Mapping the concept of vulnerability related to health care disparities: a scoping review

Social Drivers of COVID-19 Disease Severity in Pregnant Patients

OBJECTIVE

While coronavirus disease 2019 (COVID-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had global impact in all populations, certain groups of patients have experienced disproportionate rates of morbidity and mortality. The purpose of this study was to assess the relationship between COVID-19 disease severity, demographic variables, race and ethnicity, and social determinants of health among pregnant patients in a diverse urban population.

STUDY DESIGN

A retrospective analysis was performed of all pregnant patients diagnosed with COVID-19 at two urban tertiary care centers in Houston, TX between March and August 2020. Maternal demographic, COVID-19 illness criteria, and delivery characteristics were collected. The Centers for Disease Control and Prevention Social Vulnerability Index (SVI) and COVID-19 Community Vulnerability Index (CCVI) were obtained based on a patients' census tract of residence. Analyses compared persons with asymptomatic, mild, or severe-critical disease at diagnosis.

RESULTS

A total of 317 persons tested positive for COVID-19 during this time period. Asymptomatic persons were more likely to be diagnosed at later gestational ages, but there were no other differences in baseline maternal characteristics. Persons with more severe disease had greater social vulnerability specifically for housing and transportation than those with mild disease (mean SVI [standard error]: 0.72 [0.06] vs. 0.58 [0.2], p = 0.03). Total SVI, total CCVI, and other themed SVI and CCVI indices were not significantly different between groups.

CONCLUSION

In this cohort of pregnant persons infected with SARS-CoV-2, an association was shown between disease severity and increased vulnerability in living conditions and transportation. Drivers of the pandemic and COVID-19 outcomes are complex and multifactorial, and likely change over time. However, continued efforts to accurately identify and measure social determinants of health in medicine will likely help identify geographic areas and patient populations that are at risk of higher disease burden. This could facilitate preventative and mitigation measures in these areas in future disaster or pandemic situations.

KEY POINTS

· SVI and CCVI estimate social determinants of health.. · COVID-19 is associated with housing and transportation vulnerability.. · Social determinants contribute to disease burden in pregnancy..

Advancing a collective vision for equity-based cocreation through prototyping at an international forum

BACKGROUND

Cocreation has the potential to engage people with lived and living experiences in the design and evaluation of health and social services. However, guidance is needed to better include people from equity-deserving groups (EDGs), who are more likely to face barriers to participation, experience ongoing or historical harm, and benefit from accessible methods of engagement.

OBJECTIVE

The aim of this international forum (CoPro2022) was to advance a collective vision for equity-based cocreation.

DESIGN

A participatory process of engagement in experiential colearning and arts-based creative and reflective dialogue. Visual prototypes were created and synthesised to generate a collective vision for inclusive equity-based cocreation.

SETTING AND PARTICIPANTS

The Forum was held at the Gathering Place by the Grand River in Ohsweken, Ontario, Canada. A total of 48 participants attended the forum. They were purposely invited and have intersecting positionalities (21 academic experts, six experience experts, 10 trainees, and 11 members of EDGs) from nine countries (Bangladesh, Botswana, Canada, England, Italy, Norway, Scotland, Singapore, Sweden). COPRO2022 ACTIVITIES: CoPro2022 was an immersive experience hosted on Indigenous land that encouraged continuous participant reflection on their own worldviews and those of others as participants openly discussed the challenges and opportunities with engaging EDGs in cocreation activities. Visual prototypes and descriptions created in small groups were informed by participants' reflections on the panel presentations at the Forum and their own experiences with equity-based cocreation. Following the event, the authorship team inductively coded themes from the prototype descriptions and met to discuss the cross-cutting themes. These informed the design of an illustrated collective vision for Equity Based Co-Creation (EqCC).

RESULTS

Six prototypes were cocreated by each small group to illustrate their vision for EqCC. Within these, four cross-cutting themes were identified: (i) go to where people are, (ii) nurture relationships and creativity, (iii) reflect, replenish and grow, (iv) and promote thriving and transformation. These four themes are captured in the Collective EqCC Vision to guide a new era of inclusive excellence in cocreation activities.

PATIENT OR PUBLIC CONTRIBUTION

Service users, caregivers, and people with lived experience were involved in leading the design of the CoPro2022 and co-led the event. This included activities at the event such as presenting, facilitating small and large group discussion, leading art-based activities, and reflecting with the team on the lessons learned. People with lived experience were involved in the analysis and knowledge sharing from this event. Several members of the research team (students and researchers) also identified as members of EDGs and were invited to draw from their personal and academic knowledge.

The Impact of Social Vulnerability on Substance Use Detection Practices in Pregnancy

This study aimed to synthesize current literature regarding the impact of social vulnerability on pregnancy-related substance use detection in the United States and highlight disparities in substance use detection practices. Clinicaltrials.gov, Google Scholar, PubMed (includes MEDLINE), and Cochrane Library databases were searched using the following Medical Subject Headings (MeSH): (["pregnancy" or "prenatal"] AND ["substance use screening" or "urine toxicology testing" or "toxicology testing" or "urine drug screening" or "CRAFFT" or "4P's" or "4P's Plus" or "NIDA Quick Screen" or "DAST-10" or "SURP-P" or "WIDUS"], AND ("bias" or "disparities" or "social vulnerability"]). The search included systematic reviews, prospective and retrospective studies, randomized controlled trials, case studies, and qualitative and quantitative research from January 2014 through November 2023. Selected literature was limited to studies published in English, which included a study population of either pregnant individuals or pregnancy health care providers in the United States, and that were focused on inequities in pregnancy substance use detection. Using Covidence, three authors screened abstracts, and two screened full articles for inclusion. The included studies were evaluated for quality of evidence using the mixed methods appraisal tool. The search yielded 4,188 manuscripts; 37 were eligible for full review. A total of 18 manuscripts were included based on the relevancy of the topic. The most common social vulnerability domain identified was minority status (17/18), followed by socioeconomic status (11/18), household characteristics (8/18), and housing type (1/18). Social vulnerability plays a role in substance use detection among pregnant individuals. Most notably, race and ethnicity, age, and public insurance lead to increased rates of detection, though most individual factors need to be studied in greater depth. This study was registered with PROSPERO (PROSPERO ID CRD42022352598), the International Prospective Register of Systematic Reviews. KEY POINTS: · Socially vulnerable pregnant individuals are more likely to receive substance use screening or urine toxicology testing.. · Race, ethnicity, age, and insurance influence substance use detection disparities.. · More research is needed to understand how other characteristics influence disparities in substance use detection..

Association Between Community Social Vulnerability and Preventable Hospitalizations

Preventable hospitalizations are common and costly events that burden patients and our health care system. While research suggests that these events are strongly linked to ambulatory care access, emerging evidence suggests they may also be sensitive to a patient's social, environmental, and economic conditions. This study examines the association between variations in social vulnerability and preventable hospitalization rates. We conducted a cross-sectional analysis of county-level preventable hospitalization rates for 33 states linked with data from the 2020 Social Vulnerability Index (SVI). Preventable hospitalizations were 40% higher in the most vulnerable counties compared with the least vulnerable. Adjusted regression results confirm the strong relationship between social vulnerability and preventable hospitalizations. Our results suggest wide variation in community-level preventable hospitalization rates, with robust evidence that variation is strongly related to a community's social vulnerability. The human toll, societal cost, and preventability of these hospitalizations make understanding and mitigating these inequities a national priority.

Vulnerabilities and reparative strategies during pregnancy, childbirth, and the postpartum period: moving from rhetoric to action

Maternal outcomes throughout pregnancy, childbirth, and the postnatal period are influenced by interlinked and interdependent vulnerabilities. A comprehensive understanding of how various threats and barriers affect maternal and perinatal health is critical to plan, evaluate and improve maternal health programmes. This paper builds on the introductory paper of the Series on the determinants of maternal health by assessing vulnerabilities during pregnancy, childbirth, and the postnatal period. We synthesise and present the concept of vulnerability in pregnancy and childbirth, and map vulnerability attributes and their dynamic influence on maternal outcomes in early and late pregnancy and during childbirth and the postnatal period, with a particular focus on low-income and middle-income countries (LMICs). We summarise existing literature and present the evidence on the effects of various reparative strategies to improve pregnancy and childbirth outcomes. Lastly, we discuss the implications of the identified vulnerability attributes and reparative strategies for the efforts of policymakers, healthcare professionals, and researchers working towards improving outcomes for women and birthing people in LMICs.

Advancing Health Equity in Neurologic Disorders and Stroke: Stakeholder Insights Into Health Disparities, Research Gaps, and Potential Interventions

OBJECTIVES

The purpose of this study was to analyze the National Institute of Neurological Disorders and Stroke (NINDS) Request for Information (RFI) input from the public-including health care providers, researchers, patients, patient advocates, caregivers, advocacy organizations, professional societies, and private and academic stakeholders with an interest in health disparities (HDs) in neurologic disease. RFI questions were structured to solicit input on what stakeholders believe are neurologic disease HD research priorities, drivers of health inequity, and potential interventions. Furthermore, these stakeholder insights were examined within the context of contemporary scientific literature and research frameworks on health equity and health disparities.

BACKGROUND

The NINDS published a RFI from March 31 to July 15, 2020. The RFI analysis presented here is part of a larger strategic planning process aimed to guide future NINDS efforts in neurologic disorder health equity (HE) research and training. The public commented on facilitators of HDs, populations that experience HDs (HDPs), potential interventions, and research opportunities related to HDs in neurologic disease and/or care in the United States across the lifespan. Responses were analyzed using qualitative methodology. Frequently suggested interventions were thematically clustered using the interpretive phenomenological analysis methodology and are presented in this article to provide a stakeholder-identified roadmap for advancing HE.

