Social Determinants of Health. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:446-458. [PMID: 38607535 DOI: 10.1007/s11121-024-01658-x] [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] [Accepted: 02/20/2024] [Indexed: 04/13/2024]
Abstract
There is consensus about the importance of developing a strong cadre of effective multilevel interventions to eliminate the impacts of unjust social processes, such as structural racism and other harmful social determinants of health (SDOH), on health inequities in the USA. However, the available cadre of rigorously evaluated evidence-based interventions for SDOH mitigation remains underdeveloped relative to the magnitude of historic and current health inequities. The proposed manuscript addresses this gap in two ways: first, by introducing a heuristic framework to inform decisions in multilevel intervention development, study design, and selection of analytic methods and, second, by providing a roadmap for future applications of the framework in multilevel intervention research through an exemplar application using the ongoing NIH-funded evaluation study of the Nurse-Community-Family Partnership (NCFP) intervention. NCFP leverages individual, family, institutional, and system factors to shape COVID-19 mitigation outcomes at the individual and household levels. NCFP takes an approach informed by the heuristic framework to addressing and mitigating unjust social processes and other harmful SDOH. We discuss the application of a two-arm parallel explanatory group randomized trial to evaluate the efficacy of NCFP in improving the primary (COVID-19 testing uptake) and secondary (adoption of COVID-19 control measures, COVID-19 vaccine uptake, mutual aid capacity, etc.) outcomes at the individual and household levels. The analysis approach relies on random-intercept models, and we calculate the variance partitioning coefficient to estimate the extent to which household- and individual-level variables contribute to the outcome, allowing examination of NCFP effects at multiple levels.
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Affiliation(s)
- Vincent Guilamo-Ramos
- Center for Latino Adolescent and Family Health, Johns Hopkins University, Washington, DC, 20001, USA.
- Institute for Policy Solutions, Johns Hopkins University School of Nursing, Johns Hopkins University, Washington, DC, 20001, USA.
- School of Nursing, Johns Hopkins University, Baltimore, MD, 21205, USA.
- Presidential Advisory Council On HIV/AIDS, US Department of Health and Human Services, Washington, DC, USA.
| | - Marco Thimm-Kaiser
- Center for Latino Adolescent and Family Health, Johns Hopkins University, Washington, DC, 20001, USA
- Institute for Policy Solutions, Johns Hopkins University School of Nursing, Johns Hopkins University, Washington, DC, 20001, USA
- School of Nursing, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Adam Benzekri
- Center for Latino Adolescent and Family Health, Johns Hopkins University, Washington, DC, 20001, USA
- Institute for Policy Solutions, Johns Hopkins University School of Nursing, Johns Hopkins University, Washington, DC, 20001, USA
- School of Nursing, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Celia Johnson
- Center for Latino Adolescent and Family Health, Johns Hopkins University, Washington, DC, 20001, USA
- Institute for Policy Solutions, Johns Hopkins University School of Nursing, Johns Hopkins University, Washington, DC, 20001, USA
- School of Nursing, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Desiree Williams
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, 10003, USA
- Department of Social Behavioral Sciences, School of Global Public Health, New York University, New York, NY, 10003, USA
| | - Nash Wilhelm-Hilkey
- Center for Latino Adolescent and Family Health, Johns Hopkins University, Washington, DC, 20001, USA
| | - Melody Goodman
- Department of Biostatistics, School of Global Public Health, New York University, New York, NY, 10003, USA
| | - Holly Hagan
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, 10003, USA
- Department of Social Behavioral Sciences, School of Global Public Health, New York University, New York, NY, 10003, USA
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McLoughlin GM, Salmon J. How Can We Equitably Scale-Up Physical Activity Interventions to Ensure Everyone Has Opportunities to Thrive? J Phys Act Health 2024:1-2. [PMID: 38936804 DOI: 10.1123/jpah.2024-0342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 05/12/2024] [Indexed: 06/29/2024]
Affiliation(s)
- Gabriella M McLoughlin
- Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, PA, USA
- Washington University Implementation Science Center for Cancer Control, Brown School, Washington University in St. Louis, St Louis, MO, USA
| | - Jo Salmon
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
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Schwenker R, Alayli A, Rasch L, Ballmeyer C, Maguire JL, Cohen-Silver J, De Bock F. Screening for adverse social conditions in child healthcare settings: protocol for a systematic review. BMJ Open 2024; 14:e081958. [PMID: 38904138 PMCID: PMC11191832 DOI: 10.1136/bmjopen-2023-081958] [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: 05/22/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION Adverse social conditions affect children's development and health outcomes from preconception throughout their life course. Early identification of adverse conditions is essential for early support of children and their families. Healthcare contacts with children provide a unique opportunity to screen for adverse social conditions and to take preventive action to identify and address emerging, potentially harmful or accumulating social problems. The aim of our study is to identify and describe available screening tools in outpatient and inpatient healthcare settings that capture social conditions that may affect children's development, health or well-being. METHODS AND ANALYSIS We will conduct a systematic review and will report the results following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. A systematic search of three databases (PubMed (Ovid), PsycInfo (EBSCOhost) and Web of Science Core Collection (Clarivate)) for English-language and German-language articles from 2014 to date will be conducted. We will include peer-reviewed articles that develop, describe, test or use an instrument to screen children for multiple social conditions in paediatric clinics or other outpatient or inpatient child healthcare settings. Key study characteristics and information on screening tools will be extracted and presented in structured tables to summarise the available evidence. We will assess the methodological quality of the instruments with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. ETHICS AND DISSEMINATION Ethical approval is not required for this study as we will not be collecting any personal data. Dissemination will consist of publications, presentations, and other knowledge translation activities.
