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Boisvert I, Rivera SC, Smith-Merry J, Molony-Oates B, Kecman E, Hughes SE. A qualitative reflexive thematic analysis of innovation and regulation in hearing health care. BMC Med 2024; 22:417. [PMID: 39334196 PMCID: PMC11438185 DOI: 10.1186/s12916-024-03627-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 09/10/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND The hearing health sector is an example of a health sector that is experiencing a period of rapid innovation driven by digital technologies. These innovations will impact the types of interventions and services available to support the communication of deaf and hard-of-hearing individuals. This study explored the perceptions of informed participants on the topic of innovation and regulation within hearing healthcare in Australia and the United Kingdom (UK). METHODS Participants (N = 29, Australia [n = 16], UK [n = 13]) were purposively sampled and joined one of two online workshops. Participants included adults with hearing loss and family members, hearing health professionals, academics/researchers, representatives of hearing device manufacturers, regulators and policymakers. Workshop data were analysed using reflexive thematic analysis. RESULTS Participants conceptualised the hearing health sector as a network of organisations and individuals with different roles, knowledge and interests, in a state of flux driven by innovation and regulation. Innovation and regulation were perceived as mechanisms to ensure quality and mitigate risk within a holistic approach to care. Innovations encompassed technological as well as non-technological innovations of potential benefit to consumers. Participants agreed it was essential for innovation and regulation to be congruent with societal values. Critical to ethical congruence was the involvement of consumers throughout both innovation and regulation stages, and the use of innovation and regulation to tackle stigma and reduce health disparities. Participants expressed the desire for accessible and inclusive innovation in the context of fair, transparent and trustworthy commercial practices. CONCLUSIONS This study explored how stakeholders within the hearing health sector understand and make sense of innovation and the role of regulation. Overall, and despite reservations relating to health care professionals' changing roles and responsibilities, innovation and regulation were conceptualised as beneficial when situated in the context of holistic, whole-person, models of care. The results of this study will inform considerations to support the development and implementation of innovations and regulation within the hearing sector and across other health sectors influenced by technological advances.
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Affiliation(s)
- Isabelle Boisvert
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
- Centre for Disability Research and Policy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Samantha Cruz Rivera
- Centre for Patient Reported Outcome Research, Department of Applied Health Sciences, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science, Birmingham, UK
| | - Jennifer Smith-Merry
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Disability Research and Policy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Emily Kecman
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Disability Research and Policy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sarah E Hughes
- Centre for Patient Reported Outcome Research, Department of Applied Health Sciences, University of Birmingham, Birmingham, UK.
- Birmingham Health Partners Centre for Regulatory Science, Birmingham, UK.
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Rosero EB, Eslava-Schmalbach J, Garzón-Orjuela N, Buitrago G, Joshi GP. Failure to Rescue and Mortality Differences After Appendectomy in a Low-Middle-Income Country and the United States. Anesth Analg 2023; 136:1030-1038. [PMID: 36728930 DOI: 10.1213/ane.0000000000006336] [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: 02/03/2023]
Abstract
BACKGROUND Major disparities in complications and mortality after appendectomy between countries with different income levels have not been well characterized, as comparative studies at patient level between countries are scant. This study aimed to investigate variations in postoperative complications, mortality, and failure to rescue after appendectomy between a high-income country and a low-to-middle-income country. METHODS Hospital discharges on adult patients who underwent appendectomy were extracted from administrative databases from Colombia and 2 states of the United States (Florida and New York). Outcomes included major postoperative complications, in-hospital mortality, and failure to rescue. Univariate analyses were conducted to compare outcomes between the 2 countries. Multivariable logistic regression analyses were conducted to examine the independent effect of country on outcomes after adjustment for patient age, sex, comorbidity index, severity of appendicitis, and appendectomy route (laparoscopic/open). RESULTS A total of 62,338 cases from Colombia and 57,987 from the United States were included in the analysis. Patients in Colombia were significantly younger and healthier but had a higher incidence of peritonitis. Use of laparoscopy was significantly lower in Colombia (5.9% vs 89.4%; P < .0001). After adjustment for covariates, multivariable logistic regression analyses revealed that compared to the United States, Colombia had lower complication rates (2.8% vs 6.6%; odds ratio [OR], 0.41; 95% confidence interval [CI], 0.39-0.44; P < .0001) but higher mortality (0.44% vs 0.08%; OR, 8.92; 95% CI, 5.69-13.98; P < .0001) and failure to rescue (13.6% vs 1.0%; OR, 17.01; 95% CI, 10.66-27.16; P < .0001). CONCLUSIONS Despite lower rates of postoperative complications, in-hospital mortality after appendectomy was higher in Colombia than in the United States. This difference may be explained by higher rates of failure to rescue in the low-to-middle-income country (ie, decreased ability of Colombian hospitals to rescue patients from complications).
