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Li C, Thapa D, Mi Q, Gao Y, Fu X. Disparities in hepatitis B virus healthcare service access among marginalised poor populations: a mixed-method systematic review. Infect Dis Poverty 2024; 13:58. [PMID: 39123232 PMCID: PMC11312201 DOI: 10.1186/s40249-024-01225-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 07/08/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Marginalised poor populations, characterised by poverty and social exclusion, suffer disproportionately from hepatitis B virus (HBV) infections and encounter substantial disparities in access to healthcare. This has further exacerbated the global HBV burden and precluded progress towards HBV elimination. This mixed-method systematic review aimed to synthesise their utilisation and influencing factors in HBV healthcare services, including screening, vaccination, treatment, and linkage-to-care. METHODS Eleven databases were searched from their inception to May 4, 2023. Quantitative and qualitative studies examining the factors influencing HBV healthcare access among marginalised poor populations were included. A meta-analysis was conducted to synthesise the pooled rates of HBV healthcare utilisation. The factors influencing utilisation were integrated and visualised using a health disparity research framework. RESULTS Twenty-one studies were included involving 13,171 marginalised poor individuals: sex workers, rural migrant workers, irregular immigrants, homeless adults, and underprivileged individuals. Their utilisation of HBV healthcare ranged from 1.5% to 27.5%. Meta-analysis showed that the pooled rate of at least one dose of the HBV vaccine barely reached 37% (95% confidence interval: 0.26‒0.49). Fifty-one influencing factors were identified, with sociocultural factors (n = 19) being the most frequently reported, followed by behavioural (n = 14) and healthcare system factors (n = 11). Socio-cultural barriers included immigration status, prison history, illegal work, and HBV discrimination. Behavioural domain factors, including previous testing for sexually transmitted diseases, residential drug treatment, and problem-solving coping, facilitated HBV healthcare access, whereas hostility coping exerted negative influences. Healthcare system facilitators comprised HBV health literacy, beliefs, and physician recommendations, whereas barriers included service inaccessibility and insurance inadequacies. The biological and physical/built environments were the least studied domains, highlighting that geographical mobility, shelter capacity, and access to humanitarian health centres affect HBV healthcare for marginalised poor populations. CONCLUSIONS Marginalised poor populations encounter substantial disparities in accessing HBV healthcare, highlighting the need for a synergistic management approach, including deploying health education initiatives to debunk HBV misperceptions, developing integrated HBV management systems for continuous tracking, conducting tailored community outreach programmes, and establishing a human rights-based policy framework to guarantee the unfettered access of marginalised poor populations to essential HBV services.
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Affiliation(s)
- Caixia Li
- The Department of Nursing, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | | | - Qian Mi
- The School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yuanxiu Gao
- The Department of Nursing, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Xia Fu
- The Department of Nursing, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong Province, China.
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Dias-Karunaratne N, Whop L, Ward J, Vujovich-Dunn C, Amin J, Dakiniewich A, Dyda A. Representation of marginalised populations in digital surveillance for notifiable conditions in Australia: a systematic review. Perspect Public Health 2024; 144:162-173. [PMID: 38509693 PMCID: PMC11103913 DOI: 10.1177/17579139241237101] [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: 03/22/2024]
Abstract
AIM This study aims to establish whether digital surveillance methods for notifiable diseases in Australia collect and report data in relation to marginalised populations. METHODS The literature was systematically reviewed to identify primary research studies published between January 2005 and July 2023. Studies were included if they described an Australian digital surveillance system for notifiable conditions. The results were synthesised with a focus on evaluating the collection and reporting of data in relation to marginalised populations. RESULTS A total of 13 articles reporting on seven surveillance systems were identified. Influenza and adverse events following immunisation were the two most common notifiable conditions monitored. A total of six surveillance systems encompassing 16 articles reported information on sub-populations. Of these, three surveillance systems (nine articles) included data on marginalised populations. CONCLUSION The data collected or reported in relation to sub-groups that characterise diversity in terms of health care needs, access, and marginalised populations are minimal. It is recommended that a set of equity and reporting principles is established for the future creation and use of any digital surveillance system.
