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Correia T. Trust Building in Public Health Approaches: The Importance of a "People-Centered" Concept in Crisis Response. Risk Manag Healthc Policy 2024; 17:1903-1908. [PMID: 39104746 PMCID: PMC11299718 DOI: 10.2147/rmhp.s471250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 07/19/2024] [Indexed: 08/07/2024] Open
Abstract
Purpose To argue for trust-building as a key solution for responding to public health crises in the face of political ambiguity in international health governance. Patients and Methods This perspective piece reviews fundamental concepts and discusses future directions using secondary data from open-access sources. Results The promise of learning from Covid-19 and previous public health crises, along with the growing recognition of a 'Health For All Policies' approach, clash with siloed preparations, management, and recovery plans for future emergency crises. Trust is proposed as a possible solution to overcome these limitations. It acts as a binding force that unites individuals within the community, fostering a sense of belonging and participation. Trust-building is viewed as a "People-Centered" approach in Crisis Response, aimed at creating active and resilient communities to foster preparation and readiness, respond to emergent risks, facilitate recovery, and mitigate risks. A remaining question is how to measure and identify the dimensions and determinants of trust in specific circumstances. Some ideas are systematized to highlight the pathway to build trust in public health approaches, including transparency, education, robust and equitable health systems, strengthened social capital, stakeholders' engagement, and health workforce training. Conclusion Trust in public health approaches can be fostered through consistent delivery of quality care, a clear, shared vision, and values underpinned by ethical standards. It requires a commitment to stakeholder well-being, including staff, and the integration of reliability, integrity, and transparency into policies, strategies, and practices. Exemplary leadership, openness in resource utilization, addressing waste or corruption, and effective communication of these principles are essential.
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Affiliation(s)
- Tiago Correia
- Global Health and Tropical Medicine, Associate Laboratory in Translation and Innovation Towards Global Health, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
- WHO Collaborating Center for Health Workforce Policies and Planning, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisbon, Portugal
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Doose M, Mollica MA, Acevedo AM, Tesauro G, Gallicchio L, Reed C, Guida J, Maher ME, Srinivasan S, Tonorezos E. Advancing health equity in cancer survivorship research: National Institutes of Health 2017-2022 portfolio review. J Natl Cancer Inst 2024; 116:1238-1245. [PMID: 38544292 DOI: 10.1093/jnci/djae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/12/2024] [Accepted: 03/19/2024] [Indexed: 08/09/2024] Open
Abstract
BACKGROUND Communities and researchers have called for a paradigm shift from describing health disparities to a health equity research agenda that addresses structural drivers. Therefore, we examined whether the cancer survivorship research portfolio has made this shift. METHODS We identified grants focused on populations experiencing health disparities from the National Institutes of Health (NIH) Cancer Survivorship Research Portfolio (N = 724), Fiscal Years 2017-2022. Grant characteristics were abstracted, drivers of health disparities were mapped onto the levels and domains of influence, and opportunities for future research were identified. RESULTS A total of 147 survivorship grants focused on health disparities were identified, of which 73.5% of grants focused on survivors from racial and ethnic minoritized groups, 25.9% living in rural areas, 24.5% socioeconomically disadvantaged, and 2.7% sexual and gender minority groups. Study designs were 51.0% observational; 82.3% of grants measured or intervened on at least 1 individual-level of influence compared to higher levels of influence (32.7% interpersonal, 41.5% institutional and community, and 12.2% societal). Behavioral and health care system domains of influence were commonly represented, especially at the individual level (47.6% and 36.1%, respectively). Less frequently represented was the physical and built environment (12.2%). CONCLUSIONS NIH-funded cancer survivorship research on health disparities is still focused on individual level of influence. However, the proportion of grants examining structural and social drivers as well as the mechanisms that drive disparities in health care and health outcomes among cancer survivors have increased over time. Gaps in funded research on specific populations, cancer types, and focus areas of survivorship science were identified and warrant priority.