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Affiliation(s)
- Eric B Rosero
- From the Department of Anesthesiology and Pain Management' University of Texas Southwestern Medical Center, Dallas, Texas
| | - Javier Eslava-Schmalbach
- Health Equity Research Group, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Nathaly Garzón-Orjuela
- Health Equity Research Group, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Giancarlo Buitrago
- Clinical Research Institute, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Girish P Joshi
- From the Department of Anesthesiology and Pain Management' University of Texas Southwestern Medical Center, Dallas, Texas
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Luttikhuis N, Wiebe KS. Analyzing SDG interlinkages: identifying trade-offs and synergies for a responsible innovation. SUSTAINABILITY SCIENCE 2023; 18:1-19. [PMID: 37363308 PMCID: PMC10214325 DOI: 10.1007/s11625-023-01336-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/17/2023] [Indexed: 06/28/2023]
Abstract
This paper responds to recent calls to address the indivisible nature of the Sustainable Development Goal (SDG) framework and the related knowledge gap on how SDG targets interlink with each other. It examines how SDG targets interact in the context of a specific technology, point of care (PoC) microfluidics, and how this relates to the concept of responsible innovation (RI). The novel SDG interlinkages methodology developed here involves several steps to filter the relevant interlinkages and a focus group of experts for discussing these interlinkages. The main findings indicate that several social synergies occur when deploying PoC microfluidics, but that the environmental trade-offs may jeopardize the total progress toward the SDGs. More specifically, the environmental sacrifices (use of plastics and lack of recyclability) resulted in the product being cheaper and, thus, better accessible. This work suggests that attention should be given (and prioritized) to the use of renewable and recyclable materials without jeopardizing the accessibility of the product. This should minimize the identified trade-offs. These findings inform how analyzing SDG interlinkages relates to the responsibilities and dimensions of RI in several ways. First, analyzing SDG interlinkages helps to execute the governance responsibility by using the RI dimensions (anticipation, reflexivity, inclusion and responsiveness). Second, analyzing SDG interlinkages gives insights into if and how a technology relates to the do-good and avoid-harm responsibility. This is important to assess the responsiveness of the technology to ensure that the technology can become truly sustainable and leaves no one behind.
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Affiliation(s)
- Nikki Luttikhuis
- Sustainable Energy Technology, SINTEF, Torgarden, P.O. Box 4760, 7465 Trondheim, Norway
- Department of Industrial Economics and Technology Management, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - Kirsten S. Wiebe
- Sustainable Energy Technology, SINTEF, Torgarden, P.O. Box 4760, 7465 Trondheim, Norway
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Wagner S, Olesen K. Social inequalities in the self-management of type 1 diabetes: A serial multiple mediation analysis. Scand J Public Health 2023; 51:250-256. [PMID: 34515582 DOI: 10.1177/14034948211041814] [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: 11/15/2022]
Abstract
AIMS Diabetes requires complex self-management. Due to this complexity, social disparities exist in the self-management of type 1 diabetes. Various pathways to describe associations between socio-economic factors and health outcomes have been suggested. We sought to elucidate the potential of health literacy and social support to reduce social disparities in diabetes self-management. METHODS Questionnaire responses were linked to data from electronic medical records, yielding a study population of 1186 people with type 1 diabetes. Mediation analyses using adjusted linear regressions were used to establish pathways between self-reported educational attainment, social support, functional health literacy and clinically obtained measures of glycaemic control. RESULTS We found evidence of an association between education and glycated haemoglobin, partially mediated by functional health literacy and social support. However, the direct association between social support and glycaemic control was not statistically significant. CONCLUSIONS
Whilst both functional health literacy and social support play a role in glycaemic control, our findings did not explain the main impact of social disparities on glycaemic control. Interventions to reduce disparities in glycaemic control related to educational attainment should focus beyond functional health literacy and social support.