RESULTS

Respondents identified socioecological factors as driving HDs in 89% of determinants reported. Stakeholder-reported HD determinants and subsequent interventions could be classified into the following conceptual categories: HDP neurospecialty care access, innovative HDP engagement and research inclusion strategies, and development of a well-trained clinician-scientist HD workforce. Clustering of the feedback from patient and patient-adjacent respondents (i.e., caretakers and patient advocates) highlighted the prevalence of patient-provider interpersonal factors and limited resources driving access-to-care barriers among their sentiments.

DISCUSSION

Respondent sentiments suggest prioritization of social determinants of health (SDOH) research, shifting away from the common target of biological and behavioral themes addressed in the existing body of HE research provided by the stakeholder. Overall, respondents suggest focusing research prioritization on access to care, engagement across the HE research and care landscape, and HE workforce development.

Development of a curriculum in cultural determinants of health and health disparities

INTRODUCTION

Current sociopolitical events coupled with requirement modifications by the Liaison Committee on Medical Education have reinvigorated a need for training in cultural awareness and health disparities in undergraduate medical education. Many institutions, however, have not established longitudinal courses designed to address this content. Additionally, little is known about the change in learners' awareness of cultural determinants of health and health disparities after enrollment in such curricula. In 2016, the authors developed a yearlong required course entitled Cultural Determinants of Health and Health Disparities for first year medical students at a large university medical school in the United States. The course launched in the 2017 academic year.

METHODS

Two cohorts participated in twelve 2.5 to 3-hour multi-modal sessions focused on various aspects of healthcare delivery for marginalized populations and factors that contribute to health disparities. The Multicultural Assessment Questionnaire was used pre and post course to assess students' self-evaluated changes in knowledge, skills, and awareness related to cultural competency in healthcare.

RESULTS

Students' self-reported knowledge, skills, and awareness scores regarding cultural competence in health care increased from pre to post-course assessment. On the knowledge scale, students' mean score increased from 2.63 to 2.97 (P < .001), with 16% reporting a decreased score, 30% reporting no change, and 54% reporting growth. On the skills scale, students' mean score increased from 2.64 to 3.38 (P < .001), with 11% reporting a decreased score, 17% reporting no change, and 72% reporting growth. On the awareness scale, students' overall score increased from 3.76 to 3.97 (P < .05), with 16% reporting a decreased score, 50% reporting no change, and 34% reporting growth. There were no changes in KSA scores across cohorts pre and post course.

CONCLUSION

Perceived knowledge, skills, and awareness related to the importance of cultural competence in healthcare delivery increased at the end of the academic year. This type of longitudinal course model could be broadly adopted at other institutions to enhance patient, peer, and future provider awareness regarding cultural impacts on care and health disparities among vulnerable populations.

Telephone Outreach Enhances Recruitment of Underrepresented Seriously Ill Patients for an Advance Care Planning Pragmatic Trial

BACKGROUND

Patients experiencing systemic patterns of disadvantage, such as racial/ethnic minorities and those with limited English proficiency, are underrepresented in research. This is particularly true for large pragmatic trials of potentially sensitive research topics, such as advance care planning (ACP). It is unclear how phone outreach may affect research participation by underrepresented individuals.

OBJECTIVE

To assess the effect of phone outreach, in addition to standard mail survey recruitment, in a population-based ACP pragmatic trial at three academic health systems in California.

DESIGN

Retrospective cohort study PATIENTS: Primary care patients with serious illness were mailed a survey in their preferred language. Patients who did not initially respond by mail received up to three reminder phone calls with the option of survey completion by phone.

MAIN MEASURES

Effect of phone outreach on survey response rate associated with respondent demographic characteristics (e.g., Social Vulnerability Index [SVI], range 0 (low) to 1 (high)).

RESULTS

Across the health systems, 5998 seriously ill patients were mailed surveys. We obtained completed surveys from 1215 patients (20% response rate); 787 (65%) responded after mail alone and 428 (35%) participated only after phone outreach. Patients recruited after phone outreach compared to mail alone were more socially vulnerable (SVI 0.41 v 0.35, P < 0.001), were more likely to report being a racial/ethnic minority (35% v 28%, P = 0.006), and non-English speaking (16% v 10%, P = 0.005). Age and gender did not differ significantly. The inclusion of phone outreach resulted in a sample that better represented the baseline population than mail alone in racial/ethnic minority (28% mail alone, 30% including phone outreach, 36% baseline population), non-English language preference (10%, 12%, 15%, respectively), and SVI (0.35, 0.37, 0.38, respectively).

CONCLUSIONS

Phone outreach for a population-based survey in a pragmatic trial concerning a potentially sensitive topic significantly enhanced recruitment of underrepresented seriously ill patients.

Prevalence and Geographic Features of Patients Eligible for Extracorporeal Cardiopulmonary Resuscitation

OBJECTIVE

This study sought to identify Out of Hospital Cardiac Arrests (OHCA) eligible for Extracorporeal Cardiopulmonary Resuscitation (ECPR), use Geographic Information Systems (GIS) to investigate geographic patterns, and investigate if correlation between ECPR candidacy and Social Determinants of Health (SDoH) exist.

METHODS

This study is of emergency medical service (EMS) runs for OHCA to an urban medical center from January 1, 2016 to December 31, 2020. All runs were filtered to inclusion criteria for ECPR: age 18-65, initial shockable rhythm, and no return of spontaneous circulation within initial defibrillations. Address level data were mapped in a GIS. Cluster detection assessed for granular areas of high concentration. The Center for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI) was overlaid. The SVI ranges from 0-1 with higher values indicating increasing social vulnerability.

RESULTS

There were 670 EMS transports for OHCA during the study period. 12.7% (85/670) met inclusion criteria for ECPR. 90% (77/85) had appropriate addresses for geocoding. Three geographic clusters of events were detected. Two were residential areas and one was concentrated over a public use area of downtown Cleveland. The SVI for these locations was 0.79, indicative of high social vulnerability. Nearly half (32/77, 41.5%) occurred in neighborhoods with the highest level of social vulnerability (SVI ≥0.9).

CONCLUSION

A significant proportion of OHCAs were eligible for ECPR based on prehospital criteria. Utilizing GIS to map and analyze ECPR patients provided insights into the locations of these events and the SDoH that may be driving risk in these places.

Neighborhood-level social vulnerability and individual-level cognitive and motor functioning over time in older non-Latino Black and Latino adults

Introduction

Despite known health disparities in cognitive aging, a comprehensive rationale for the increased burden in older minoritized populations including non-Latino Black and Latino adults has yet to be elucidated. While most work has focused on person-specific risk, studies are increasingly assessing neighborhood-level risk. We evaluated multiple aspects of the environmental milieu that may be critical when considering vulnerability to adverse health outcomes.

Methods

We investigated associations between a Census-tract derived Social Vulnerability Index (SVI) and level of and change in cognitive and motor functioning in 780 older adults (590 non-Latino Black adults, ∼73 years old at baseline; 190 Latinos, ∼70 years old baseline). Total SVI scores (higher = greater neighborhood-level vulnerability) were combined with annual evaluations of cognitive and motor functioning (follow-up ranged from 2 to 18 years). Demographically-adjusted mixed linear regression models tested for associations between SVI and cognitive and motor outcomes in analyses stratified by ethno-racial group.

Results

For non-Latino Black participants, higher SVI scores were associated with lower levels of global cognitive and motor functioning-specifically, episodic memory, motor dexterity and gait-as well as longitudinal change in visuospatial abilities and hand strength. For Latinos, higher SVI scores were associated with lower levels of global motor functioning only-specifically, motor dexterity; there were no significant associations between SVI and change in motor functioning.

Discussion

Neighborhood-level social vulnerability is associated with cognitive and motor functioning in non-Latino Black and Latino older adults, although associations appear to contribute to level more so than longitudinal change.

Diversitäts- und kultursensible Gesundheitsinformationen für mehr digitale Gesundheitskompetenz: Eine kollaborative Community-Forschung zu Barrieren und Bedarfen

Hintergrund

Bei Gesundheitsfragen spielt das Internet eine zentrale Rolle, wobei Verbraucher:innen vor der Herausforderung stehen, geeignete Such- und Bewertungsstrategien zu entwickeln. Damit Informationen zur Gesundheit im Internet gefunden, verstanden, beurteilt und angewendet werden können, bedarf es digitaler Gesundheitskompetenz auf individueller und auf organisationaler Ebene. Vor dem Hintergrund gesellschaftlicher Pluralität und Diversität wurden Fähigkeiten und Zugänge marginalisierter Communities in diesem Zusammenhang bisher wenig beforscht.

Ziel

Diese Studie untersuchte die Nutzung von Online-Gesundheitsinformationen im Alltag aus einer postmigrantischen Perspektive, welche nicht Migrationshintergründe, sondern lokale Kontexte von Migrant:innen in Deutschland als Vulnerabilitätsvariable versteht. Ziel dieser Studie war es, sowohl das digitale Gesundheitsinformationsverhalten marginalisierter Communities ethnografisch und kollaborativ zu erforschen als auch praxisnahe und kultursensible Ansätze für Akteur:innen der Gesundheitskommunikation zu entwickeln ohne migrantisierende Zuschreibungen zu reproduzieren.

Methoden

Im Rahmen einer kollaborativen ethnografischen Feldforschung im Stadtteillabor der Bochumer Hustadt von 10/2020–01/2021 führten Community-Forscher:innen online leitfadengestützte Interviews in ihrem Umfeld durch. Die Interviews wurden mittels einer qualitativen Inhaltsanalyse ausgewertet.