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Affiliation(s)
- Michelle Doose
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Michelle A Mollica
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Amanda M Acevedo
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Gina Tesauro
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Lisa Gallicchio
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Crystal Reed
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Jennifer Guida
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Molly E Maher
- Office of Cancer Centers, Office of the Director, National Cancer Institute, Rockville, MD, USA
| | - Shobha Srinivasan
- Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Emily Tonorezos
- Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Zegeye AF, Mekonen EG, Tekeba B, Alemu TG, Ali MS, Gonete AT, Kassie AT, Workneh BS, Tamir TT, Wassie M. Spatial distribution and determinants of measles vaccination dropout among under-five children in Ethiopia: A spatial and multilevel analysis of 2019 Ethiopian demographic and health survey. PLoS One 2024; 19:e0305393. [PMID: 38976660 PMCID: PMC11230542 DOI: 10.1371/journal.pone.0305393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 05/30/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Each year, vaccine-preventable diseases cost the lives of 8.8 million under-five children. Although vaccination prevents 1-2 million childhood deaths worldwide, measles vaccination dropouts are not well studied in developing countries, particularly in Ethiopia. Therefore, this study aims to assess the spatial distribution of the measles vaccination dropout and its determinants among under-five children in Ethiopia. METHODS Data from Ethiopian Demographic and Health Survey 2019 was used for data analysis. The study used a total of 5,753 children. Spatial autocorrelations was used to determine the spatial dependency of measles vaccination dropout. Ordinary interpolation was employed to forecast measles vaccination dropout. Factors associated with measles vaccination dropout were declared significant at p-values <0.05. The data were interpreted using the confidence interval and adjusted odds ratio. A model with the lowest deviance and highest logliklihood ratio was selected as the best-fit model. RESULTS In Ethiopia, one in three under-five children had measles vaccination dropouts. Factors such as birth interval (AOR = 1.87, 95% CI: 1.30, 2.70), unmarried marital status women (AOR = 3.98, 95% CI: 1.08, 8.45), ≤1 number of under-five children (AOR = 3.86, 95% CI: 2.56, 5.81), rural place of residence (AOR = 2.43, 95% CI: 2.29, 3.11), low community-level ANC utilization (AOR = 3.20, 95% CI: 2.53, 3.56), and residing in Benishangul Gumuz (AOR = 1.80, 95% CI: 1.061, 3.06) had higher odds of measles vaccination dropout. CONCLUSIONS Measles vaccination dropout rates in Ethiopia among under-five children were high compared to the maximum tolerable vaccination dropout level of 10% by the WHO. Both individual and community-level variables were determinants of measles vaccination dropout. The ministry of health in Ethiopia should give attention to those mothers of under-five children who reported underutilization of ANC services and rural residences while designing policies and strategies in areas of high spatial clustering of vaccine dropout in Ethiopia.
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Affiliation(s)
- Alebachew Ferede Zegeye
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Enyew Getaneh Mekonen
- Department of Surgical Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berhan Tekeba
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohammed Seid Ali
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Almaz Tefera Gonete
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemneh Tadesse Kassie
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences University of Gondar, Gondar, Ethiopia
| | - Belayneh Shetie Workneh
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Wassie
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Althans AR, Meshkin D, Holder-Murray J, Cunningham K, Celebrezze J, Medich D, Tessler RA. Deprivation and Rurality Mediate Income Inequality's Association with Colorectal Cancer Outcomes. Am J Prev Med 2024:S0749-3797(24)00192-2. [PMID: 38866078 DOI: 10.1016/j.amepre.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 06/01/2024] [Accepted: 06/02/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Income inequality is associated with poor health outcomes, but its association with colorectal cancer is not well-studied. The authors aimed to determine the association between income inequality and colorectal cancer incidence/mortality in U.S. counties, and hypothesized that this association was mediated by deprivation. METHODS The authors performed a cross-sectional study of U.S. counties from 2015-2019 using statewide cancer registries and the Centers for Disease Control and Prevention WONDER database. Generalized linear negative binomial regression was performed in 2024 to estimate the association between Gini coefficient (income inequality) and colorectal cancer incidence/mortality using incidence rate ratios (IRRs) for the entire cohort and stratified by rurality. RESULTS A total of 697,981 colorectal cancer cases were diagnosed in the 5-year study period. On adjusted regression, for every 0.1 higher Gini coefficient, there was an 11% higher risk of both colorectal cancer incidence and mortality (IRR 1.11, 95%CI 1.03,1.19 and IRR 1.11, 95%CI 1.05, 1.18 respectively). The association between income inequality and incidence/mortality peaked in more rural counties, however there was not an overall dose-dependent relationship between rurality and these associations. Deprivation mediated the association between income inequality and colorectal cancer incidence (indirect effect B coefficient 0.088, p<0.001) and mortality (B coefficient 0.088, p<0.001). The magnitude and direction of the direct, indirect, and total effects differed in each rurality strata. CONCLUSIONS Much of income inequality's association with colorectal cancer outcomes operates through deprivation. Rural counties have a stronger association between higher income inequality and higher mortality, which works in tandem with deprivation.