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Baumann MF, Weinberger N, Maia M, Schmid K. User types, psycho-social effects and societal trends related to the use of consumer health technologies. Digit Health 2023; 9:20552076231163996. [PMID: 37034307 PMCID: PMC10074638 DOI: 10.1177/20552076231163996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 02/23/2023] [Indexed: 04/05/2023] Open
Abstract
Objective The term consumer health technologies we use in this paper refers to fitness and health apps, wearables and other self-tracking devices that collect health-related data. Our paper aims to bridge the gap between the growing literature base of sociological research and ethical reflection on the (non-intended) effects of consumer health technology use on the psycho-social level, such as stress, responsibilization or a loss of intuitive sense for signs of health or illness. Special consideration should be given to vulnerable individuals, as the positive and negative effects of consumer health technology use may be unequally distributed. This perspective may help to guide policymaking and the responsible development of consumer health technologies. Methods Using a narrative review approach, we refer to empirical and theoretical studies dealing with user types and effects related to the use of consumer health technologies. We provide an overview of consumer health technology user typologies and evidence of the unintended psycho-social effects of consumer health technology use. On this basis, we propose a user typology that may serve as a future tool for ethical reflection on negative side effects. Results Evidence of the potential negative side effects of consumer health technology use, as presented in the literature, is inconclusive due to the high diversity of consumer health technology users and the way they use consumer health technologies. Our proposed user typology aims to more comprehensively document the diversity of users by incorporating the way in which users identify with and use their self-tracked data, attitudes towards the new technology and social interactions via consumer health technologies, and the purpose and self-determinedness of consumer health technology use. Conclusions More systematic and quantitative empirical research on the effects of consumer health technology use in diverse settings and with diverse user types is necessary to inform public health policy. In addition to evidence-based certification of medical consumer health technologies, more practical and flexible ways to protect users from side effects may have to be developed and adopted, especially regarding the increasing number of non-medical consumer health technologies.
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Affiliation(s)
- Martina F Baumann
- Institute of Technology Assessment and Systems Analysis, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Nora Weinberger
- Institute of Technology Assessment and Systems Analysis, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Maria Maia
- Institute of Technology Assessment and Systems Analysis, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Karolin Schmid
- Institute of Technology Assessment and Systems Analysis, Karlsruhe Institute of Technology, Karlsruhe, Germany
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van Leersum CM, Konrad KE, Siebrand E, Malik ZB, den Ouden MEM, Bults M. Engaging older adults with a migration background to explore the usage of digital technologies in coping with dementia. Front Public Health 2023; 11:1125834. [PMID: 37124775 PMCID: PMC10140574 DOI: 10.3389/fpubh.2023.1125834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/15/2023] [Indexed: 05/02/2023] Open
Abstract
Background Coping with dementia can imply particular challenges for people with a migration background due to diversity in their life course, personal characteristics, and living environment. Some of the services available for people with dementia include digital technologies for care, providing health services, and maintaining or increasing participation, independence, and safety. This study aimed to explore the role of digital technology in coping with dementia in the lives of older adults with a migration background, and the possibilities to engage and collaborate with older adults. Methods This study combined a qualitative interview-based approach with citizen science principles in the design and execution of a project studying the use of Anne4Care. Results and discussion Participants valued that technology should provide health benefits and fit into aspects of their daily lives. Anne4Care was considered helpful in staying independent and connecting to loved ones in their country of birth. The participants needed to learn new competencies to work with the device, and not all had the material prerequisites, such as an internet connection. Still, this learning process was considered purposeful in their life, and the virtual assistant could be integrated into care and daily practices. The involvement of the older adults with dementia as co-researchers made them feel valuable and as equal partners during this research. An important prerequisite for the involvement of older adults with a migration background was existing relations with carers and care organizations. Conclusion Digital care technologies to cope with dementia can become a valuable part of care practices in the lives of older adults with a migration background. Involving older adults in the development of technology, acknowledging their expertise and needs, and working together in short iterations to adapt the technology for their specific needs and situations were experienced as valuable by the researchers, older adults, and care professionals.
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Affiliation(s)
- Catharina M. van Leersum
- Science, Technology, and Policy Studies, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, Netherlands
- *Correspondence: Catharina M. van Leersum,
| | - Kornelia E. Konrad
- Science, Technology, and Policy Studies, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, Netherlands
| | - Egbert Siebrand
- Ethics and Technology Research Group, Saxion University of Applied Science, Deventer, Netherlands
| | - Zohrah B. Malik
- Technology, Health and Care Research Group, Saxion University of Applied Science, Enschede, Netherlands
| | - Marjolein E. M. den Ouden
- Technology, Health and Care Research Group, Saxion University of Applied Science, Enschede, Netherlands
| | - Marloes Bults
- Technology, Health and Care Research Group, Saxion University of Applied Science, Enschede, Netherlands
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Elstad JI, Heggebø K, Dahl E. Nordic research on health inequalities: A scoping review of empirical studies published in Scandinavian Journal of Public Health 2000-2021. Scand J Public Health 2022; 50:843-851. [PMID: 35731011 PMCID: PMC9578093 DOI: 10.1177/14034948221101304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/29/2022] [Accepted: 04/28/2022] [Indexed: 11/17/2022]
Abstract
AIMS An important task for the Scandinavian Journal of Public Health is to address health inequality topics. This scoping review characterises Nordic empirical studies within this research field, published 2000-2021 by the Scandinavian Journal of Public Health. METHODS Original empirical research studies using data from Denmark, Finland, Iceland, Norway and/or Sweden, which linked differences in health or health-related aspects to socioeconomic positions, immigrant status, family structures and/or residential areas, were included in the review. The initial search in the Web of Science article database resulted in 294 possibly relevant articles, and 171 were judged to comply with our criteria. RESULTS Only one study was based on qualitative data, while all others used either surveys or register data, or both in combination. A wide variety of outcomes was addressed. Most studies had a social causation design, but 16 studies analysed health-related mobility processes and four reported intervention results. The most common statistical method was logistic regression. Poisson, Cox and ordinary least squares regression were less used. Few studies engaged explicitly with health inequality theories or with rigorous causality designs. CONCLUSIONS The empirical health inequality studies published by the Scandinavian Journal of Public Health are rich sources for knowledge on a large array of health and health-related inequalities in Nordic countries. Drawbacks are underuse of qualitative data, few theoretical discussions and lack of studies assessing effects of interventions and policies.