Ergebnisse und Diskussion

Die Ergebnisse machen deutlich, dass sprachliche, inhaltliche und mediale Aspekte von Online-Gesundheitsinformationen den Zugang zu und Umgang mit diesen für marginalisierte Communities bedingen. Die postmigrantische Perspektive stellt einerseits Migration als hinreichende Analyse- und Erklärungskategorie in Frage und begründet zugleich Diversitäts- und Kultursensibilität als zentrale Komponenten des Zugangs zu Gesundheitsinformationen und der Entwicklung von Maßnahmen zur Stärkung der digitalen Gesundheitskompetenz in pluralen Gesellschaften. Es bedarf sowohl vielsprachiger, transkulturell resonierender und technisch barrierearmer Online-Gesundheitsinformationen als auch gestärkter Interaktion zwischen Individuen einer pluralen postmigrantischen Gesellschaft und der Online-Gesundheitskommunikation.

Defining vulnerability subgroups among pregnant women using pre-pregnancy information: a latent class analysis

BACKGROUND

Early detection of vulnerability during or before pregnancy can contribute to optimizing the first 1000 days, a crucial period for children's development and health. We aimed to identify classes of vulnerability among pregnant women in the Netherlands using pre-pregnancy data on a wide range of social risk and protective factors, and validate these classes against the risk of adverse outcomes.

METHODS

We conducted a latent class analysis based on 42 variables derived from nationwide observational data sources and self-reported data. Variables included individual, socioeconomic, lifestyle, psychosocial and household characteristics, self-reported health, healthcare utilization, life-events and living conditions. We compared classes in relation to adverse outcomes using logistic regression analyses.

RESULTS

In the study population of 4172 women, we identified five latent classes. The largest 'healthy and socioeconomically stable'-class [n = 2040 (48.9%)] mostly shared protective factors, such as paid work and positively perceived health. The classes 'high care utilization' [n = 485 (11.6%)], 'socioeconomic vulnerability' [n = 395 (9.5%)] and 'psychosocial vulnerability' [n = 1005 (24.0%)] were characterized by risk factors limited to one specific domain and protective factors in others. Women classified into the 'multidimensional vulnerability'-class [n = 250 (6.0%)] shared multiple risk factors in different domains (psychosocial, medical and socioeconomic risk factors). Multidimensional vulnerability was associated with adverse outcomes, such as premature birth and caesarean section.

CONCLUSIONS

Co-existence of multiple risk factors in various domains is associated with adverse outcomes for mother and child. Early detection of vulnerability and strategies to improve parental health and well-being might benefit from focussing on different domains and combining medical and social care and support.

Sociodemographic disparities in preterm birth and low birthweight in the State of Georgia: Results from the 2017-2018 Pregnancy Risk Assessment Monitoring System

PURPOSE

To update the overall prevalence of preterm birth (PTB) (<37 weeks gestation) and low birthweight (LBW) (<2,500 g) in the State of Georgia, including rural and urban counties.

METHODS

A sample was drawn from the 2017-2018 Georgia Pregnancy Risk Assessment Monitoring System (PRAMS). In the complete-case data of singleton births (n=1,258), we estimated the weighted percentage prevalence of PTB, LBW, early/late PTB, and moderately/very LBW subcategories in association with maternal sociodemographic characteristics, and the prevalence stratified by rural/urban county of residence. Univariate and multivariate logistic regression models were fitted to estimate the odds ratios (ORs) of PTB and LBW adjusting for selected covariates. Logistic regression results from multiple imputation by chained equations (MICE) were used for comparison.

FINDINGS

The overall rate for PTB was 9.3% and 6.8% for LBW and among them, 2.3% were early PTB, 7.0% were late PTB, 5.4% were moderately LBW (MLBW), and 1.3% were very LBW (VLBW). Non-Hispanic Black women had the highest prevalence of PTB, LBW, early PTB, MLBW, and VLBW, as well as PTB and LBW in urban counties and LBW in rural counties. The odds of PTB (aOR 1.38; 95% CI: 0.81, 2.35) and LBW (aOR 2.68; 95% CI: 1.32, 5.43) were also higher among non-Hispanic Black relative to non-Hispanic White women and among women who received adequate-plus prenatal care compared to inadequate prenatal care.

CONCLUSIONS

Socioeconomic and health disparities created by disadvantage should be a focus of state policy to improve neonatal outcomes in the State of Georgia.

[Transversal Health Research Networks, a strategy for translational medicine]

Translational research, in its regulatory function as a current policy for the research activities being performed at the Mexican Institute for Social Security (Instituto Mexicano del Seguro Social: IMSS), demands a collaborative work among people involved in the generation of knowledge and in those who consume such knowledge. Being an organization who has among its major objectives for almost 80 years the health care of Mexican population, the Institute has an important human capital represented by its physician leaders, researchers and directors, who, by working closely together, will be able to find a better respond to the health care needs of the Mexican population. Through collaborative groups, transversal research networks oriented to the priority health problems of Mexican people are being organized as a strategy whose purpose is making research more efficient and ensuring rapidly applicable results, in order to improve the quality of health care services offered by the Institute, whose commitment is primarily to Mexican society, although the results of this strategy could also be shown to the world, considering that the Institute is one of the largest public health service organizations, at least in Latin America, and its results could be a benchmark for the region. Collaborative work in research networks began more than 15 years ago at IMSS, but today it is being consolidated and its objectives are being reoriented, aligning them with both national policies and those of the Institute itself.

The role of scoping reviews in reducing research waste

OBJECTIVES

Scoping reviews and evidence map methodologies are increasingly being used by researchers. The objective of this article is to examine how scoping reviews can reduce research waste.

STUDY DESIGN AND SETTING

This article summarizes the key issues facing the research community regarding research waste and how scoping reviews can make an important contribution to the reduction of research waste in both primary and secondary research.

RESULTS

The problem of research waste is an enduring challenge for global health, leading to a waste of human and financial resources and producing research outputs that do not provide answers to the most pressing research questions. Research waste occurs within primary research but also in secondary research such as evidence syntheses. The focus of scoping reviews on characterizing the nature of existing evidence on a topic and including all types of evidence, potentially reduces research waste in five ways: (1) identifying key research gaps on a topic, (2) determining appropriate outcome measures, (3) mapping existing methodological approaches, (4) developing a consistent understanding of terms and concepts used in existing evidence, and (5) ensuring scoping reviews do not exacerbate the issue of research waste.

CONCLUSION

To ensure that scoping reviews do not themselves end up contributing to research waste, it is important to register the scoping review and to ensure that international reporting standards and methodological guidance are followed.

The challenge for general practitioners to keep in touch with vulnerable patients during the COVID-19 lockdown: an observational study in France

Background

In France, the first COVID-19-related lockdown (17th March to 10th May 2020) resulted in a major decrease in healthcare service utilization. This raised concerns about the continuity of care for vulnerable patients.

Objectives

To identify individual and organizational factors associated with the initiatives taken by French GPs to contact vulnerable patients during the lockdown.

Methods

A national observational survey using an online questionnaire was conducted to document French GPs’ adaptations to the COVID-19 situation, their individual and organizational characteristics, including practice type (individual, group, multidisciplinary) and size. Data were collected from 7th to 20th May 2020 using mailing lists of GPs from the study partners and GPs who participated in a previous survey. This paper analysed answers to the question exploring whether and how GPs took initiatives to contact vulnerable patients. Responses were categorized in: no initiative; selection of patients to contact with a criteria-based strategy; initiative of contact without criteria-based strategy. Multivariate multinomial logistic regression identified factors associated with each category. Key components of the reported initiatives were described by inductive analysis of verbatim material.

Results

Among the 3012 participant GPs (~ 5.6% of French GPs), 1419 (47.1%) reported initiatives to contact some patients without criteria-based strategy, and 808 (26.8%) with a strategy using various clinical/psychological/social criteria. Women GPs more often declared initiatives of contacts with a criteria-based strategy (OR = 1.41, 95% CI [1.14-1.75]) as well as GPs with more than two patients who died due to COVID-19 in comparison with those having none (OR = 1.84, 95% CI [1.43-2.36]). Teaching GPs more often used criteria-based strategies than the other GPs (OR = 1.94, 95% CI [1.51-2.48]). Compared with those working in small monodisciplinary practice, GPs working alone were less likely to implement criteria-based initiatives of contacts (OR = 0.70, 95% CI [0.51-0.97]), while GPs working in multidisciplinary practice were more likely (OR = 1.94, 95% CI [1.26-2.98] in practices > 20 professionals).

Conclusion

French GPs took various initiatives to keep in touch with vulnerable patients, more frequently when working in group practices. These findings confirm the importance of primary care organization to ensure continuity of care for vulnerable people.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-022-01694-y.

Significance of an Electrochemical Sensor and Nanocomposites: Toward the Electrocatalytic Detection of Neurotransmitters and Their Importance within the Physiological System

A prominent neurotransmitter (NT), dopamine (DA), is a chemical messenger that transmits signals between one neuron to the next to pass on a signal to and from the central nervous system (CNS). The imbalanced concentration of DA may cause numerous neurological sicknesses and syndromes, for example, Parkinson's disease (PD) and schizophrenia. There are many types of NTs in the brain, including epinephrine, norepinephrine (NE), serotonin, and glutamate. Electrochemical sensors have offered a creative direction to biomedical analysis and testing. Researches are in progress to improve the performance of sensors and develop new protocols for sensor design. This review article focuses on the area of sensor growth to discover the applicability of polymers and metallic particles and composite materials as tools in electrochemical sensor surface incorporation. Electrochemical sensors have attracted the attention of researchers as they possess high sensitivity, quick reaction rate, good controllability, and instantaneous detection. Efficient complex materials provide considerable benefits for biological detection as they have exclusive chemical and physical properties. Due to distinctive electrocatalytic characteristics, metallic nanoparticles add fascinating traits to materials that depend on the material's morphology and size. Herein, we have collected much information on NTs and their importance within the physiological system. Furthermore, the electrochemical sensors and corresponding techniques (such as voltammetric, amperometry, impedance, and chronoamperometry) and the different types of electrodes' roles in the analysis of NTs are discussed. Furthermore, other methods for detecting NTs include optical and microdialysis methods. Finally, we show the advantages and disadvantages of different techniques and conclude remarks with future perspectives.