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Affiliation(s)
- N Dias-Karunaratne
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - L Whop
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, ACT, Australia
| | - J Ward
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD, Australia
| | - C Vujovich-Dunn
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - J Amin
- Department of Health Science, Macquarie University, Sydney, NSW, Australia
| | - A Dakiniewich
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - A Dyda
- School of Public Health, The University of Queensland, 288 Herston Road, Herston, Brisbane, QLD 4072, Australia
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Plage S, Baker K, Parsell C, Stambe R, Kuskoff E, Mansuri A. Staying safe, feeling welcome, being seen: How spatio-temporal configurations affect relations of care at an inclusive health and wellness centre. Health Expect 2023; 26:2620-2629. [PMID: 37656503 PMCID: PMC10632618 DOI: 10.1111/hex.13858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND People experiencing homelessness also experience poorer health and frequently attend acute care settings when primary health care would be better equipped to meet their needs. Existing scholarship identifies a complex mix of individual and structural-level factors affecting primary health care engagement driving this pattern of health services utilisation. We build on this existing knowledge, by bringing the spatio-temporal configurations of primary health care into focus. Specifically, we interrogate how space and time inflect situated practices and relations of care. METHODS This study took an ethnographic approach and was conducted 2021-2022 at an inclusive health and wellness centre ("the Centre") in Southeast Queensland, Australia. The data consists of 46 interviews with 48 people with lived experience of homelessness, including participants who use the services offered at the Centre (n = 26) and participants who do not (n = 19). We also interviewed 20 clinical and non-clinical service providers affiliated with the Centre and observed how service delivery took place. Interviews and observations were complemented by visual data, including participant-produced photography. All data were analysed employing a narrative framework. RESULTS We present three interrelated themes demonstrating how space and time affect care, that is 'staying safe', 'feeling welcome' and 'being seen'. 'Staying safe' captures the perceptions and practices around safety, which sit in tension with making service users feel welcome. 'Feeling welcome' attends to the sense of being invited to use services free of judgment. 'Being seen' depicts capacities to see a health care provider as well as being understood in one's lived experience. CONCLUSION Spatio-temporal configurations, such as attendance policies, consultation modalities and time allocated to care encounters afford differential opportunities to nurture reciprocal relations. We conclude that flexible service configurations can leverage a relational model of care. PATIENT OR PUBLIC CONTRIBUTION Service providers were consulted during the design stage of the project and had opportunities to inform data collection instruments. Two service providers contributed to the manuscript as co-authors. People with lived experience of homelessness who use the services at the inclusive health centre contributed as research participants and provided input into the dissemination of findings. The photography they produced has been featured in an in-person exhibition, to which some have contributed as consultants or curators. It is hoped that their insights into experiences of welcomeness, safety and being seen will inform flexible and relational primary health care design, delivery, and evaluation to better cater for people experiencing housing instability and poverty.
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Affiliation(s)
- Stefanie Plage
- ARC Centre of Excellence for Children and Families over the Life CourseIndooroopillyAustralia
| | - Kirsten Baker
- Australian Research Centre in Complementary and Integrative MedicineThe University of Technology SydneyBroadwayAustralia
- Inclusive Health and Wellness HubSouth BrisbaneAustralia
| | - Cameron Parsell
- ARC Centre of Excellence for Children and Families over the Life CourseIndooroopillyAustralia
| | - Rose‐Marie Stambe
- ARC Centre of Excellence for Children and Families over the Life CourseIndooroopillyAustralia
| | - Ella Kuskoff
- ARC Centre of Excellence for Children and Families over the Life CourseIndooroopillyAustralia
| | - Arif Mansuri
- Inclusive Health and Wellness HubSouth BrisbaneAustralia
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Marjadi B, Flavel J, Baker K, Glenister K, Morns M, Triantafyllou M, Strauss P, Wolff B, Procter AM, Mengesha Z, Walsberger S, Qiao X, Gardiner PA. Twelve Tips for Inclusive Practice in Healthcare Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4657. [PMID: 36901666 PMCID: PMC10002390 DOI: 10.3390/ijerph20054657] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
This paper outlines practical tips for inclusive healthcare practice and service delivery, covering diversity aspects and intersectionality. A team with wide-ranging lived experiences from a national public health association's diversity, equity, and inclusion group compiled the tips, which were reiteratively discussed and refined. The final twelve tips were selected for practical and broad applicability. The twelve chosen tips are: (a) beware of assumptions and stereotypes, (b) replace labels with appropriate terminology, (c) use inclusive language, (d) ensure inclusivity in physical space, (e) use inclusive signage, (f) ensure appropriate communication methods, (g) adopt a strength-based approach, (h) ensure inclusivity in research, (i) expand the scope of inclusive healthcare delivery, (j) advocate for inclusivity, (k) self-educate on diversity in all its forms, and (l) build individual and institutional commitments. The twelve tips are applicable across many aspects of diversity, providing a practical guide for all healthcare workers (HCWs) and students to improve practices. These tips guide healthcare facilities and HCWs in improving patient-centered care, especially for those who are often overlooked in mainstream service provision.