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Affiliation(s)
- Jon Ivar Elstad
- NOVA, Centre for Welfare and Labour Research, Oslo Metropolitan University, Norway
| | - Kristian Heggebø
- NOVA, Centre for Welfare and Labour Research, Oslo Metropolitan University, Norway
| | - Espen Dahl
- Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Norway
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Alami H, Lehoux P, Shaw SE, Papoutsi C, Rybczynska-Bunt S, Fortin JP. Virtual Care and the Inverse Care Law: Implications for Policy, Practice, Research, Public and Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710591. [PMID: 36078313 PMCID: PMC9518297 DOI: 10.3390/ijerph191710591] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 05/31/2023]
Abstract
Virtual care spread rapidly at the outbreak of the COVID-19 pandemic. Restricting in-person contact contributed to reducing the spread of infection and saved lives. However, the benefits of virtual care were not evenly distributed within and across social groups, and existing inequalities became exacerbated for those unable to fully access to, or benefit from virtual services. This "perspective" paper discusses the extent to which challenges in virtual care access and use in the context of COVID-19 follow the Inverse Care Law. The latter stipulates that the availability and quality of health care is inversely proportionate to the level of population health needs. We highlight the inequalities affecting some disadvantaged populations' access to, and use of public and private virtual care, and contrast this with a utopian vision of technology as the "solution to everything". In public and universal health systems, the Inverse Care Law may manifests itself in access issues, capacity, and/or lack of perceived benefit to use digital technologies, as well as in data poverty. For commercial "Direct-To-Consumer" services, all of the above may be encouraged via a consumerist (i.e., profit-oriented) approach, limited and episodic services, or the use of low direct cost platforms. With virtual care rapidly growing, we set out ways forward for policy, practice, and research to ensure virtual care benefits for everyone, which include: (1) pay more attention to "capabilities" supporting access and use of virtual care; (2) consider digital technologies as a basic human right that should be automatically taken into account, not only in health policies, but also in social policies; (3) take more seriously the impact of the digital economy on equity, notably through a greater state involvement in co-constructing "public health value" through innovation; and (4) reconsider the dominant digital innovation research paradigm to better recognize the contexts, factors, and conditions that influence access to and use of virtual care by different groups.
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Affiliation(s)
- Hassane Alami
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Pascale Lehoux
- Center for Public Health Research and Department of Health Management, Evaluation and Policy, University of Montreal, Montreal, QC H3C 3J7, Canada
| | - Sara E. Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Sarah Rybczynska-Bunt
- Community and Primary Care Research Group, Faculty of Health, Plymouth University, Plymouth PL6 8BX, UK
| | - Jean-Paul Fortin
- VITAM Research Centre on Sustainable Health, Faculty of Medicine, Laval University, Quebec, QC G1J 2G1, Canada
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Mahmud N, Goldberg DS, Kaplan DE, Serper M. Major Shifts in Outpatient Cirrhosis Care Delivery Attributable to the COVID-19 Pandemic: A National Cohort Study. Hepatol Commun 2022; 6:3186-3193. [PMID: 36321766 PMCID: PMC9592756 DOI: 10.1002/hep4.1638] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has disrupted health care delivery in the United States, with increased reliance on telemedicine visits as opposed to in-person outpatient appointments. We used national data to evaluate shifts in modes of hepatology outpatient care for patients with cirrhosis during the pandemic. This was a retrospective cohort study among U.S. veterans with cirrhosis. We used linear regression to evaluate absolute and percentage changes from baseline in hepatology in-person visits and telemedicine visits from January 1, 2020, to August 11, 2020. The proportion of in-person and telemedicine visits were plotted geographically to demonstrate state-level shifts in care delivery over time. Patient-level characteristics in the pre-COVID and during-COVID periods were also compared. We identified 5,618 in-person and 6,210 telemedicine hepatology visits among patients with cirrhosis. In-person visits significantly declined (-16.0% per week; 95% confidence interval [CI] -20.7, -11.2; P < 0.001), while telemedicine visits significantly increased (61.3% per week; 95% CI 45.1, 77.5; P < 0.001) in the early during-COVID period. At the U.S. state level, we found that nearly all states experienced a significant shift toward telemedicine over the course of several weeks. Patients over the age of 70 years and Black patients were less likely to receive telemedicine visits in the pre-COVID period (each P < 0.05), although these differences were eliminated in the during-COVID periods. Conclusion: Among patients with cirrhosis, hepatology outpatient care delivery has shifted heavily toward telemedicine due to COVID-19. This occurred across the United States, and changes have been sustained through August 2020. Expanded telemedicine visits among older patients and Black patients may reflect dedicated efforts to increased access to care among these groups.