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Affiliation(s)
- Rosemarie Schwenker
- Clinic of General Pediatrics, Neonatology and Pediatric Cardiology and Center for Health and Society (CHS), Unit of Child Health Services Research, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Adrienne Alayli
- Clinic of General Pediatrics, Neonatology and Pediatric Cardiology and Center for Health and Society (CHS), Unit of Child Health Services Research, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Lena Rasch
- Clinic of General Pediatrics, Neonatology and Pediatric Cardiology and Center for Health and Society (CHS), Unit of Child Health Services Research, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Ballmeyer
- Clinic of General Pediatrics, Neonatology and Pediatric Cardiology and Center for Health and Society (CHS), Unit of Child Health Services Research, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jonathon L Maguire
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Freia De Bock
- Clinic of General Pediatrics, Neonatology and Pediatric Cardiology and Center for Health and Society (CHS), Unit of Child Health Services Research, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Perez N, He N, Wright F, Condon E, Weiser S, Aouizerat B. Social determinants of inflammatory markers linking depression and type 2 diabetes among women: A scoping review. J Psychosom Res 2024; 184:111831. [PMID: 38905780 DOI: 10.1016/j.jpsychores.2024.111831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/03/2024] [Accepted: 06/10/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE Inflammation is implicated in the pathophysiology of depression and type 2 diabetes (T2D) and is linked to social determinants of health (SDoH) associated with socioeconomic disadvantage. The objective of this review is to identify and map the range of SDoHs associated with inflammation in depression, T2D, or their co-occurrence among women. METHODS PubMed, CINAHL, PsychINFO, and Web of Science were searched March-July 2023 to identify studies where 1) an SDoH was a predictor or independent variable, 2) depression or T2D was a clinical focus, 3) inflammatory markers were collected, and 4) analysis was specific to women. We used the National Institute on Minority Health and Health Disparities research framework to guide searching SDoHs, organize findings, and identify gaps. RESULTS Of the 1135 studies retrieved, 46 met criteria. Within the reviewed studies, the most used inflammatory measures were C-reactive protein, interleukin-6, and tumor necrosis factor-α, and the most studied SDoHs were early life stress and socioeconomic status. Individual and interpersonal-level variables comprised the bulk of SDoHs in the included studies, while few to no studies examined built environment (n = 6) or health system level (n = 0) factors. Disadvantageous SDoHs were associated with higher levels of inflammation across the included studies. CONCLUSION The scope and intersection of depression and T2D represent a syndemic that contributes to and results from socioeconomic inequities and disproportionately affects women. Simultaneous inclusion of social and inflammatory measures, particularly understudied SDoHs, is needed to clarify potent targets aimed at advancing health and equity.
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Affiliation(s)
- Nicole Perez
- New York University, Rory Meyers College of Nursing, 433 1(st) Ave, New York, NY 10010, USA.
| | - Ning He
- New York University, Silver School of Social Work, 1 Washington Squire North, New York, NY 10003, United States of America.
| | - Fay Wright
- Northwell Health Northern Westchester Hospital, 400 East Main Street, Mt Kisco, NY 10549, United States of America.
| | - Eileen Condon
- University of Connecticut, College of Nursing, 231 Glenbrook Rd, Storrs, CT 06269, United States of America.
| | - Sheri Weiser
- University of San Francisco, School of Medicine, 533 Parnassus Ave, San Francisco, CA 94143, United States of America.
| | - Brad Aouizerat
- New York University, College of Dentistry, 345 E 24th St, New York, NY 10010, United States of America; University of San Francisco, School of Pharmacy, 513 Parnassus Ave, San Francisco, CA 94143, United States of America.
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Endalamaw A, Gilks CF, Ambaw F, Assefa Y. Equity in HIV/AIDS services requires optimization of mainstreaming sectors in Ethiopia. BMC Public Health 2024; 24:1477. [PMID: 38824520 PMCID: PMC11144345 DOI: 10.1186/s12889-024-19016-5] [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: 10/25/2023] [Accepted: 05/30/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Mainstreaming HIV and AIDS across sectors is crucial to close the disparities in service provision and coverage. However, evidence has shown that certain social groups are left behind in receiving HIV/AIDS services. The objective of this study was twofold: to understand the reasons behind the existing inequities and to explore challenges of equity in HIV/AIDS services in the Amhara region of Ethiopia. METHODS Twenty-two adults (aged 26-57 years) from eighteen sectors that are mainstreaming HIV and AIDS were purposefully selected until the point of saturation and participated in a semi-structured in-depth interview conducted between January 20 and February 17, 2023. Interviewees were asked to describe their mainstreaming experiences in equitable HIV/AIDS services, reflect on the challenges and barriers that impede equitable service provision, or explain the reasons behind the existence of inequity in HIV/AIDS services. The interviews were audio recorded, transcribed, translated, and iteratively analysed, with early analysis informing subsequent interviews. An inductive-reflexive thematic analysis was conducted, whereby themes and subthemes were identified, and the relationships between subthemes and patterns were critically reviewed. RESULTS The challenges to equitable HIV/AIDS service provision were grouped into eight thematic areas: (1) changing contexts that shifts public and government attention to emerging diseases, war and political instability, and poverty; (2) leadership-related, such as the lack of supervision and monitoring, not politicising HIV/AIDS (not providing political attention to HIV/AIDS) and weak intersectoral collaboration; (3) financial constraints due to a random budgeting and contract interruption with non-governmental organisations (NGOs); (4) lack of resources due to scarcity and unfair distribution; (5) inadequate skilled personnel due to inadequate numbers and lack of continuous professional and career development; (6) lack of equity-related evidence-based tools and guidelines; (7) inadequate understanding of equity due to lack of training and misunderstanding, and lack of access to equity-oriented tools and guidelines; and (8) cultural norms, values, and perceptions. CONCLUSIONS This study identified critical challenges faced in the equitable HIV/AIDS services provision. To achieve equity in HIV/AIDS services, mainstreaming sectors need to invest in mechanisms to sustain services in emergency situations; identify effective leaders to maintain collaboration, monitoring, and evaluation; institutionalise responsive budgeting and establish alternative funds to maintain non-governmental organisations initiatives; provide continuous up-to-date training and create a common evidence-sharing platform; implement proper recruitment, education, and professional development of HIV/AIDS focal persons; and promote and practice culturally safe care. It is, therefore, essential to optimise sectors that are mainstreaming HIV/AIDS and incorporate equity considerations in their strategic plans and working guidelines.