Do Socioeconomic Factors Influence Knowledge, Attitudes, and Representations of End-of-Life Practices? A Cross-Sectional Study

OBJECTIVE

Access to palliative and end-of-life (EOL) care might be influenced by knowledge, attitudes, and representations of these practices. Socioeconomic factors might then affect what people know about EOL care practices, and how they perceive them. This study aims to compare knowledge, attitudes, and representations regarding EOL practices including assisted suicide, medical assistance in dying, and continuous palliative sedation of adults, according to socioeconomic variables.

METHODS

A cross-sectional community-based questionnaire study featuring two evolving vignettes and five end-of-life practices was conducted in Quebec, Canada. Three sample subgroups were created according to the participants' perceived financial situation and three according to educational attainment. Descriptive analysis was used to compare levels of knowledge, attitudes, and representations between the subgroups.

RESULTS

Nine hundred sixty-six (966) people completed the questionnaire. Two hundred and seventy participants (28.7%) had a high school diploma or less, and 42 participants (4.4%) were facing financial hardship. The majority of respondents supported all end-of-life options and the loosening of eligibility requirements for medical assistance in dying. Differences between subgroups were minor. While respondents in socioeconomically disadvantaged subgroups had less knowledge about EOL practices, those with lower educational attainment were more likely to be in favor of medical assistance in dying, and less likely to favor continuous palliative sedation.

CONCLUSIONS

People living with situational social and economic vulnerabilities face multiple barriers in accessing health care. While they may have poorer knowledge about EOL practices, they have a positive attitude towards medical assistance in dying and assisted suicide, and a negative attitude towards continuous palliative sedation. This highlights the need for future research and interventions aimed at empowering this population and enhancing their access to EOL care.

Vulnerable groups and protective habits associated with the number of symptoms caused by pesticide application in Kratie, Cambodia: a cross-sectional questionnaire study

Objective: The present study aimed to identify pesticide poisoning symptoms and related protective habits to effectively prevent pesticide poisoning among farmworkers in Kratie, Cambodia, where pesticide poisoning is an urgent public health problem. Materials and Methods: This cross-sectional study based on a questionnaire survey analyzing social demographics, number of symptoms, and protective behavior regarding pesticide application was conducted in Kratie Province from January 25 to 31, 2021. In total, 210 farmworkers completed the survey. The effects of social demographics and pesticide-protective behavioral scores on the number of symptoms were investigated using multivariable regression analysis. Results: The observed number of symptoms was 1.16 times higher among women (P=0.004), increased with the duration of work, and decreased with age. In addition, we identified five significant pesticide-protective behaviors: 1) preparing using gloves, 2) using protective equipment, 3) avoiding wiping sweat, 4) avoiding leaking, and 5) resting when feeling ill. Pesticide-protective behaviors tended to decrease with the duration of working years in the low-education group (B=-0.04, SE=0.01), whereas no association was observed in the high-education group (B=0.01, SE=0.01). Conclusion: Pesticide-protective behaviors significantly correlated with fewer symptoms. The female and aging groups required continuous special education or instructions for implementing pesticide-protective actions, especially the aforementioned five protective actions.

Accessibility in People with Disabilities in Primary Healthcare Centers: A Dimension of the Quality of Care

The purpose of this research is to evaluate universal accessibility in primary healthcare (PHC) centers in the Atacama region, Chile, through an analytical cross-sectional study with a quality approach, which uses the external audit model with the application of a dichotomous comparison guideline, evaluating levels of compliance with four dimensions of universal accessibility described in the literature: participation, information, accessibility chain and architectural aspects. This was carried out in 18 PHC, and set as Lower Control Limit (LCL) of 70% to compare levels of compliance, and a hierarchical model and k-mean analysis were applied. Results: Very low compliance averages were obtained, 37.7% participation, 4% information, 44.4% access chain, and 63.9% architectural aspects, indicating a critical situation. Moreover, the cluster comparison allowed to observe that a group of healthcare centers complies more than other groups, which requires more attention. Conclusions: The low level of accessibility for people with disabilities may be associated with various factors that require further monitoring and analysis. However, low levels of accessibility require changing the way of relating to this vulnerable group of the population, and considering including them in the design and reasonable adjustments made in PHC centers. The findings from this research open the possibility for future research that increases understanding of how to reduce barriers in a such wide variety of forms of disability.

Vulnerability through the Eyes of People Attended by a Portuguese Community-Based Association: A Thematic Analysis

Vulnerability is associated with the individual’s social and biological conditions, but also the conditions of their enveloping environment and society, leading to terms such as vulnerable populations or risk groups. This study aimed to give a voice to people with experiences of vulnerability and explore their perspectives, using a descriptive qualitative design. Purportedly vulnerable adults were recruited and interviewed with semi-structured questions on vulnerability. Data were organized, using WebQDA software, and submitted to thematic content analysis, as proposed by Clark and Braun, which generated a thematic tree. The study included six men and six women with a mean age of 43.8 [SD = 14.17] years old. Thematic analysis generated three themes: (1) Conceptions about vulnerability, (2) Barriers imposed by vulnerability, and (3) Strategies for dealing with vulnerability. The results highlight that vulnerability is a highly dynamic process of openness to circumstances that influence individual outcomes. However, there is a lack of conceptual clarity. Although being vulnerable is perceived as something negative, we need to transform the social mindset, because vulnerability also has the potential to change priorities in life for the better.

Greater community vulnerability is associated with poor living donor navigator program fidelity

BACKGROUND

Community-level factors contribute to living donor kidney transplantation disparities but may also influence the interventions aimed to mitigate these disparities. The Living Donor Navigator Program was designed to separate the advocacy role from the patient in need of transplantation-friends/family are encouraged to participate as the patients' advocates to identify living donors, though some of the patients participate alone as self-advocates. Self-advocates have a lower living donor kidney transplantation likelihood compared to the patients with an advocate. We sought to evaluate the relationship between the patients' community-level vulnerability and living donor navigator self-advocacy as a surrogate for program fidelity.

METHODS

This single-center, retrospective study included 110 Living Donor Navigator participants (April 2017-June 2019). Program fidelity was assessed using the participants' advocacy status. Measures of community vulnerability were obtained from the Centers for Disease Control and Prevention Social Vulnerability Index. Modified Poisson regression was used to evaluate the association between community-level vulnerability and living donor navigator self-advocacy.

RESULTS

Of the 110 participants, 19% (n = 21) were self-advocates. For every 10% increase in community-level vulnerability, patients had 17% higher risk of self-advocacy (adjusted relative risk 1.17, 95% confidence interval: 1.03-1.32, P = .01). Living in areas with greater unemployment (adjusted relative risk: 1.18, 95% confidence interval: 1.04-1.33, P = .01), single-parent households (adjusted relative risk: 1.23, 95% confidence interval: 1.06-1.42, P = .006), minority population (adjusted relative risk: 1.30, 95% confidence interval: 1.04-1.55, P = .02), or no-vehicle households (adjusted relative risk: 1.17, 95% confidence interval: 1.02-1.35, P = .02) were associated with increased risk of self-advocacy.

CONCLUSION

Having a greater community-level vulnerability was associated with poor Living Donor Navigator Program fidelity. The potential barriers identified using the Social Vulnerability Index may direct resource allocation and program refinement to optimize program fidelity and efficacy for all participants.

Placement disruption of children with disabilities in foster care

PURPOSE

To investigate and describe available data on children with disabilities in the United States foster care system and examine placement disruptions.

DESIGN

This quantitative descriptive study was a secondary data analysis of the Adoption and Foster Care Analysis and Reporting System (AFCARS) and included 680,611 children.

METHODS

Descriptive and regression analyses were conducted.

FINDINGS

Of 680,611 children in the U.S. foster care system in 2017, 22% had a medical or disability diagnosis, requiring additional or specialized care. Children with disabilities in foster care (CDFC) had a mean of 4.0 disruptions-significantly higher than the mean 2.37 disruptions among those without a disability (p < .001, d = 0.51). CDFC spent an average of 915 days in foster care compared to 514 days for children without a disability (p < .001, d = 0.59). Predictive risk factors for disruptions were increased child age, race (American Indian or Black), and increased foster parent age. Protective factors against disruptions included married foster parents and a child being placed outside of the child's initial state of residence.

CONCLUSIONS

CDFC have significantly more disruptions and longer stays in foster care. While risk and protective factors affect all foster children similarly, they have significantly greater effect on foster children with disabilities.

PRACTICE IMPLICATIONS

Increased disruptions compound the vulnerability of CDFC as relationships and support systems are broken. Understanding the extent to which childhood disabilities play a role allows school nurses, healthcare providers, and child advocates to better design interventions to improve lifelong health outcomes.