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Affiliation(s)
- Alison R Althans
- University of Pittsburgh Medical Center, Department of Surgery, 200 Lothrop Street, Presbyterian Hospital, Pittsburgh, PA, 15213.
| | - Dana Meshkin
- University of Pittsburgh, School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15213
| | - Jennifer Holder-Murray
- University of Pittsburgh Medical Center, Department of Surgery, 200 Lothrop Street, Presbyterian Hospital, Pittsburgh, PA, 15213
| | - Kellie Cunningham
- University of Pittsburgh Medical Center, Department of Surgery, 200 Lothrop Street, Presbyterian Hospital, Pittsburgh, PA, 15213
| | - James Celebrezze
- University of Pittsburgh Medical Center, Department of Surgery, 200 Lothrop Street, Presbyterian Hospital, Pittsburgh, PA, 15213
| | - David Medich
- University of Pittsburgh Medical Center, Department of Surgery, 200 Lothrop Street, Presbyterian Hospital, Pittsburgh, PA, 15213
| | - Robert A Tessler
- University of Pittsburgh Medical Center, Department of Surgery, 200 Lothrop Street, Presbyterian Hospital, Pittsburgh, PA, 15213
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Beaumont JD, Ioannou E, Harish K, Elewendu N, Corrigan N, Nield L. "We're one small piece of the puzzle": evaluating the impact of short-term funding for tier two weight management services. Front Public Health 2024; 12:1381079. [PMID: 38841679 PMCID: PMC11150676 DOI: 10.3389/fpubh.2024.1381079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/09/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Overweight and obesity are a global health epidemic and many attempts have been made to address the rising prevalence. In March 2021 the UK government announced £100 million of additional funding for weight management provisions. Of this, £30.5 million was split across local authorities in England to support the expansion of tier two behavioural weight management services for adults. The present work aimed to explore how this funding was used within the Yorkshire and Humber region to consolidate learning, collate best practice, and provide recommendations for future funding use. Method One-hour semi-structured interviews were conducted with 11 weight management service commissioners representing 9 of the 15 local authorities in the region. Interviews were recorded, transcribed and analysed using an established health inequality framework. From this, recommendations were co-developed with the commissioner group to establish best practice for future funding use. Results Commissioners recognised that targeted weight management services were only one small piece of the puzzle for effectively managing obesity. Therefore, recommendations include targeting underserved communities, focussing on early prevention, addressing weight management in a whole systems context, and embracing innovative and holistic approaches to weight management. Discussion Current short-term funding and restrictive commissioning processes of tier two services prevents sustainable and innovative weight management practice which is detrimental to patients, falls short of addressing health inequalities and negatively impacts staff health and wellbeing.