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Affiliation(s)
- Aklilu Endalamaw
- School of Public Health, The University of Queensland, Brisbane, Australia.
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Charles F Gilks
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Fentie Ambaw
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Australia
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Johnson C, Ingraham MK, Stafford SR, Guilamo-Ramos V. Adopting a nurse-led model of care to advance whole-person health and health equity within Medicaid. Nurs Outlook 2024; 72:102191. [PMID: 38781773 DOI: 10.1016/j.outlook.2024.102191] [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: 01/16/2024] [Revised: 04/18/2024] [Accepted: 04/27/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Medicaid payment reforms and delivery model innovations are needed to fully transform U.S. healthcare structuring and provision. PURPOSE To synthesize nurse-led models of care and their implications for improving health care access, quality, and reducing costs for Medicaid recipients. METHODS A critical review of the literature regarding nurse-led models and implications for addressing social determinants of health (SDOH), adopting population health approaches, managing complex care, and integrating behavioral and physical health care within Medicaid. DISCUSSION Three interrelated findings emerged (a) investing in dynamic nurse-led models is important for mitigating SDOH and adopting value-based care, (b) regulations preventing nurses from practicing at the fullest extent of their training and licensure limit clinical impact and value, and (c) directed payments can establish value-based expectations for Medicaid managed care. CONCLUSION Adoption of a nurse-led model of care has the potential to advance the goals of reducing inequity and promoting whole-person health within Medicaid and nationally.
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Affiliation(s)
- Celia Johnson
- Institute for Policy Solutions, Johns Hopkins School of Nursing, Washington, DC; Center for Latino Adolescent and Family Health, Johns Hopkins School of Nursing, Baltimore, MD
| | | | - Stephen R Stafford
- Institute for Policy Solutions, Johns Hopkins School of Nursing, Washington, DC; Center for Latino Adolescent and Family Health, Johns Hopkins School of Nursing, Baltimore, MD
| | - Vincent Guilamo-Ramos
- Institute for Policy Solutions, Johns Hopkins School of Nursing, Washington, DC; Center for Latino Adolescent and Family Health, Johns Hopkins School of Nursing, Baltimore, MD; Presidential Advisory Council on HIV/AIDS, U.S. Department of Health and Human Services, Washington, DC.
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Tsumura H, Pan W, Brandon D. Exploring Differences in Intraoperative Medication Use Between African American and Non-Hispanic White Patients During General Anesthesia: Retrospective Observational Cohort Study. Clin Nurs Res 2024:10547738241253652. [PMID: 38767246 DOI: 10.1177/10547738241253652] [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: 05/22/2024]
Abstract
This study aimed to explore whether differences exist in anesthesia care providers' use of intraoperative medication between African American and non-Hispanic White patients in adult surgical patients who underwent noncardiothoracic nonobstetric surgeries with general anesthesia. A retrospective observational cohort study used electronic health records between January 1, 2018 and August 31, 2019 at a large academic health system in the southeastern United States. To evaluate the isolated impact of race on intraoperative medication use, inverse probability of treatment weighting using the propensity scores was used to balance the covariates between African American and non-Hispanic White patients. Regression analyses were then performed to evaluate the impact of race on the total dose of opioid analgesia administered, and the use of midazolam, sugammadex, antihypotensive drugs, and antihypertensive drugs. Of the 31,790 patients included in the sample, 58.9% were non-Hispanic Whites and 13.6% were African American patients. After adjusting for significant covariates, African American patients were more likely to receive midazolam premedication (p < .0001; adjusted odds ratio [aOR] = 1.17, 99.9% CI [1.06, 1.30]), and antihypertensive drugs (p = .0002; aOR = 1.15, 99.9% CI [1.02, 1.30]), and less likely to receive antihypotensive drugs (p < .0001; aOR = 0.85, 99.9% CI [0.76, 0.95]) than non-Hispanic White patients. However, we did not find significant differences in the total dose of opioid analgesia administered, or sugammadex. This study identified differences in intraoperative anesthesia care delivery between African American and non-Hispanic White patients; however, future research is needed to understand mechanisms that contribute to these differences and whether these differences are associated with patient outcomes.
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Affiliation(s)
- Hideyo Tsumura
- Duke University School of Nursing, Durham, NC, USA
- Duke University Health System, Durham, NC, USA
| | - Wei Pan
- Duke University School of Nursing, Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
| | - Debra Brandon
- Duke University School of Nursing, Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
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Hanneke R, Brunskill A. Searching for the social determinants of health: observations from evidence synthesis publications. Syst Rev 2024; 13:134. [PMID: 38755700 PMCID: PMC11097542 DOI: 10.1186/s13643-024-02551-y] [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: 11/29/2023] [Accepted: 04/26/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The social determinants of health (SDOH) are the focus of an exponentially increasing number of publications, including evidence syntheses. However, there is not an established standard for searching for SDOH literature. This study seeks to identify published evidence syntheses pertaining to the SDOH, analyzing the search strategies used and the studies included within these reviews. The primary objectives are to compare search strategies and create a test set of SDOH publications. METHODS We searched PubMed, Embase, and Scopus for evidence syntheses that mentioned the SDOH in their research questions and included an SDOH search strategy. Relevant data extracted from each review included databases searched; search terms used for the SDOH; conceptual frameworks referenced; and the citations of primary studies included in the reviews, which were compiled to form a test set of cited papers. The relative recall of the respective search strategies was tested by documenting the total number of MEDLINE results each retrieved and the number of test set papers retrieved. RESULTS Sixty-four evidence syntheses were identified and included in the analysis, and 2750 cited papers were extracted. Findings indicate few commonalities across search strategies in search terms used, the total number of results retrieved, and the number of test set cited papers retrieved. One hundred and ninety-three unique MeSH terms and 1385 unique keywords and phrases were noted among the various search strategies. The number of total results retrieved by the SDOH search strategies ranged from 21,793 to over 16 million. The percentage of cited papers retrieved by the search strategies ranged from 2.46 to 97.9%. Less than 3% of the cited papers were indexed with the Social Determinants of Health MeSH. CONCLUSIONS There has been little consistency across evidence syntheses in approaches to searching for SDOH literature. Differences in these strategies could have a significant impact on what literature is retrieved, included in reviews, and, consequently, incorporated into evidence-based practice. By documenting these differences and creating a set of papers relevant to SDOH, this research provides a snapshot of the current challenges in searching for SDOH content and lays the groundwork for the creation of a standardized search approach for SDOH literature.