The Prenatal Primary Nursing Care Experience of Pregnant Women in Contexts of Vulnerability: A Systematic Review With Thematic Synthesis

The contexts of vulnerability are diversified and cover a wide range of situations where pregnant women are likely to experience threats or disparities. Nurses should consider the particular circumstances of women in contexts of vulnerability. We used a qualitative thematic synthesis to describe the experience of these women regarding their prenatal primary nursing care. We identified that the women's experience is shaped by the prenatal care. The fulfillment of their needs and expectations will guide their decision regarding the utilization of their prenatal care. We propose a theoretical model to guide nurses, promoting person-centered delivery of prenatal care.

Relationship Between Social Vulnerability Indicators and Trial Participant Attrition: Findings From the HYVALUE Trial

BACKGROUND

Social vulnerability indicators are associated with health care inequities and may similarly impede ongoing participation in research studies. We evaluated the association of social vulnerability indicators and research participant attrition in a trial focused on reducing health disparities.

METHODS

Self-identified White or Black adults enrolled in the HYVALUE trial (Hypertension and VALUEs), a randomized trial testing a values-affirmation intervention on medication adherence, from February 2017 to September 2019 were included. The self-reported measures of social vulnerability indicators included: (1) Black race; (2) female gender; (3) no health insurance; (4) unemployment; (5) a high school diploma or less; and (6) financial-resource strain. Full attrition was defined as not completing at least one 3- or 6-month follow-up study visit. Log-binomial regression models adjusted for age, gender, race, medical comorbidities, and the other social vulnerability indicators to estimate the relative risk of each social vulnerability indicator with study attrition.

RESULTS

Among 825 participants, the mean age was 63.3 years (±11.7 years), 60% were women, 54% were Black, and 97% reported at least one social vulnerability. Overall, 21% participants had full attrition after study enrollment. After adjustment for all other social vulnerabilities, only financial-resource strain remained consistently associated with full attrition (relative risk, 1.71 [95% CI, 1.28-2.29]). In a secondary analysis of partial attrition (completed only one follow-up visit), financial-resource strain (relative risk, 1.40 [95% CI, 1.09-1.81]) and being uninsured (relative risk, 1.54 [95% CI, 1.01-2.34]) were associated with partial attrition.

CONCLUSIONS

In a trial aimed at reducing disparities in medication adherence, participants who reported financial-resource strain had a higher risk of participant attrition independent of race or gender. Our findings suggest that efforts to retain diverse populations in clinical trials should extend beyond race and gender to consider other social vulnerability indicators.

REGISTRATION

URL: https://www.

CLINICALTRIALS

gov; Unique identifier: NCT03028597.

Disruption and adaptation in response to the coronavirus pandemic - Assets as contextual moderators of enactment of health behaviours

PURPOSE

During the COVID-19 UK first national lockdown (March-July 2020) enactment of healthy behaviours was fundamentally changed due to social restrictions. This study sought to understand perspectives on health behaviour change, as part of a wider study tracking reported health behaviour change over time.

METHODS

A purposive sample was selected. N = 40 qualitative interviews were conducted remotely (phone/video) from participants across England and Wales, and transcribed verbatim. Descriptive case studies were shared at regular analysis meetings. Inductive reflexive thematic coding was undertaken and coding was discussed using a team approach to agreeing analytical codes. A multiple lens theoretical perspective was adopted to illuminate the perceived influences and restrictions on participants' reports of health behaviour change.

RESULTS

There was a clear progressive narrative for all participants, through initial responses and reactions to the pandemic, framed as 'disruption', then, as lockdown was acclimatized to, evidence of 'adaptation'. Adaptation was seen in terms of modification, substitution, adoption, discontinuation/cessation, stultification, maintenance and recalibration of health behaviours. An illustrative case study exemplifies the narrative encompassing these features and demonstrating the complex non-linear interactions between context and enacted health behaviours.

CONCLUSIONS

Individuals responded to pandemic-related social restrictions in complex ways. Those in contexts with existing social assets, community links and established patterns of healthy behaviours were able to respond positively, adapting by modifying behaviour and using technology to engage in healthy behaviours in new and innovative ways. For those in more vulnerable contexts, enacting (negative) health behaviour change was an expression of frustration at the limitations imposed by social restrictions.

Diagnosis and treatment of vulnerable migrants: a retrospective study at a Doctors of the World clinic in Stockholm

Background

At Doctors of the World Medical Clinic in Stockholm (DWMCS), medical care is offered to migrants who live under particularly vulnerable conditions and who lack access to subsidized care. The demographic, diagnostic and therapeutic panorama of vulnerable migrants is unknown.

Methods

A quantitative, retrospective study mapping gender, age, diagnostic group, primary diagnosis, therapeutics, referrals, and session timing (whether the care session took place in summer -April to September, or winter - October to March) by reading all patients’ electronic journals at DWMCS between 2014-04-01 and 2017-12-31. Diagnostic groups were classified according to the classification system ICPC-2 which contains six diagnostic groups: symptoms/complaints, infections, neoplasms, injuries, congenital anomalies and other diagnoses. Primary diagnosis was defined as the diagnosis that was first in the diagnosis list for the visit. Difference in median age was calculated with the Mann-Whitney test (MW), and two-group analysis of nominal data was performed with Monte Carlo simulations (MC) and chi square test´s (X²).

Results

The study included 1323 patients: 838 women and 485 men. The median age for women 37 years (29-47) was slightly lower than for men, 40 years (31-47) MW (p = 0.002). The largest diagnostic group was symptoms / complaints. The five most common primary diagnoses were cough (4%), back symptom / complaint (4%), cystitis (3%), upper respiratory infection acute (3%) and abdominal pain epigastric (2%). The most common therapeutic (55%) was pharmaceutical. Referrals accounted for 12% of the therapeutics and 25% of the referrals were to an emergency room. Tests of significance indicated an uneven distribution of diagnostic groups MC (p = 0.003), infectious primary diagnoses MC (p = 0.0001) and referrals MC (p = 0.006) between men and women and an uneven seasonal distribution among the Other diagnoses MC (0.04) and ten most common drug treatments MC (p=0.002).

Conclusions

The demographic, diagnostic and therapeutic panorama of vulnerable migrants at DWMCS was elucidated. Vulnerable migrants have differences in morbidity depending on gender and season, differences in therapeutics depending on gender and differences among their most common drug treatments depending on season. This knowledge is important when addressing the health problems of vulnerable migrants.

Prospective Surveillance for Breast Cancer-Related Arm Lymphedema: A Systematic Review and Meta-Analysis

PURPOSE

The call to integrate prospective surveillance for lymphedema into cancer care pathways is building momentum to enable early intervention and prevent the progression of the condition. We offer a critical evaluation of the literature on prospective surveillance and early management for cancer-related lymphedema and evaluate the effect of such programs in preventing chronic lymphedema (CRD42019137965).

METHODS

Five databases and two registries were searched for randomized controlled trials or observational studies that assessed the incidence or prevalence of lymphedema associated with participation in a prospective surveillance program, published until February 26, 2021. Numbers triggered for early lymphedema management, resolved, and chronic lymphedema were extracted. Pooled relative risk (trials) and pooled rate (cumulative incidence; observational studies) of chronic lymphedema was calculated. Subgroup analyses assessed the effect of study design, length of follow-up, and extent of axillary surgery.

RESULTS

Twenty-three studies were included, of which 21 studies evaluated breast cancer-related arm lymphedema (BCRaL). Participation in prospective surveillance with early management reduced the risk of chronic BCRaL versus usual care (relative risk 0.31; 95% CI, 0.10 to 0.95; two randomized controlled trials; N = 106). The pooled rate of chronic BCRaL was 4% (95% CI, 3 to 6; 15 observational studies; N = 3,545), and 6% (95% CI, 4 to 9) when restricted to participants with axillary lymph node dissection (12 studies; N = 1,527).

CONCLUSION

The findings suggest that participation in prospective surveillance with early management reduces the risk of chronic BCRaL. Only a minority of patients at high risk of lymphedema because of axillary surgery developed chronic lymphedema. More robust research is needed to determine whether prospective surveillance with early management can reduce the risk of chronic lymphedema, particularly among cancer survivors other than breast cancer.

Interprofessional primary care practice including social workers: exploring the experiences of patients in vulnerable situations

The link between social inequality and health has been widely recognized, as there are systematic differences in health between people from lower and higher social classes. Furthermore, the complexity and multidimensionality of health and social problems has resulted in primary health care services that are increasingly integrating the approach of interprofessional collaboration between medical professionals and social workers. Despite this current focus, there is a lack of empirical insights into patients' experience of the quality of care resulting from these collaborations. This paper aims to contribute to knowledge by adopting a research approach that captures the narratives of patients in vulnerable situations from a primary care center by conducting semi-structured interviews. Through content analysis, data was analyzed according to five themes: (1) availability, (2) accessibility, (3) affordability, (4) comprehensibility, and (5) usefulness. The results suggest a positive role for interprofessional collaboration between medical professionals and social workers within a primary health care setting. This includes the opportunity for giving greater attention to social rights and collaboration within the local community.

Multimorbidity Among Migrant and Non-Migrant Ghanaians: The RODAM Study

Objectives: Multimorbidity is a growing public health concern due to the increasing burden of non-communicable diseases, yet information about multimorbidity in low- and middle-income countries and migrant populations is scarce. We aimed to investigate the distribution and patterns of multimorbidity in rural and urban areas in Ghana and Ghanaian migrants in Europe. Methods: The RODAM cross-sectional study included 4,833 participants. Multimorbidity was defined as presence of multiple non-communicable chronic conditions. Patterns were determined from frequent combination of conditions. Prevalence ratios were estimated by logistic regression. Results: Prevalence of multimorbidity was higher in women and in urban Ghana and Europe. We observed a cardiometabolic pattern in all sites as well as circulatory-musculoskeletal and metabolic-musculoskeletal combinations in Ghana. Multimorbidity prevalence ratios were higher in Europe (men 1.47, 95% CI 1.34-1.59, women 1.18, 1.10-1.26) and urban Ghana (men 1.46, 1.31-1.59, women 1.27, 1.19-1.34). Conclusion: Distribution and patterns of multimorbidity differed by sex and site. With a higher burden of multimorbidity in urban areas, prevention strategies should focus on forestalling its increase in rapidly growing rural areas.