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Affiliation(s)
- Nadim Mahmud
- Division of Gastroenterology and HepatologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA,Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - David S. Goldberg
- Division of Digestive Health and Liver DiseasesUniversity of Miami Miller School of MedicineMiamiFLUSA
| | - David E. Kaplan
- Division of Gastroenterology and HepatologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA,Department of MedicineCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPAUSA
| | - Marina Serper
- Division of Gastroenterology and HepatologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA,Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPAUSA,Department of MedicineCorporal Michael J. Crescenz VA Medical CenterPhiladelphiaPAUSA
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Lee G, Chang A, Pal A, Tran TA, Cui X, Quach T. Understanding and Addressing the Digital Health Literacy Needs of Low-Income Limited English Proficient Asian American Patients. Health Equity 2022; 6:494-499. [PMID: 36186613 PMCID: PMC9518790 DOI: 10.1089/heq.2022.0045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2022] [Indexed: 01/28/2023] Open
Abstract
Introduction: During the pandemic, Asian Health Services (AHS), a federally qualified health center serving patients in 14 Asian languages, transformed rapidly to provide telehealth visits, developed an intensive remote patient monitoring program, and conducted a digital health literacy survey. Method: This article describes how AHS collected and utilized descriptive data on our patient population to inform our rapid adoption of telehealth and assess our patients' response to these changes. Results: Our experiences show that audio visits are invaluable for our patients. In addition, our remote monitoring program resulted in 96% of patients improving their blood pressure control. Conclusion: Many barriers to widespread adoption of telehealth exist, including low digital literacy and the need for in-language digital training. Disaggregated data by ethnicity and language are needed to inform future work.
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Affiliation(s)
- George Lee
- Asian Health Services, Oakland, California, USA
| | - Anita Chang
- Asian Health Services, Oakland, California, USA
| | - Agnita Pal
- Asian Health Services, Oakland, California, USA
| | - Thu-An Tran
- Asian Health Services, Oakland, California, USA
| | - Xinyue Cui
- Asian Health Services, Oakland, California, USA
| | - Thu Quach
- Asian Health Services, Oakland, California, USA
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Stewart-Knox BJ, Poínhos R, Fischer ARH, Chaudhrey M, Rankin A, Davison J, Bunting BP, Frewer LJ, Oliveira BMPM. Sex and age differences in attitudes and intention to adopt personalised nutrition in a UK sample. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2021; 31:1-7. [PMID: 34926128 PMCID: PMC8670611 DOI: 10.1007/s10389-021-01676-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/11/2021] [Indexed: 11/29/2022]
Abstract
AIM There has been an increase in the development of technologies that can deliver personalised dietary advice. Devising healthy, sustainable dietary plans will mean taking into consideration extrinsic factors such as individual social circumstances. The aim of this study was to identify societal groups more or less receptive to and likely to engage with personalised nutrition initiatives. SAMPLE AND METHODS Volunteers were recruited via a social research agency from within the UK. The resultant sample (N = 1061) was 49% female, aged 18-65 years. RESULTS MANOVA (Tukey HSD applied) indicated that females and younger people (aged 18-29 years) had more favourable attitudes and were more likely to intend to adopt personalised nutrition. There were no differences in attitude toward or intention to adopt personalised nutrition between different education levels, income brackets or occupational groups. CONCLUSION These results imply that females and younger people may be most likely to adopt personalised nutrition in the future. Initiatives to promote healthy eating should target males and older people.