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Affiliation(s)
- Rosie Hanneke
- Library of the Health Sciences, University of Illinois Chicago, 1750 W Polk St. MC 763, Chicago, IL, 60612, USA.
| | - Amelia Brunskill
- Library of the Health Sciences, University of Illinois Chicago, 1750 W Polk St. MC 763, Chicago, IL, 60612, USA
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Van den Bergh BRH, Antonelli MC, Stein DJ. Current perspectives on perinatal mental health and neurobehavioral development: focus on regulation, coregulation and self-regulation. Curr Opin Psychiatry 2024; 37:237-250. [PMID: 38415742 DOI: 10.1097/yco.0000000000000932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
PURPOSE OF REVIEW Perinatal mental health research provides an important perspective on neurobehavioral development. Here, we aim to review the association of maternal perinatal health with offspring neurodevelopment, providing an update on (self-)regulation problems, hypothesized mechanistic pathways, progress and challenges, and implications for mental health. RECENT FINDINGS (1) Meta-analyses confirm that maternal perinatal mental distress is associated with (self-)regulation problems which constitute cognitive, behavioral, and affective social-emotional problems, while exposure to positive parental mental health has a positive impact. However, effect sizes are small. (2) Hypothesized mechanistic pathways underlying this association are complex. Interactive and compensatory mechanisms across developmental time are neglected topics. (3) Progress has been made in multiexposure studies. However, challenges remain and these are shared by clinical, translational and public health sciences. (4) From a mental healthcare perspective, a multidisciplinary and system level approach employing developmentally-sensitive measures and timely treatment of (self-)regulation and coregulation problems in a dyadic caregiver-child and family level approach seems needed. The existing evidence-base is sparse. SUMMARY During the perinatal period, addressing vulnerable contexts and building resilient systems may promote neurobehavioral development. A pluralistic approach to research, taking a multidisciplinary approach to theoretical models and empirical investigation needs to be fostered.
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Affiliation(s)
| | - Marta C Antonelli
- Laboratorio de Programación Perinatal del Neurodesarrollo, Instituto de Biología Celular y Neurociencias "Prof.E. De Robertis", Facultad de Medicina. Universidad de Buenos Aires, Buenos Aires, Argentina
- Frauenklinik und Poliklinik, Klinikum rechts der Isar, Munich, Germany
| | - Dan J Stein
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, Cape Town, South Africa
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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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Duckie CL, Boston KA, Champagne B, Thompson J, Halpern DJ, Granger BB. Improving Hypertension Control in the Black Patient Population: A Quality Improvement Study of Workflow Redesign Using the Electronic Health Record to Integrate Self-Monitoring, Education, and Reporting. J Nurs Care Qual 2024; 39:175-182. [PMID: 37782914 DOI: 10.1097/ncq.0000000000000743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
BACKGROUND Nearly half of American adults have hypertension (HTN), and non-Hispanic Black patients are diagnosed at a higher rate than others. LOCAL PROBLEM Our local clinic population reflected disproportionate rates of uncontrolled HTN among Black patients. METHODS A quality improvement pre-/postintervention design was used to evaluate an educational intervention to reduce blood pressure (BP) and improve self-monitoring of BP in Black patients using the Chronic Care Model. INTERVENTIONS A team-based approach was used to redesign clinic workflows and patient education, prescribe self-paced videos from an electronic health record (EHR) patient portal, and provide home BP cuffs. RESULTS Black participants (n = 79) improved viewing of prescribed videos (7.9% to 68.5%), knowledge scores (67.9 to 75.2), and mean systolic BP (-20.3 mm Hg; P > .001). CONCLUSIONS This team-based approach enhanced patient engagement, self-monitoring skills, EHR-reported BP, and overall BP control for a cohort of Black patients with uncontrolled BP.
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Affiliation(s)
- Charmaine L Duckie
- Author Affiliations: Duke Primary Care Riverview, Durham, North Carolina (Drs Duckie, Champagne, Boston, and Halpern); Duke Primary Care Croasdaile and Riverview, Duke Population Health Management Office, Durham, North Carolina (Dr Champagne); Duke University School of Nursing, Durham, North Carolina (Drs Thompson and Granger); Quality & Population Health, Duke Primary Care, Durham, North Carolina (Dr Halpern); and Duke Heart Center Nursing Research Program, Durham, North Carolina (Dr Granger)
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13
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Trapani D, Girardi F, Cinieri S, Curigliano G. There is no such a thing as a ' biological' basis for cancer disparities: A call to end misreporting of the ultimate determinants of health outcomes. TUMORI JOURNAL 2024; 110:82-87. [PMID: 37688414 DOI: 10.1177/03008916231196369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Improved strategies of cancer prevention and control have resulted in tangible benefits for patients with cancer. Disparities in outcome have been reported as a result of inequal access to health care. Historically, differences in health outcomes at population level have been reported according to key characteristics, including race, ethnicity and, more recently, ancestry. These population descriptors have been used to display the differences in the outcome and highlight actionable areas of health disparities, through policy and population health interventions. Yet, they have been commonly mis-intended as ultimate determinants of health outcomes, as recapitulating intrinsic biological differences. A plethora of past literature has described "biological" differences in patients belonging to a specific racial, ethnical or ancestral group, with certain cancers - commonly overlooking the social and economic contextures. The attention has ultimately focused on the existence of intrinsic differences and biological reasons, as opposed to social and economic determinants of disparities in the outcome in disadvantaged or excluded communities, thus nurturing double stigma. In our editorial, we evaluate some key roots of racial attitudes in displaying patient outcomes in oncology epidemiological studies, and call to report ultimate determinants of health - that are, primarily social and economic determinants.