Expectations and needs of socially vulnerable patients for navigational support of primary health care services

BACKGROUND

Primary healthcare is the main entry to the health care system for most of the population. In 2008, it was estimated that about 26% of the population in Quebec (Canada) did not have a regular family physician. In early 2017, about 10 years after the introduction of a centralized waiting list for patients without a family physician, Québec had 25% of its population without a family physician and nearly 33% of these or 540,000, many of whom were socially vulnerable (SV), remained registered on the list. SV patients often have more health problems. They also face access inequities or may lack the skills needed to navigate a constantly evolving and complex healthcare system. Navigation interventions show promise for improving access to primary health care for SV patients. This study aimed to describe and understand the expectations and needs of SV patients.

METHODS

A descriptive qualitative study rooted in a participatory study on navigation interventions implemented in Montérégie (Quebec) addressed to SV patients. Semi-structured individual face-to-face and telephone interviews were conducted with patients recruited in three primary health care clinics, some of whom received the navigation intervention. A thematic analysis was performed using NVivo 11 software.

RESULTS

Sixteen patients living in socially deprived contexts agreed to participate in this qualitative study. Three main expectations and needs of patients for navigation interventions were identified: communication expectations (support to understand providers and to be understood by them, discuss about medical visit, and bridge the communication cap between patients and PHC providers); relational expectations regarding emotional or psychosocial support; and pragmatic expectations (information on available resources, information about the clinic, and physical support to navigate the health care system).

CONCLUSIONS

Our study contributes to the literature by identifying expectations and needs specified to SV patients accessing primary health care services, that relate to navigation interventions. This information can be used by decision makers for navigation interventions design and inform health care organizational policies.

The Increase in Frequency of Protective Behavior against Pesticide Poisoning in Narail, Bangladesh through Use of an Easy Paper Checklist; an Interventional Study

Protecting the health of farmworkers is a crucial issue. Previous studies report that safety training and educational interventions might increase farmworkers’ protective behaviors. The present study aimed to investigate the effectiveness of distributing a checklist as an interventional measure for pesticide protection in rural Asia, where pesticide poisoning is a major problem. This study was a community-based interventional study, using the distribution of a checklist with pesticide protective habits in Narail district, Bangladesh, with a total of 100 eligible males. Two questionnaire surveys were conducted before distributing the checklist and 25 days after. Change between the baseline and follow-up surveys was measured by frequency scores of protective behavior. The average pesticide-protective behavioral score increased from 4.58 in the baseline survey to 8.11 in the follow-up. Additionally, the checklist was more effective in the group with higher education, the younger group, and the group with lower pesticide-protective behavioral scores in the baseline survey. The paper checklist on protective behaviors against pesticide poisoning was effective because of the increase in the frequency of such positive behavior among farmworkers. Thus, intervention measures should be implemented to increase the knowledge and awareness regarding pesticide protection habits to protect the health of farmworkers.

Social Vulnerability Indices as a Risk Factor for Heart Failure Readmissions

Objectives: The objective of our study was to use the parameters of social vulnerability index (SVI) to observe their association with the 30-day hospital readmissions in the heart failure population.Methods: Data required for analysis were extracted from the electronic medical record. The geographic SVI data was then merged with the clinical data. Qualitative variables and reported as frequency and quantitative variables and reported as the mean ± standard deviation. Variables from univariate analysis with a P value of ≤ 0.10 were evaluated using multivariate logistic regression with stepwise backward variable selection and receiver operating curve (ROC) analysis.Results: The odds ratio of readmission predicted by HOSPITAL score was 1.137 (P value = 0.004, 95% CI = 1.041-1.241). SVI parameter recording disability showed odds ratio of 1.521 (P value = 0.006, 95% CI = 1.125-2.058) and SVI parameter tracking vehicle ownership showed odds ratio of 15.355 (P value = 0.014, 95% CI = 1.755 - 134.383). The ROCs were generated for three scenarios: (i) HOSPITAL score only which had area under the curve (AUC) of 0.702 (P value = 0.015), (ii) SVI indicators tracking vehicle ownership and disability resulted in the AUC of 0.589 (P value = 0.016), and (iii) all of the above combined increased the AUC increased to 0.718 (P value = 0.015).Conclusions: Two social parameters (limited vehicle access and prevalence of disability) from the SVI showed a strong association with 30-day hospital readmissions.

Influence of patient immigrant status on physician trainee diabetes treatment decisions: a virtual patient experimental study

To determine the effect of patient immigrant status on physician trainees' diabetes treatment decisions. Participants were 140 physician trainees ('providers'). Providers viewed videos and vignettes of virtual patients differing in immigrant status (born in Mexico or U.S.; other characteristics held constant). Analyses were completed at the group and individual levels. Providers were less likely to refer foreign-born (vs. U.S.-born) patients to endocrinology. Individual-level results showed an almost even split between treatment ratings for foreign-born vs. U.S.-born patients for three decisions (take no action, add oral hypoglycemic agent, add/switch to insulin), explaining why group-level differences for these ratings did not emerge (i.e., they were cancelled out). Physician trainees are less likely to refer foreign-born patients to endocrinology. Half of individual-level decisions were influenced by patient immigrant status, but group-level analyses mask these differences. Systematic treatment differences based on non-relevant factors could lead to adverse outcomes for immigrants.

A Qualitative Study of the Health Perceptions in the Venezuelan Immigrant Population in Medellín (Colombia) and Its Conditioning Factors

This study explored the general and oral health perceptions in the Venezuelan immigrant population in Medellín (Colombia) and its conditioning factors. A qualitative study involving Venezuelan immigrants ≥18 years with a minimum stay of six months in Colombia was conducted. Dentists, dental students, and other health professionals also participated. Semi-structured interviews (n = 17), focus groups (n = 2), and key informants' interviews (n = 4) were utilized. The interviews and focus groups were recorded and transcribed for later narrative content analysis. A high degree of vulnerability of participants was found due to the precarious living conditions from the premigratory moment and the lack of job placement possibilities at the time of settling in Colombia, where the migratory status played a fundamental role. Among the perceived needs, the mitigation of noncommunicable diseases stood out. Poor mental health symptoms (depression and anxiety) were perceived, and oral health was not a priority. Barriers to accessing health and dental care were found. The migrant condition was found to be a determinant that affected physical, mental, and oral health and the provision of health care. This situation is of interest to the construction of public health policies that guarantee access to fundamental rights.

Precarity and Aging: A Scoping Review

BACKGROUND AND OBJECTIVE

The concept of precarity holds the potential to understand insecurities and risks experienced by older people in the contemporary social, economic, political and cultural context. This study maps existing conceptualizations of precarity in relation to aging and later life, identifies key themes, and considers the use of precarity in two subfields.

RESEARCH DESIGN AND METHODS

This article presents the findings of a two-phase scoping study of the international literature on precarity in later life. Phase I involved a review of definitions and understandings of precarity and aging. Phase II explored two emerging subthemes of disability and im/migration as related to aging and late life.

RESULTS

A total of 121 published studies were reviewed across Phase I and Phase II. Findings reveal that the definition of precarity is connected with insecurity, vulnerability, and labor and that particular social locations, trajectories, or conditions may heighten the risk of precarity in late life.

IMPLICATIONS AND DISCUSSION

The article concludes by outlining the need for conceptual clarity, research on the unique multidimensional features of aging and precarity, the delineation of allied concepts and emerging applications, and the importance of linking research results with processes of theory building and the development of policy directives for change.

Vulnerability as a palimpsest: Practices and public policy in a Mexican hospital setting

Vulnerability is a concept associated with the effects of social inequities to access health care services. On a hospital level, vulnerable populations must be identified and favored over others. The aims of this study were the analysis of the conceptions and practices of social workers regarding vulnerable patients, and the identification of theoretical elements of vulnerability given by academics. Hospital ethnography and a focus group were implemented. Social workers related vulnerability to the social needs of each patient; however, they state that they have dilemmas to identify a person in a vulnerable condition; these dilemmas are related to social differences and deservingness. Academics indicated that the vulnerability should refer to the lack of access to health services offered by the institution. Academics agree with social workers regarding the importance of considering the overlapped social and individual circumstances in each patient to recognize their vulnerable condition, regardless of belonging to any of the pre-established vulnerable groups. Finally, taking into account the way of conceptualizing vulnerability and how public policy on the identification of vulnerable patients in the hospital has been implemented, these two elements are explained using the palimpsest model, which is a figure of thought that can be applied to analyze the sociocultural significance of this complex issue, as well as other social dynamics.

Older patients' perspectives and experience of hospitalisation during the COVID-19 pandemic: a qualitative explorative study

Background and Objectives

The aim of this study was to gain in‐depth knowledge and an increased understanding on how isolation from close relatives and carers, during the COVID‐19 pandemic, impacted older patients during hospitalisation in a Geriatric department.

Method

We conducted a qualitative study using semi‐structured interviews and a phenomenological‐hermeneutic approach, to get an understanding of the older participants' perspectives and lived experiences. Complete interviews were available for 11 patients—six men and five women, between 69 and 91 years of age.