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Affiliation(s)
- Barbara J. Stewart-Knox
- Division of Psychology, School of Social Sciences, University of Bradford, Richmond Road, Bradford, BD71DP UK
| | - Rui Poínhos
- Faculty of Nutrition and Food Sciences, University of Porto, Rua do Campo Alegre, n.° 823, 4150-180 Porto, Portugal
| | - Arnout R. H. Fischer
- Social-Sciences, Marketing and Consumer Behaviour, Wageningen University, Hollandseweg 1, 6706 KN Wageningen, The Netherlands
| | - Mutassam Chaudhrey
- Division of Psychology, School of Social Sciences, University of Bradford, Richmond Road, Bradford, BD71DP UK
| | - Audrey Rankin
- School of Pharmacy, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL UK
| | - Jenny Davison
- School of Psychology, Ulster University, Cromore Road, Coleraine, County Londonderry BT52 1SA UK
| | - Brendan P. Bunting
- School of Psychology, Ulster University, Cromore Road, Coleraine, County Londonderry BT52 1SA UK
| | - Lynn J. Frewer
- School of Natural and Environmental Sciences, Newcastle University, Newcastle Upon Tyne, NE191AA UK
| | - Bruno M. P. M. Oliveira
- Faculty of Nutrition and Food Sciences, University of Porto, Rua do Campo Alegre, n.° 823, 4150-180 Porto, Portugal
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Affiliation(s)
- Signe Smith Jervelund
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Terje Andreas Eikemo
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Norway
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Barrozo LV, Fornaciali M, de André CDS, Morais GAZ, Mansur G, Cabral-Miranda W, de Miranda MJ, Sato JR, Amaro Júnior E. GeoSES: A socioeconomic index for health and social research in Brazil. PLoS One 2020; 15:e0232074. [PMID: 32348328 PMCID: PMC7190143 DOI: 10.1371/journal.pone.0232074] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/02/2020] [Indexed: 02/07/2023] Open
Abstract
The individual’s socioeconomic conditions are the most relevant to predict the quality of someone’s health. However, such information is not usually found in medical records, making studies in the area difficult. Therefore, it is common to use composite indices that characterize a region socioeconomically, such as the Human Development Index (HDI). The main advantage of the HDI is its understanding and adoption on a global scale. However, its applicability is limited for health studies since its longevity dimension presents mathematical redundancy in regression models. Here we introduce the GeoSES, a composite index that summarizes the main dimensions of the Brazilian socioeconomic context for research purposes. We created the index from the 2010 Brazilian Census, whose variables selection was guided by theoretical references for health studies. The proposed index incorporates seven socioeconomic dimensions: education, mobility, poverty, wealth, income, segregation, and deprivation of resources and services. We developed the GeoSES using Principal Component Analysis and evaluated its construct, content, and applicability. GeoSES is defined at three scales: national (GeoSES-BR), Federative Unit (GeoSES-FU), and intra-municipal (GeoSES-IM). GeoSES-BR dimensions showed a good association with HDI-M (correlation above 0.85). The model with the poverty dimension best explained the relative risk of avoidable cause mortality in Brazil. In the intra-municipal scale, the model with GeoSES-IM was the one that best explained the relative risk of mortality from circulatory system diseases. By applying spatial regressions, we demonstrated that GeoSES shows significant explanatory potential in the studied scales, being a compelling complement for future researches in public health.
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Affiliation(s)
- Ligia Vizeu Barrozo
- Departamento de Geografia, Faculdade de Filosofia, Letras e Ciências Humanas, Universidade de São Paulo, São Paulo, SP, Brazil
- Programa de Apoio ao Desenvolvimento Institucional do SUS (PROADI-SUS), São Paulo, Brazil
- Instituto de Estudos Avançados, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Michel Fornaciali
- Hospital Israelita Albert Einstein—Big Data Analytics, Morumbi, São Paulo, SP, Brazil
| | - Carmen Diva Saldiva de André
- Departamento de Estatística, Instituto de Matemática e Estatística, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Giselle Mansur
- Departamento de Geografia, Faculdade de Filosofia, Letras e Ciências Humanas, Universidade de São Paulo, São Paulo, SP, Brazil
- Programa de Apoio ao Desenvolvimento Institucional do SUS (PROADI-SUS), São Paulo, Brazil
| | - William Cabral-Miranda
- Departamento de Geografia, Faculdade de Filosofia, Letras e Ciências Humanas, Universidade de São Paulo, São Paulo, SP, Brazil
- Instituto de Estudos Avançados, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marina Jorge de Miranda
- Departamento de Análise em Saúde e Vigilância de Doenças não Transmissíveis (DASNT), Secretaria de Vigilância em Saúde (SVS), Ministério da Saúde (MS), Brasília, DF, Brazil
| | - João Ricardo Sato
- Hospital Israelita Albert Einstein—Big Data Analytics, Morumbi, São Paulo, SP, Brazil
- Centro de Matemática, Computação e Cognição, Universidade Federal do ABC, São Paulo, SP, Brazil
| | - Edson Amaro Júnior
- Hospital Israelita Albert Einstein—Big Data Analytics, Morumbi, São Paulo, SP, Brazil
- * E-mail:
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Nabi J, Friedlander DF, Chen X, Cole AP, Hu JC, Kibel AS, Dasgupta P, Trinh QD. Assessment of Out-of-Pocket Costs for Robotic Cancer Surgery in US Adults. JAMA Netw Open 2020; 3:e1919185. [PMID: 31940036 PMCID: PMC6991257 DOI: 10.1001/jamanetworkopen.2019.19185] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Expensive technologies-including robotic surgery-experience rapid adoption without evidence of superior outcomes. Although previous studies have examined perioperative outcomes and costs, differences in out-of-pocket costs for patients undergoing robotic surgery are not well understood. OBJECTIVE To assess out-of-pocket costs and total payments for 5 types of common oncologic procedures that can be performed using an open or robotic approach. DESIGN, SETTING, AND PARTICIPANTS A retrospective, cross-sectional, propensity score-weighted analysis was performed using deidentified insurance claims for 1.9 million enrollees from the MarketScan database from January 1, 2012, to December 31, 2017. The final study sample comprised 15 893 US adults aged 18 to 64 years who were enrolled in an employer-sponsored health plan. Patients underwent either an open or robotic radical prostatectomy, hysterectomy, partial colectomy, radical nephrectomy, or partial nephrectomy for a solid-organ malignant neoplasm. Statistical analysis was performed from December 18, 2018, to June 5, 2019. EXPOSURES Type of surgical procedure-robotic vs open. MAIN OUTCOMES AND MEASURES The primary outcome of interest was out-of-pocket costs associated with robotic and open surgery. The secondary outcome of interest was associated total payments. RESULTS Among 15 893 patients (11 102 men; mean [SD] age, 55.4 [6.6] years), 8260 underwent robotic and 7633 underwent open procedures; patients undergoing robotic hysterectomy were older than those undergoing open hysterectomy (mean [SD] age, 55.7 [6.7] vs 54.6 [7.2] years), and patients undergoing open radical nephrectomy had more comorbidities than those undergoing robotic radical nephrectomy (≥2 comorbidities, 658 of 861 [76.4%] vs 244 of 347 [70.3%]). After adjustment for baseline characteristics, the robotic approach was associated with lower out-of-pocket costs for all procedures: -$137.75 (95% CI, -$240.24 to -$38.63) for radical prostatectomy (P = .006); -$640.63 (95% CI, -$933.62 to -$368.79) for hysterectomy (P < .001); -$1140.54 (95% CI, -$1397.79 to -$896.54) for partial colectomy (P < .001); -$728.32 (95% CI, -$1126.90 to -$366.08) for radical nephrectomy (P < .001); and -$302.74 (95% CI, -$523.14 to -$97.10) for partial nephrectomy (P = .003). The robotic approach was similarly associated with lower adjusted total payments: -$3872.62 (95% CI, -$5385.49 to -$2399.04) for radical prostatectomy (P < .001); -$29 640.69 (95% CI, -$36 243.82 to -$23 465.94) for hysterectomy (P < .001); -$38 151.74 (95% CI, -$46 386.16 to -$30 346.22) for partial colectomy; (P < .001); -$33 394.15 (95% CI, -$42 603.03 to -$24 955.20) for radical nephrectomy (P < .001); and -$9162.52 (95% CI, -$12 728.33 to -$5781.99) for partial nephrectomy (P < .001). CONCLUSIONS AND RELEVANCE This study found significant variation in perioperative costs according to surgical technique for both patients (out-of-pocket costs) and payers (total payments); the robotic approach was associated with lower out-of-pocket costs for all studied oncologic procedures.
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Affiliation(s)
- Junaid Nabi
- Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - David F. Friedlander
- Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Xi Chen
- Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexander P. Cole
- Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jim C. Hu
- Department of Urology, Weill Cornell Medical College, New York, New York
| | - Adam S. Kibel
- Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Prokar Dasgupta
- Medical Research Council Centre for Transplantation, National Institute for Health Research Biomedical Research Centre, King’s College, London, United Kingdom
| | - Quoc-Dien Trinh
- Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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15
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Antonio MG, Petrovskaya O, Lau F. Is research on patient portals attuned to health equity? A scoping review. J Am Med Inform Assoc 2019; 26:871-883. [PMID: 31066893 PMCID: PMC7647227 DOI: 10.1093/jamia/ocz054] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/27/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Our scoping review examined how research on patient portals addresses health equity. Questions guiding our review were: 1) What health equity concepts are addressed in patient portal research-both explicitly and implicitly? 2) What are the gaps? 3) Is the potential for ehealth-related health inequities explicitly acknowledged in studies on patient portals? 4) What novel approaches and interventions to reduce health inequities are tested in patient portal research? MATERIALS AND METHODS We searched 4 databases. Search terms included "patient portal" in combination with a comprehensive list of health equity terms relevant in ehealth context. Authors independently reviewed the papers during initial screening and full-text review. We applied the eHealth Equity Framework to develop search terms and analyze the included studies. RESULTS Based on eHealth Equity Framework categories, the main findings generated from 65 reviewed papers were governance structures, ehealth policies, and cultural and societal values may further inequities; social position of providers and patients introduces differential preferences in portal use; equitable portal implementation can be supported through diverse user-centered design; and intermediary strategies are typically recommended to encourage portal use across populations. DISCUSSION The predominant focus on barriers in portal use may be inadvertently placing individual responsibility in addressing these barriers on patients already experiencing the greatest health disparities. This approach may mask the impact of the socio-technical-economic-political context on outcomes for different populations. CONCLUSION To support equitable health outcomes related to patient portals we need to look beyond intermediary initiatives and develop equitable strategies across policy, practice, research, and implementation.