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Affiliation(s)
- Dario Trapani
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Fabio Girardi
- Division of Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Saverio Cinieri
- Department of Medical Oncology, Perrino Hospital, ASL Brindisi, Brindisi, Italy
- Associazione Italiana di Oncologia Medica (AIOM), Milan, Italy (President)
| | - Giuseppe Curigliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Knippler ET, Martinez AJ, Amiri I, Madundo K, Mmbaga BT, Goldston DB, Relf MV, Knettel BA. Challenges and opportunities for improving mental health care and preventing suicide among people living with HIV: Perspectives of mental health professionals in Tanzania. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002762. [PMID: 38363789 PMCID: PMC10871509 DOI: 10.1371/journal.pgph.0002762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/17/2024] [Indexed: 02/18/2024]
Abstract
People living with HIV (PLWH) experience unique stressors that contribute to emotional distress, and PLWH are more than twice as likely to die by suicide when compared to the general population. In countries like Tanzania, there is a relatively high burden of HIV but few resources to support mental health needs. To gain a better understanding of mental health challenges experienced by PLWH in northern Tanzania and identify opportunities for intervention, we interviewed 12 mental health professionals working in the Kilimanjaro region. Thematic analysis was used to explore drivers and impacts of emotional distress, community influences on mental health, and gaps and barriers to existing mental health care. Perspectives from mental health workers highlight the compounding effects of stress related to HIV status, family conflict, finances, and other social challenges, which can lead to poor HIV treatment outcomes and suicidal ideation. Cultural beliefs and stigma surrounding both mental health and HIV limit care-seeking behavior for mental health issues. Those who do seek care often encounter barriers related to poor mental health infrastructure, including a lack of providers, limited financial resources, and little integration into other health services. There is a clear need for investment in the mental health care system, as well as interventions to improve knowledge and perceptions of mental health and comprehensively address stressors. We describe feedback on a proposed telehealth counseling intervention integrated into routine HIV services, which shows strong potential to mitigate barriers to mental health treatment, reduce suicidal ideation, and support the wellbeing of PLWH.
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Affiliation(s)
- Elizabeth T. Knippler
- Duke Center for AIDS Research, Durham, North Carolina, United States of America
- Duke University School of Nursing, Durham, North Carolina, United States of America
| | - Alyssa J. Martinez
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Ismail Amiri
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Kim Madundo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
| | - Blandina T. Mmbaga
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - David B. Goldston
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, North Carolina, United States of America
| | - Michael V. Relf
- Duke University School of Nursing, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Brandon A. Knettel
- Duke University School of Nursing, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
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15
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Shetty RM, Shetty M, Shetty NS, Deoghare A, Walia T, Berdouses E, Shetty SR, Shetty S. Evaluation of RURS elbow guard in the management of thumb-sucking habit in children with and without intellectual disability. Eur Arch Paediatr Dent 2024; 25:75-84. [PMID: 38281253 DOI: 10.1007/s40368-023-00858-3] [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: 09/18/2023] [Accepted: 12/11/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Digit sucking is a common oral habit among many children, which involves placing the thumb/finger into the mouth, which can cause malocclusion in mixed and permanent dentition. AIM To evaluate the efficacy of the RURS elbow guard in the management of thumb-sucking habits in children with intellectual disabilities and those without in terms of the mean duration of appliance therapy. The secondary objective was to compare the RURS elbow guard with an intraoral crib in healthy children (without intellectual disabilities) to manage the habit of thumb-sucking. DESIGN Children with intellectual disabilities and those without between the age of 4 and 16 years were included in the study and categorised into three groups, namely group I (50 normal children; intraoral crib appliance), group II (50 normal children; RURS elbow guard) and group III (50 children with intellectual disabilities; RURS elbow guard). RESULTS The mean duration of appliance therapy for groups I, II and III were 200.20 ± 20.43 days, 204.34 ± 20.56 days, and 218.43 ± 15.66 days, respectively (p < 0.001). The differences in the mean duration between group I and group II were statistically non-significant, with statistically significant differences between group I and group III (p < 0.001) and between group II and group III (p < 0.05). CONCLUSION The RURS elbow guard was found to be an efficient appliance in treating thumb-sucking among children who had mild to moderate intellectual disabilities. RURS elbow guard was equally efficient as an intraoral crib appliance in managing thumb-sucking habits in children without intellectual disabilities.
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Affiliation(s)
- R M Shetty
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, UAE.
- Center of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, UAE.
- Department of Pediatric and Preventive Dentistry, Adjunct Faculty, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research (Declared as Deemed-to-be University), Wardha, Maharashtra, India.