Results

The participants' narratives identified several themes. Feeling isolated from and having no contact with close relatives or carers was prominent. The COVID‐19 pandemic created fear and anxiety among hospitalized patients. Relationships with family members and some staff became strained. The transformation from being “a person” to being “a patient” and loss of dignity, autonomy and a “sense of self” were themes identified in the analysis. Although virtual contact can't replace the real world, the use of technology to maintain contact with family and carers, and the need for help from hospital staff in facilitating this contact was deemed important. The environment of care was a prominent theme. The attitude of staff made a difference to how patients felt and some patients expressed a loss of decision‐making capability. The interviews were challenging in some cases because the interviews had to be interrupted or shortened due to ethical considerations around the individual person's needs and condition.

Conclusions and implication for practice

Our study provided in‐depth knowledge on how older patients experienced hospitalisation during the COVID‐19 pandemic in a Danish hospital. The results emphasise that compassionate care includes a willingness to listen to older patients' narratives and to imagine life as depicted by them. This can lead to better understanding of an individual person's needs and increase the quality of care provided.

Psychological Distress and Somatization in Immigrants in Primary Health Care Practices

The process of international migration causes a situation of vulnerability in people’s health and greater difficulty in coping with disease. Furthermore, the adversities suffered during migration can trigger reactive signs of stress and cause anxious, depressive, confusional and somatic symptoms. This article studies the relationships between psychosocial risk, psychological distress and somatization in immigrants from four communities: Maghrebis, Sub-Saharans, South Americans and South Asian. A cross-sectional study was carried out with questionnaires on 602 immigrants who were surveyed in the primary care centers of an urban area of Catalonia. The instruments used were the Demographic Psychosocial Inventory (DPSI), the Brief Symptom Inventory (BSI) and the Somatic Symptom Inventory (SSI). The average psychosocial risk obtained was 0.35, with the highest values in the Sub-Saharan community. Psychological distress showed a mean value of 0.66, with the Sub-Saharan community scoring the lowest in all dimensions except depression. The average somatization values were 1.65, with the Sub-Saharan community scoring the least. The female gender is a risk factor for somatization and psychological distress. Perceived psychosocial risk is a predictor of psychological distress, but not somatization, suggesting that the use of more adaptive coping strategies could minimize the effect of the migration process on somatizations.

The (in)visible victims of disaster: Understanding the vulnerability of undocumented Latino/a and indigenous immigrants

As climate change advances, communities across the United States are adapting to the increased threat of wildfires, drought, heatwaves, and infectious diseases. Such disasters are expected to become more frequent and severe. Now more than ever, it is crucial to understand how these events amplify existing inequalities, and how to lessen the resulting harms. Differences in human vulnerability to disaster stem from a range of social, economic, historical, and political factors. We argue that given their social status, undocumented Latino/a and Indigenous immigrants are particularly vulnerable to disasters and require special consideration in disaster planning. They are disproportionately affected by racial discrimination, exploitation, economic hardships, less English and Spanish proficiency, and fear of deportation in their everyday lives- their pre-disaster marginalized status. In the case of the Thomas Fire in California's Ventura and Santa Barbara counties, we show that emergency response and recovery efforts ignored their needs. Resources were directed toward privileged individuals, leaving local immigrant rights and environmental justice groups to provide essential services such as language access to emergency information in Spanish and Indigenous tongues; labor protections for farmworkers endangered in the fields; and a private disaster relief fund for undocumented immigrants ineligible for federal aid. The article concludes with preliminary participant observations from the COVID-19 pandemic response in the region, indicating how lessons from the fire have informed official actions. As governments grapple with the increasing severity of disasters, understanding the differential impacts on undocumented immigrants can help improve disaster planning to protect the most vulnerable and stigmatized populations.

Changes in self-rated health and quality of life among Syrian refugees migrating to Norway: a prospective longitudinal study

Background

Forced migrants can be exposed to various stressors that can impact their health and wellbeing. How the different stages in the migration process impacts health is however poorly explored. The aim of this study was to examine changes in self-rated health (SRH) and quality of life (QoL) among a cohort of adult Syrian refugees before and after resettlement in Norway.

Method

We used a prospective longitudinal study design with two assessment points to examine changes in health among adult Syrian resettlement refugees in Lebanon accepted for resettlement in Norway. We gathered baseline data in 2017/2018 in Lebanon and subsequently at follow-up one year after arrival. The main outcomes were good SRH measured by a single validated item and QoL measured by WHOQOL-BREF. We used generalized estimating equations to investigate changes in outcomes over time and incorporated interaction terms in the models to evaluate effect modifications.

Results

In total, 353 subjects participated in the study. The percentage of participants reporting good SRH showed a non-significant increase from 58 to 63% RR, 95%CI: 1.1 (1.0, 1.2) from baseline to follow-up while mean values of all four QoL domains increased significantly from baseline to follow-up; the physical domain from 13.7 to 15.7 B, 95%CI: 1.9 (1.6, 2.3), the psychological domain from 12.8 to 14.5 B, 95%CI: 1.7 (1.3, 2.0), social relationships from 13.7 to 15.3 B, 95%CI: 1.6 (1.2, 2.0) and the environmental domain from 9.0 to 14.0 5.1 B, 95%CI: (4.7, 5.4). Positive effect modifiers for improvement in SRH and QoL over time include male gender, younger age, low level of social support and illegal status in transit country.

Conclusion

Our results show that good SRH remain stable while all four QoL domains improve, most pronounced in the environment domain. Understanding the dynamics of migration and health is a fundamental step in reaching health equity.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s12939-020-01300-6.

Resources in vulnerable young adults: self-assessments during preventive consultation with their general practitioner in Denmark

Inequality in health is increasing. People with many problems often lack energy to improve well-being and reduce their problems. This study analyses how psycho-socially challenged younger (20- to 44-year-old) patients described their own resources to reach lifestyle goals or alter life circumstances. Within the context of a randomized controlled trial, Danish participants had two structured preventive person-centred consultations with their general practitioner. Consultations focused on well-being, salutogenesis, resources, barriers and support of autonomy. Using the qualitative method: Systematic Text Condensation, we made thematic cross-analysis of patients' goal-specific resource statements described at the first consultation. Of the 209 patients, 191 (91%) chose one or two goals for a better life next year; nearly all (179) could recall and describe which resources they would use to reach their goal. We categorized resource statements into (i) personal constitution as 'willpower' and 'tenacity'; (ii) network, e.g. family; (iii) personal experience with identical or similar problems. Some patients needed to free up resources by handling psychological problems before being able to focus on lifestyle goals. The study demonstrates that patients with particular psycho-social problems could describe essential resources in a structured, salutogenic, preventive consultation with their general practitioner. Reflecting intrinsic and extrinsic motivation, these resources reflected dimensions of essential health theories like sense of coherence, self-efficacy and self-determination theory. Increased awareness of these resources seems essential for vulnerable patients by improving psychological well-being and optimism, thereby facilitating health-related changes. This may be an important step to reducing inequality in health.

Innovative postnatal risk assessment in preventive child health Care: A study protocol

AIM

To introduce the rationale and design of a postnatal risk assessment study, which will be embedded in Preventive Child Health Care. This study will evaluate: (a) the predictive value of an innovative postnatal risk assessment, meant to assess the risk of growth and developmental problems in young children; and (b) its effectiveness in combination with tailored care pathways.

DESIGN

This study concerns a historically controlled study design and is designed as part of the Healthy Pregnancy 4 All-2 program. We hypothesize that child growth and developmental problems will be reduced in the intervention cohort due to the postnatal risk assessment and corresponding care pathways.

METHODS

The study was approved in August 2016. Children and their parents, visiting well-baby clinics during regular visits, will participate in the intervention (N = 2,650). Additional data of a historical control group (N = 2,650) in the same neighbourhoods will be collected. The intervention, consisting of the risk assessment and its corresponding care pathways, will be executed in the period between birth and 2 months of (corrected) age. The predictive value of the risk assessment and its effectiveness in combination with its corresponding care pathways will be assessed by Preventive Child Health Care nurses and physicians in four Preventive Child Health Care organisations in three municipalities with adverse perinatal outcomes. A total risk score above a predefined threshold, which is based on a weighted risk score, determines structured multidisciplinary consultation.

DISCUSSION

The successful implementation of this innovative postnatal risk assessment including corresponding care pathways has potential for further integration of risk assessment and a family-centred approach in the work process of Preventive Child Health Care nurses and physicians.

IMPACT

This study introduces a systematic approach in postnatal health care which may improve growth and developmental outcomes of children and even future generations.

Does healthcare inequity reflect variations in peoples' abilities to access healthcare? Results from a multi-jurisdictional interventional study in two high-income countries

Background

Primary healthcare services must respond to the healthcare-seeking needs of persons with a wide range of personal and social characteristics. In this study, examined whether socially vulnerable persons exhibit lower abilities to access healthcare. First, we examined how personal and social characteristics are associated with the abilities to access healthcare described in the patient-centered accessibility framework and with the likelihood of reporting problematic access. We then examined whether higher abilities to access healthcare are protective against problematic access. Finally, we explored whether social vulnerabilities predict problematic access after accounting for abilities to access healthcare.

Methods

This is an exploratory analysis of pooled data collected in the Innovative Models Promoting Access-To-Care Transformation (IMPACT) study, a Canadian-Australian research program that aimed to improve access to primary healthcare for vulnerable populations. This specific analysis is based on 284 participants in four study regions who completed a baseline access survey. Hierarchical linear regression models were used to explore the effects of personal or social characteristics on the abilities to access care; logistic regression models, to determine the increased or decreased likelihood of problematic access.