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Affiliation(s)
- Brahmaputra Marjadi
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Joanne Flavel
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- Stretton Health Equity, Stretton Institute, School of Social Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Kirsten Baker
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- Australian Research Consortium in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Kristen Glenister
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- Department of Rural Health, The University of Melbourne, Wangaratta, VIC 3677, Australia
| | - Melissa Morns
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- The Australian Centre for Public and Population Health Research, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Mel Triantafyllou
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- Health Research Institute, University of Canberra, Bruce, ACT 2617, Australia
| | - Penelope Strauss
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA 6009, Australia
| | - Brittany Wolff
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- School of Psychological Sciences, The University of Western Australia, Crawley, WA 6009, Australia
| | - Alexandra Marie Procter
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Zelalem Mengesha
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- Centre for Primary Health Care and Equity, The University of New South Wales, UNSW, Sydney, NSW 2025, Australia
| | - Scott Walsberger
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- ACON, Surry Hills, NSW 2010, Australia
| | - Xiaoxi Qiao
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
| | - Paul A. Gardiner
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
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Carson A, Cameron ES, Paynter M, Norman WV, Munro S, Martin-Misener R. Nurse practitioners on 'the leading edge' of medication abortion care: A feminist qualitative approach. J Adv Nurs 2023; 79:686-697. [PMID: 36369652 PMCID: PMC10100085 DOI: 10.1111/jan.15487] [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: 05/25/2022] [Revised: 10/09/2022] [Accepted: 10/19/2022] [Indexed: 11/15/2022]
Abstract
AIMS To explore nurse practitioners' experiences of medication abortion implementation in Canada and to identify ways to further support the implementation of medication abortion by nurse practitioners in Canada. DESIGN A qualitative approach informed by feminist theory and integrated knowledge translation. METHODS Qualitative interviews with stakeholders and nurse practitioners between January 2020 and May 2021. Data were analysed using critical feminist theory. RESULTS Participants included 20 stakeholders, 16 nurse practitioner abortion providers, and seven nurse practitioners who did not provide abortions. We found that nurse practitioners conduct educational, communication and networking activities in the implementation of medication abortion in their communities. Nurse practitioners navigated resistance to abortion care in the health system from employers, colleagues and funders. Participants valued making abortion care more accessible to their patients and indicated that normalizing medication abortion in primary care was important to them. CONCLUSION When trained in abortion care and supported by employers, nurse practitioners are leaders of abortion care in their communities and want to provide accessible, inclusive services to their patients. We recommend nursing curricula integrate abortion services in education, and that policymakers and health administrators partner with nurses, physicians, midwives, social workers and pharmacists, for comprehensive provincial/territorial sexual and reproductive health strategies for primary care. IMPACT The findings from this study may inform future policy, health administration and curriculum decisions related to reproductive health, and raise awareness about the crucial role of nurse practitioners in abortion care and contributions to reproductive health equity. PATIENT OR PUBLIC CONTRIBUTION This study focused on provider experiences. In-kind support was provided by Action Canada for Sexual Health & Rights, an organization that provides direct support and resources to the public and is committed to advocating on behalf of patients and the public seeking sexual and reproductive health services.
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Affiliation(s)
- Andrea Carson
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Martha Paynter
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Munro
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
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