| | - M Shetty
- A. B. Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to Be University), Deralakatte, Mangalore, Karnataka, India
| | - N S Shetty
- A. B. Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to Be University), Deralakatte, Mangalore, Karnataka, India
| | - A Deoghare
- Department of Pediatric and Preventive Dentistry, Chhattisgarh Dental College and Research Institute, Rajnandgaon, Chhattisgarh, India
| | - T Walia
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, UAE
- Center of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, UAE
| | - E Berdouses
- Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, UAE
- Center of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, UAE
| | - S R Shetty
- Department of Oral and Cranio-Facial Health Sciences, University of Sharjah, Sharjah, UAE
| | - S Shetty
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
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Cardenas-Iniguez C, Schachner JN, Ip KI, Schertz KE, Gonzalez MR, Abad S, Herting MM. Building towards an adolescent neural urbanome: Expanding environmental measures using linked external data (LED) in the ABCD study. Dev Cogn Neurosci 2024; 65:101338. [PMID: 38195369 PMCID: PMC10837718 DOI: 10.1016/j.dcn.2023.101338] [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: 10/02/2023] [Revised: 12/20/2023] [Accepted: 12/31/2023] [Indexed: 01/11/2024] Open
Abstract
Many recent studies have demonstrated that environmental contexts, both social and physical, have an important impact on child and adolescent neural and behavioral development. The adoption of geospatial methods, such as in the Adolescent Brain Cognitive Development (ABCD) Study, has facilitated the exploration of many environmental contexts surrounding participants' residential locations without creating additional burdens for research participants (i.e., youth and families) in neuroscience studies. However, as the number of linked databases increases, developing a framework that considers the various domains related to child and adolescent environments external to their home becomes crucial. Such a framework needs to identify structural contextual factors that may yield inequalities in children's built and natural environments; these differences may, in turn, result in downstream negative effects on children from historically minoritized groups. In this paper, we develop such a framework - which we describe as the "adolescent neural urbanome" - and use it to categorize newly geocoded information incorporated into the ABCD Study by the Linked External Data (LED) Environment & Policy Working Group. We also highlight important relationships between the linked measures and describe possible applications of the Adolescent Neural Urbanome. Finally, we provide a number of recommendations and considerations regarding the responsible use and communication of these data, highlighting the potential harm to historically minoritized groups through their misuse.
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Affiliation(s)
- Carlos Cardenas-Iniguez
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.
| | - Jared N Schachner
- Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | - Ka I Ip
- Institute of Child Development, University of Minnesota, MN, USA
| | - Kathryn E Schertz
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Marybel R Gonzalez
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Shermaine Abad
- Department of Radiology, University of California, San Diego, CA, USA
| | - Megan M Herting
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
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17
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Kehoe TJ, May A, Holbrook C, Barker R, Hill D, Jones H, Moodie R, Varnava A, Westmore A. The past as present in health promotion: the case for a 'public health humanities'. Health Promot Int 2023; 38:daad163. [PMID: 38128084 DOI: 10.1093/heapro/daad163] [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: 12/23/2023] Open
Abstract
Health promotion is conceived as a unifying concept for improving the health of populations. This means addressing the socio-cultural, economic and commercial causes of ill-health, which are necessarily informed by past policies and socio-cultural contexts. However, historical scholarship has rarely figured in health promotion practice or scholarship. This gap resides in the determinants of health, and notably in the analyses of tobacco control and skin cancer prevention, two long-running campaigns that have shaped modern health promotion in Australia. Both highlight a need for understanding the profound impact of history on the present and the value of learning from past successes and failures. Doing so requires integrating historical analyses into existing health promotion scholarship. To achieve this aim, we present a new 'public health humanities' methodology. This novel interdisciplinary framework is conceived as a spectrum in which historical studies integrate with existing health promotion disciplines to solve complex health problems. We draw on the many calls for more interdisciplinarity in health promotion and derive this methodology from proposals in the medical humanities and cognate fields that have wrestled with combining history and present-focused disciplines. Using tobacco control and skin cancer prevention as case studies, we demonstrate how public health humanities uses interdisciplinary teams and shared research questions to generate valuable new knowledge unavailable with traditional methods. Furthermore, we show how it creates evaluation criteria to consider the powerful impact of issues like colonialism on current inequities that hinder health promotion strategies, and from which lessons may be derived for the future.
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Affiliation(s)
- Thomas J Kehoe
- Cancer Council of Victoria, 200 Victoria Pde., East Melbourne, Victoria, 3002, Australia
| | - Andrew May
- School of Historical and Philosophical Studies, University of Melbourne, Arts West Building, Arts West - North Wing, Royal Parade, Parkville, Victoria, 3052, Australia
| | - Carolyn Holbrook
- School of Humanities and Social Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia
| | - Richie Barker
- School of Communications and Creative Arts, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia
| | - David Hill
- Cancer Council of Victoria, 200 Victoria Pde., East Melbourne, Victoria, 3002, Australia
- Melbourne School of Population and Global Health, 207 Bouverie St, Carlton, Victoria, 3053, Australia
| | - Hayley Jones
- McCabe Centre for Law and Cancer, 200 Victoria Pde., East Melbourne, Victoria, 3002, Australia
| | - Rob Moodie
- School of Humanities and Social Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia
| | - Andrekos Varnava
- College of Humanities and Social Sciences, Flinders University, GPO Box 2100, Adelaide 5001, South Australia, Australia
| | - Ann Westmore
- School of Historical and Philosophical Studies, University of Melbourne, Arts West Building, Arts West - North Wing, Royal Parade, Parkville, Victoria, 3052, Australia
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18
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Still CH, Flores DD, Brooks J, Santa Maria D. Advancing health equity through nursing research. Nurs Outlook 2023; 71:102049. [PMID: 37718191 DOI: 10.1016/j.outlook.2023.102049] [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: 02/14/2023] [Revised: 08/18/2023] [Accepted: 08/20/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Health inequities are major predictors of poor health and remain a complex and persistent challenge globally and in the United States. Research has documented the underlying causes and mechanisms that give rise to health disparities. However, it lacks adequate attention to the strategies needed to build upon promulgated research to address equity-based challenges to improve health. PURPOSE This paper describes how building and supporting diverse research teams can play a central role in increasing the research capacity and participation of diverse populations to improve the health of individuals, families, and communities. METHODS Exemplars from work and discussion of strategies to grow nursing's health equity workforce are presented. DISCUSSION Actions to build and leverage partnerships to expand capacity, maximize the impact of health equity outcomes, and cultivate a supportive environment to grow the health equity scientific workforce are discussed. CONCLUSION Nurse scientists can address health equity through the research process.
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Affiliation(s)
- Carolyn Harmon Still
- Center for the Advancement of Community-Engaged Innovation in Health Equity (CACHE), Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH.
| | | | - Jada Brooks
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Diane Santa Maria
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX.