Results

The likelihood of problematic access varies by personal and social characteristics. Those reporting at least two social vulnerabilities are more likely to experience all indicators of problematic access except hospitalizations. Perceived financial status and accumulated vulnerabilities were also associated with lower abilities to access care. Higher scores on abilities to access healthcare are protective against most indicators of problematic access except hospitalizations. Logistic regression models showed that ability to access is more predictive of problematic access than social vulnerability.

Conclusions

We showed that those at higher risk of social vulnerability are more likely to report problematic access and also have low scores on ability to seek, reach, pay, and engage with healthcare. Equity-oriented healthcare interventions should pay particular attention to enhancing people’s abilities to access care in addition to modifying organizational processes and structures that reinforce social systems of discrimination or exclusion.

Building a sanitary vulnerability map from open source data in Argentina (2010-2018)

Background

Designing public health policies to target the needs of specific places requires highly granular data. When geographic health statistics from official sources are absent or lacking in spatial detail, Sanitary Vulnerability metrics derived from Census and other georeferenced public data can be used to identify areas in particular need of attention. With that aim, a Vulnerability Map was developed, identifying areas with a substantial deficit in its population health coverage. As a result a novel methodology for measuring Sanitary Vulnerability is presented, that can potentially be applied to different time periods or geographies.

Methods

Census, official listings of public health facilities and crowdsourced georeferenced data are used. The Vulnerability Index is built using dimensionality reduction techniques such as Autoencoders and Non-parametric PCA.

Main results

The high resolution map shows the geographical distribution of a Sanitary Vulnerability Index, produced using official and crowdsourced open data sources, overcoming the lack of official sources on health indicators at the local level.

Conclusions

The Sanitary Vulnerability Map’s value as a tool for place specific policymaking was validated by using it to predict local health related metrics such as health coverage. Further lines of work contemplate using the Map to study the interaction between Sanitary Vulnerability and the prevalence of different diseases, and also applying its methodology in the context of other public services such as education, security, housing, etc.

Shared concern with current breast cancer rehabilitation services: a focus group study of survivors' and professionals' experiences and preferences for rehabilitation care delivery

OBJECTIVES

Breast cancer survivors experience a wide spectrum of physical sequelae from cancer treatment. National and international guidelines recommend that rehabilitation is offered from the point of diagnosis. However, there is a lack of data on the translation of these recommendations into clinical care. The objective of this study was to explore the experiences of breast cancer survivors, rehabilitation professionals and breast surgeons on current rehabilitation services including preferences for care delivery, specific ways to promote early detection and timely management of upper body issues and attitudes towards self-managed surveillance and rehabilitation.

DESIGN

Qualitative focus groups. Breast cancer survivors completed a questionnaire about rehabilitation services received and experience of upper body issues. These quantitative data were collected to provide context for the qualitative data and increase transferability. Transcripts were analysed using content analysis.

SETTING

Five geographically distinct health authorities in British Columbia, Canada.

PARTICIPANTS

Eleven focus groups were conducted with 35 breast cancer survivors, 29 rehabilitation professionals and 5 breast surgeons.

RESULTS

Three categories captured participants' concern and wish for improved care: (1) cut the cancer out and goodbye; (2) you have to look out for yourself and (3) in a perfect world. All breast cancer survivors reported chronic upper body issues (mean 4.5 unique issues). Breast cancer survivors expressed worry and uncertainty in their solo management of the rehabilitation. The current services were reported to not enable early detection and timely management. Suggestions included reorganising the timing of patient education and improving the quality of and access to rehabilitation services by elevating the knowledge among healthcare professionals and providing multimodal self-management resources.

CONCLUSIONS

The results revealed a gap between oncology guidelines and the current clinical reality. The rehabilitation services were reported in need of revamping to increase equity of care. Multiple upper body issues were reported by many breast cancer survivors.

Association of immigration background with kidney graft function in a publicly funded health system: a nationwide retrospective cohort study in Italy

The impact of immigration background on kidney graft function (eGFR) is unknown. Italy has a publicly funded health system with universal coverage. Since immigration from non-European Union (EU) countries beyond Eastern Europe is a recent and extensive phenomenon, Italy is a rather unique setting for studying the effect of immigration status as a socioeconomic and cultural condition. We retrospectively identified all adult deceased donor kidney transplant recipients (KTRs) in Italy (2010-2015) and followed them until death, dialysis or 5-years post-transplantation; 6346 were EU-born, 161 Eastern European-born, and 490 non-European-born. We examined changes in eGFR after 1-year post-transplant using multivariable-adjusted joint longitudinal survival random-intercept Cox regression. Compared to EU-born KTRs, in non-European-born KTRs the adjusted average yearly eGFR decline was -0.96 ml/min/year (95% confidence interval: -1.48 to -0.45; P < 0.001), whereas it was similar in Eastern European-born KTRs [+0.02 ml/min/year (-0.77 to +0.81; P = 0.96)]. Adjusted 5-year transplant survival did not statistically differ between non-European-born, Eastern European-born, and EU-born. In those surviving beyond 1-year, it was 91.8% in EU-born (87.1-96.8), 92.5% in Eastern European-born (86.1-99.4), and 89.3% in non-European-born KTRs (83.0-96.0). This study provides evidence that among EU KTRs, non-European immigration background is associated with eGFR decline.

Implementation of health-focused interventions in vulnerable populations: protocol for a scoping review

INTRODUCTION

Vulnerable populations face significant challenges in navigating the care continuum, ranging from diagnosis of illness to linkage and retention in healthcare. Understanding how best to move individuals within these vulnerable populations across the care continuum is critical to improving their health. A large body of literature has focused on evaluation of implementation of various health-focused interventions in this population. However, we do not fully understand the unique challenges to implementing healthcare interventions for vulnerable populations. This study aims to examine the literature describing implementation of health service interventions among vulnerable populations to identify how implementations using the Consolidated Framework for Implementation Research are adapted. Findings from this review will be useful to implementation scientists to identify gaps in evidence and for adapting similar interventions in unique settings.

METHODS AND ANALYSIS

This study protocol outlines a scoping review of the peer-reviewed and grey literature, using established approaches delineated in Arksey and O'Malley's scoping review framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist. Search strategies will be developed and refined by a medical librarian in collaboration with the research team. Searches will be conducted in electronic databases (CINAHL, Cochrane, PsychINFO, PubMed, Social Services Abstracts, Web of Science, Google and Google Scholar) and limited to studies published between 1 August 2009 and 1 June 2020. Additionally, hand searches will be conducted in three relevant journals-Implementation Science, Systematic Reviews and BMJ Open. English-language studies and reports meeting inclusion criteria will be screened independently by two reviewers and the final list will be abstracted and charted in duplicate.

ETHICS AND DISSEMINATION

This is a review of the literature; ethics approval is not indicated. We will disseminate findings from this study in peer-reviewed journals as well as presentations to relevant stakeholders and conferences.

Women's vulnerability within the childbearing continuum: A scoping review

INTRODUCTION

The aim of this scoping review is to explore the concept of ‘vulnerability’ affecting pregnant women and to identify an appropriate definition of this term.

METHODS

Five stages were adopted for conducting the scoping review. A literature search was undertaken between 1 October 2017 and 5 January 2018, using three databases. Relevant publications were appraised, and semantic content analysis was performed to identify emergent themes and four determinants of the vulnerability concept. This involved combining items that seem to address the same issue.

RESULTS

Eleven publications were considered, and eight definitions of vulnerability were identified, and from these four themes emerged: poor health outcome or status; exposure to risk; complex social needs; and lack of resources. Further analysis of evidence found examples of groups of people considered to be vulnerable; they were reported into six matrices, mainly with social and psychological difficulties. From these, eleven themes arose. Following a semantic and content analysis of all themes, thirteen final themes were identified. They represent the characteristics associated with women considered to be vulnerable and are called indices of vulnerability. Semantic and content analysis allowed addressing the thirteen indices of vulnerability into four categories called determinants of the vulnerability concept: deficiency, need, risk exposure, and barriers.

CONCLUSIONS

The vulnerability could be defined as a lack of health, related to the presence of at least one of the four determinants. Midwives are the key to identify vulnerable women, offering appropriate care.

Disparities in Service Use Among Children With Autism: A Systematic Review

CONTEXT

Research reveals racial, ethnic, and socioeconomic disparities in autism diagnosis; there is limited information on potential disparities related to other dimensions of services.

OBJECTIVE

We reviewed evidence related to disparities in service use, intervention effectiveness, and quality of care provided to children with autism by race, ethnicity, and/or socioeconomic status.

DATA SOURCES

Medline, PsychInfo, Educational Resources Informational Clearinghouse, and the Cumulative Index to Nursing and Allied Health Literature were searched by using a combination of Medical Subject Headings terms and keywords related to autism, disparities, treatment, and services.

STUDY SELECTION

Included studies addressed at least one key question and met eligibility criteria.

DATA EXTRACTION

Two authors reviewed the titles and abstracts of articles and reviewed the full text of potentially relevant articles. Authors extracted information from articles that were deemed appropriate.

RESULTS

Treatment disparities exist for access to care, referral frequency, number of service hours, and proportion of unmet service needs. Evidence revealed that racial and ethnic minority groups and children from low-income families have less access to acute care, specialized services, educational services, and community services compared with higher-income and white families. We found no studies in which differences in intervention effectiveness were examined. Several studies revealed disparities such that African American and Hispanic families and those from low-income households reported lower quality of care.

LIMITATIONS

The body of literature on this topic is small; hence it served as a limitation to this review.

CONCLUSIONS

The documented disparities in access and quality of care may further identify groups in need of outreach, care coordination, and/or other interventions.