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Affiliation(s)
- Marcy G Antonio
- Schools of Health Information Science and Nursing, Victoria, British Columbia, Canada
| | - Olga Petrovskaya
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Francis Lau
- School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
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Mitchell UA, Chebli PG, Ruggiero L, Muramatsu N. The Digital Divide in Health-Related Technology Use: The Significance of Race/Ethnicity. THE GERONTOLOGIST 2019; 59:6-14. [PMID: 30452660 DOI: 10.1093/geront/gny138] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Indexed: 01/31/2023] Open
Abstract
Background and Objectives Technology can enhance the health and quality of life of diverse populations and may play an important role in reducing health disparities. Although a "digital divide" between the young and the old has been noted, it is unclear whether the use of technology for managing health differs by race/ethnicity among older adults. This study uses nationally representative data from community-dwelling older Americans to characterize racial/ethnic differences in health-related technology use. Design and Methods Data came from 1,336 white, black, and Hispanic adults aged 54 and older who completed the 2014 technology module of the Health and Retirement Study. Racial/ethnic differences in overall health-related technology use were assessed using Poisson regression. Then, F-tests were used to assess differences in the use of phone calls, text messages, E-mails, social media, health management sites, health-related mobile applications, web searches, and brain games for health purposes. Results Compared to whites, older blacks and Hispanics were less likely to use technology for health-related purposes after accounting for demographic characteristics, education, and health conditions. They were also less likely to make or receive phone calls, use health management sites, search the web for health information, and use brain games for their health. Discussion and Implications Older racial and ethnic minorities are less likely than whites to use certain technologies when managing their health. These findings highlight the importance of understanding the patterns of health-related technology use across racially and ethnically diverse populations to appropriately tailor interventions aimed at improving minority health and eliminating health disparities.
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Affiliation(s)
- Uchechi A Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
| | - Perla G Chebli
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
| | - Laurie Ruggiero
- Behavioral Health and Nutrition Department, College of Health Sciences, University of Delaware, Newark
| | - Naoko Muramatsu
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
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17
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Holst J. Addressing upstream determinants of health in Germany's new global health strategy: recommendations from the German Platform for Global Health. BMJ Glob Health 2019; 4:e001404. [PMID: 31139459 PMCID: PMC6509597 DOI: 10.1136/bmjgh-2019-001404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- Jens Holst
- Nursing and health sciences, Hochschule Fulda, Fulda, Germany
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18
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Veinot TC, Mitchell H, Ancker JS. Good intentions are not enough: how informatics interventions can worsen inequality. J Am Med Inform Assoc 2018; 25:1080-1088. [PMID: 29788380 PMCID: PMC7646885 DOI: 10.1093/jamia/ocy052] [Citation(s) in RCA: 279] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 04/12/2018] [Accepted: 05/03/2018] [Indexed: 01/09/2023] Open
Abstract
Health informatics interventions are designed to help people avoid, recover from, or cope with disease and disability, or to improve the quality and safety of healthcare. Unfortunately, they pose a risk of producing intervention-generated inequalities (IGI) by disproportionately benefiting more advantaged people. In this perspective paper, we discuss characteristics of health-related interventions known to produce IGI, explain why health informatics interventions are particularly vulnerable to this phenomenon, and describe safeguards that can be implemented to improve health equity. We provide examples in which health informatics interventions produced inequality because they were more accessible to, heavily used by, adhered to, or effective for those from socioeconomically advantaged groups. We provide a brief outline of precautions that intervention developers and implementers can take to guard against creating or worsening inequality through health informatics. We conclude by discussing evaluation approaches that will ensure that IGIs are recognized and studied.
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Affiliation(s)
- Tiffany C Veinot
- School of Information and Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Hannah Mitchell
- Department of Healthcare Policy & Research, Division of Health Informatics, Weill Cornell Medical College, New York, New York, USA
| | - Jessica S Ancker
- Department of Healthcare Policy & Research, Division of Health Informatics, Weill Cornell Medical College, New York, New York, USA
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