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19
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Guilamo-Ramos V, Johnson C, Thimm-Kaiser M, Benzekri A. Nurse-led approaches to address social determinants of health and advance health equity: A new framework and its implications. Nurs Outlook 2023; 71:101996. [PMID: 37349232 DOI: 10.1016/j.outlook.2023.101996] [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: 01/05/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND The U.S. health care system is burdened by inefficiencies, longstanding health inequities, and unstainable costs. Within the nursing profession and the broader health care sector, there is growing recognition of the need for a paradigm shift that addresses persistent structural problems and advances health equity. PURPOSE Despite evidence of the importance of the social determinants of health (SDOH) in shaping inequitable health outcomes, practical tools for applying SDOH theory in the development of effective nurse-led programs to mitigate harmful SDOH remain scarce. METHODS We synthesize extant SDOH literature into a heuristic framework for conceptualizing core SDOH mechanisms, constructs, and principles. FINDINGS To illustrate how nurse scientists can use the framework to guide the development of programs for SDOH mitigation, we outline a three-step exemplar application to the U.S. Latino HIV epidemic. DISCUSSION Our framework can inform a paradigm shift toward nurse-led, multi-level SDOH mitigation across practice, education, and research.
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Affiliation(s)
- Vincent Guilamo-Ramos
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC; School of Medicine, Department of Family Medicine and Community Health, Department of Infectious Diseases, Duke University, Durham, NC; Presidential Advisory Council on HIV/AIDS, US Department of Health and Human Services, Washington, DC.
| | - Celia Johnson
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC
| | - Marco Thimm-Kaiser
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC
| | - Adam Benzekri
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC
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20
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Marzano M, Caniano L, Abram MD. Nurse-led models of care for metabolic syndrome in primary care: A scoping review. J Clin Nurs 2023; 32:7707-7717. [PMID: 37674281 DOI: 10.1111/jocn.16867] [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: 04/28/2023] [Revised: 07/09/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023]
Abstract
AIM To identify and map out existing nurse-led models of care for treatment and prevention of metabolic syndrome in primary care settings. DESIGN A scoping review. METHODS Conducted in accordance with the JBI methodology. DATA SOURCES A search of the databases PubMed, CINAHL Complete, Cochrane Library, Scopus, handsearch and a grey literature search was conducted in June 2022 and updated in March 2023. RESULTS Title and abstract screening was performed on 926 articles resulting in 40 articles for full text screening. Full text screening yielded seven articles that met inclusion criteria. CONCLUSION Additional research is needed on nursing models of care to prevent and treat metabolic syndrome. Future studies should concentrate on rigour with clearly defined objective inclusion criteria. IMPLICATIONS TO CLINICAL PRACTICE This review contributes a synthesis of the evidence on nurse-led models for metabolic syndrome in primary care. IMPACT This scoping review addresses metabolic syndrome, the precursor to non-communicable disease. The review mapped the evidence for nurse-led models of care for metabolic syndrome in the primary care setting. These findings promote the development and evaluation of novel nurse-led models of care which can mitigate the effect of the current epidemic. REPORTING METHOD PRISMA checklist for scoping reviews. No patient or public contribution was part of this study. PROTOCOL REGISTRATION Open Science Framework accessible at: https://osf.io/jfpw7/.
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Affiliation(s)
- Maryta Marzano
- College of Nursing and Public Health, Adelphi University, Garden City, New York, USA
- Stony Brook Population and Preventive Medicine, East Setauket, New York, USA
| | - Lori Caniano
- College of Nursing and Public Health, Adelphi University, Garden City, New York, USA
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21
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Lewis CL, Yan A, Williams MY, Apen LV, Crawford CL, Morse L, Valdez AM, Alexander GR, Grant E, Valderama-Wallace C, Beatty D. Health equity: A concept analysis. Nurs Outlook 2023; 71:102032. [PMID: 37683597 DOI: 10.1016/j.outlook.2023.102032] [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: 02/09/2023] [Revised: 07/28/2023] [Accepted: 08/09/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Although health equity is critically important for healthcare delivery, there are inconsistencies in its definitions or lack of definitions. PURPOSE Develop a comprehensive understanding of health equity to guide nursing practice and healthcare policy. METHOD Walker and Avant's concept analysis method was used to establish defining attributes, antecedents, consequences, and empirical referents of health equity. FINDINGS Health equity defining attributes are grounded in ethical principles, the absence of unfair and avoidable differences, and fair and just opportunities to attain a person's full health potential. Health equity antecedents are categorized into environmental; financial or economic; law, politics, and policy; societal and structural; research; and digital and technology. DISCUSSION Health equity's antecedents are useful to distinguish health disparities from health outcomes resulting from individual preferences. To achieve health equity, organizations need to focus on addressing the antecedents.
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Affiliation(s)
- Chrystal L Lewis
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA.
| | - Alice Yan
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Michelle Y Williams
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA; Division of Primary Care and Population Health and Nursing Research Section, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Lynette V Apen
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Cecelia L Crawford
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Lisa Morse
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Anna M Valdez
- Department of Nursing, Sonoma State University, Rohnert Park, CA
| | - G Rumay Alexander
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Dale Beatty
- Executive Administration, Stanford Health Care, Palo Alto, CA
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22
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Guilamo-Ramos V, Thimm-Kaiser M, Benzekri A. Community-engaged Mpox vaccination provides lessons for equitable health care in the United States. Nat Med 2023; 29:2160-2161. [PMID: 37468666 DOI: 10.1038/s41591-023-02447-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Affiliation(s)
- Vincent Guilamo-Ramos
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC, USA.
- School of Nursing, Duke University, Durham, NC, USA.
- School of Medicine, Department of Family Medicine and Community Health, Department of Infectious Diseases, Duke University, Durham, NC, USA.
- Presidential Advisory Council on HIV/AIDS, US Department of Health and Human Services, Washington, DC, USA.
- CDC/HRSA Advisory Committee on HIV, Viral Hepatitis and STD Prevention and Treatment, US Department of Health and Human Services, Atlanta, GA, USA.
| | - Marco Thimm-Kaiser
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC, USA
- School of Nursing, Duke University, Durham, NC, USA
| | - Adam Benzekri
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC, USA
- School of Nursing, Duke University, Durham, NC, USA
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23
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Gray TF, Henderson MD, Barakat LP, Knafl KA, Deatrick JA. Advancing family science and health equity through the 2022-2026 National Institute of Nursing Research strategic plan. Nurs Outlook 2023; 71:102030. [PMID: 37696135 DOI: 10.1016/j.outlook.2023.102030] [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: 05/24/2023] [Revised: 07/25/2023] [Accepted: 08/09/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Consistent with the National Institute of Nursing Research's mission of leading nursing research to address current health challenges, the new Strategic Plan identifies five research lenses: health equity, social determinants of health, population and community health, prevention and health promotion, and systems and models of care. Family research, central to nursing research and practice, is the cornerstone of social ecology and represents a critical intersection of social and structural determinants of health. PURPOSE We argue why family health is essential to the 2022-2026 Strategic Plan and how the lenses can strengthen family research. METHODS Drawing from collective expertise and existing literature in family research, sociology, psychology, and nursing science, the authors present a new conceptual model that integrates structural racism and heteropatriarchy to examine the salience of family structure statuses for family outcomes and discuss approaches to research design, empirical measurement, and interpretation in order to bring this new model into practice. DISCUSSION The NINR Strategic Plan has the potential to dismantle structures that perpetuate racism and health inequity within and across family structures. An underaddressed research area under the new Strategic Plan relates to how social determinants of health influence and are influenced by families. CONCLUSION We challenge all investigators, not just family scientists, to expand the scope of their research to conceptualize the role of family on health inequities.
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Affiliation(s)
- Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA; Division of Palliative Medicine, Brigham and Women's Hospital, Boston, MA; Cancer Outcomes Research and Education Program, Massachusetts General Hospital Cancer Center, Boston, MA.
| | - Marcus D Henderson
- Johns Hopkins School of Nursing, Baltimore, MD; Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Lamia P Barakat
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Child and Adolescent Psychiatry and Behavioral Science, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kathleen A Knafl
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Janet A Deatrick
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA
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Mulawa MI, Knippler ET, Al-Mujtaba M, Wilkinson TH, Ravi VK, Ledbetter LS. Interventions to Improve Adolescent HIV Care Outcomes. Curr HIV/AIDS Rep 2023; 20:218-230. [PMID: 37300592 PMCID: PMC10528099 DOI: 10.1007/s11904-023-00663-z] [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] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE OF REVIEW This review of recent studies evaluating interventions to improve HIV care outcomes among adolescents with HIV (AHIV) was conducted to provide a comprehensive overview of the recent evidence, highlight promising approaches, and suggest directions for future research. RECENT FINDINGS Our scoping review revealed 65 studies evaluating a variety of interventions and using a range of study designs at various stages of research. Effective approaches included community-based, integrated service delivery models with case management, trained community adolescent treatment supporters, and consideration of social determinants of health. Recent evidence also supports the feasibility, acceptability, and preliminary efficacy of other innovative approaches, including mental health interventions as well as technology-delivered approaches; however, more research is needed to build the evidence base for these interventions. Our review's findings suggest that interventions providing comprehensive, individualized support are essential to improving HIV care outcomes among adolescents. More research is needed to build the evidence base for such interventions and ensure effective, equitable implementation to support the global target of ending the AIDS epidemic by 2030.
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Affiliation(s)
- Marta I Mulawa
- School of Nursing, Duke University, DUMC 3322, Durham, NC, 27710, USA.
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | | | - Maryam Al-Mujtaba
- School of Nursing, Duke University, DUMC 3322, Durham, NC, 27710, USA
| | | | | | - Leila S Ledbetter
- Duke University Medical Center Library and Archives, Durham, NC, USA
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Guilamo-Ramos V, Thimm-Kaiser M, Benzekri A. Is the USA on track to end the HIV epidemic? Lancet HIV 2023; 10:e552-e556. [PMID: 37541707 DOI: 10.1016/s2352-3018(23)00142-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/26/2023] [Accepted: 06/09/2023] [Indexed: 08/06/2023]
Abstract
Despite progress in reducing new HIV infections in the USA, publicly available data suggest that new HIV infections continue to occur at an alarming rate. In this Viewpoint, we highlight the regularity with which the existing systems for HIV prevention and treatment delivery in the USA fail and the clearly inequitable effect of the systems' failure among several priority populations of the Ending the HIV Epidemic (EHE) initiative. Existing data cast doubt on whether the current EHE efforts will suffice to achieve its 2030 goal of reducing annual new HIV infections to fewer than 3000. We outline future directions in four priority areas to regain lost ground in pursuit of the 2030 EHE goals: reducing the stigma affecting people living with and most at risk of HIV; broadening the HIV workforce; mitigating harmful social determinants of health; and recommitting and reinvesting in health in the USA more broadly.
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Affiliation(s)
- Vincent Guilamo-Ramos
- Center for Latino Adolescent and Family Health and School of Nursing, Duke University, Durham, NC, USA; Department of Family Medicine and Community Health and Department of Infectious Diseases, School of Medicine, Duke University, Durham, NC, USA; Presidential Advisory Council on HIV/AIDS, US Department of Health and Human Services, Washington, DC, USA; CDC/HRSA Advisory Committee on HIV, Viral Hepatitis and STD Prevention and Treatment, US Department of Health and Human Services, Atlanta, GA, USA; Panel on Antiretroviral Guidelines for Adults and Adolescents, Office of AIDS Research Advisory Council, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA.
| | - Marco Thimm-Kaiser
- Center for Latino Adolescent and Family Health and School of Nursing, Duke University, Durham, NC, USA
| | - Adam Benzekri
- Center for Latino Adolescent and Family Health and School of Nursing, Duke University, Durham, NC, USA
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