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Affiliation(s)
- Jordan D. Beaumont
- College of Business, Technology and Engineering, Sheffield Hallam University, Sheffield, United Kingdom
| | - Elysa Ioannou
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, United Kingdom
| | - Krishna Harish
- College of Business, Technology and Engineering, Sheffield Hallam University, Sheffield, United Kingdom
| | - Nnedinma Elewendu
- College of Social Sciences and Arts, Sheffield Hallam University, Sheffield, United Kingdom
| | - Nicola Corrigan
- Office for Health Improvement and Disparities, Department of Health and Social Care, Blenheim House, Leeds, United Kingdom
| | - Lucie Nield
- College of Business, Technology and Engineering, Sheffield Hallam University, Sheffield, United Kingdom
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Abbaticchio A, Theodorlis M, Marshall D, MacKay C, Borkhoff CM, Hazlewood GS, Battistella M, Lofters A, Ahluwalia V, Gagliardi AR. Policies in Canada fail to address disparities in access to person-centred osteoarthritis care: a content analysis. BMC Health Serv Res 2024; 24:522. [PMID: 38664819 PMCID: PMC11044343 DOI: 10.1186/s12913-024-10966-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 04/09/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Women are disproportionately impacted by osteoarthritis (OA) but less likely than men to access OA care, particularly racialized women. One way to reduce inequities is through policies that can influence healthcare services. We examined how OA-relevant policies in Canada address equitable, person-centred OA care for women. METHODS We used content analysis to extract data from English-language OA-relevant documents referred to as policies or other synonymous terms published in 2000 or later identified by searching governmental and other web sites. We used summary statistics to describe policy characteristics, person-centred care using McCormack's six-domain framework, and mention of OA prevalence, barriers and strategies to improve equitable access to OA care among women. RESULTS We included 14 policies developed from 2004 to 2021. None comprehensively addressed all person-centred care domains, and few addressed individual domains: enable self-management (50%), share decisions (43%), exchange information (29%), respond to emotions (14%), foster a healing relationship (0%) and manage uncertainty (0%). Even when mentioned, content offered little guidance for how to achieve person-centred OA care. Few policies acknowledged greater prevalence of OA among women (36%), older (29%) or Indigenous persons (29%) and those of lower socioeconomic status (14%); or barriers to OA care among those of lower socioeconomic status (50%), in rural areas (43%), of older age (37%) or ethno-cultural groups (21%), or women (21%). Four (29%) policies recommended strategies for improving access to OA care at the patient (self-management education material in different languages and tailored to cultural norms), clinician (healthcare professional education) and system level (evaluate OA service equity, engage lay health leaders in delivering self-management programs, and offer self-management programs in a variety of formats). Five (36%) policies recommended research on how to improve OA care for equity-seeking groups. CONCLUSIONS Canadian OA-relevant policies lack guidance to overcome disparities in access to person-centred OA care for equity-seeking groups including women. This study identified several ways to strengthen policies. Ongoing research must identify the needs and preferences of equity-seeking persons with OA, and evaluate the impact of various models of service delivery, knowledge needed to influence OA-relevant policy.
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Affiliation(s)
- Angelina Abbaticchio
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada
| | - Madeline Theodorlis
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada
| | | | | | - Cornelia M Borkhoff
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Marisa Battistella
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | | | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada.
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Cash-Gibson L, Benach J. Understanding Health Inequalities Research Capacities: Insights and Recommendations From Comparing Two High Income Settings. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024; 54:163-170. [PMID: 38311911 DOI: 10.1177/27551938241230006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Generating evidence on health inequalities (HI) is necessary to raise awareness of these issues, describe and monitor their evolution, analyze their causes, and inform interventions aiming to improve health equity. Yet not all cities and countries have the capacity to produce this type of research. Recent research provides new contextual and causal insights into this research production process, and in-depth understanding on why and how this type of research is produced in certain settings. This article aims to analyze two recent case studies that have uniquely explored this process in two high producers of HI research and high-income country settings to identify learning and distil recommendations, which may be insightful for other settings. Expanding and investing in this line of research is critical, particularly in places with lower HI research output and related capacity, in order to identify key contextual conditions and mechanisms that may enable or hinder this process. This new knowledge could guide the development of new HI research capacity strengthening strategies to foster this research in different settings, worldwide. More understanding is also needed on the relationship between HI research, policy, and action in order to tackle HI.
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Affiliation(s)
- Lucinda Cash-Gibson
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (UPF-BSM), Barcelona, Spain
- UPF- Barcelona School of Management (UPF-BSM), University Pompeu Fabra, Barcelona, Spain
| | - Joan Benach
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (UPF-BSM), Barcelona, Spain
- UPF- Barcelona School of Management (UPF-BSM), University Pompeu Fabra, Barcelona, Spain
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Ecological Humanities Research Group (GHECO), Universidad Autónoma de Madrid, Madrid, Spain
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Aaltonen K, Vaalavuo M. Financial burden of medicines in five Northern European countries: A decommodification perspective. Soc Sci Med 2024; 347:116799. [PMID: 38518482 DOI: 10.1016/j.socscimed.2024.116799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 02/12/2024] [Accepted: 03/15/2024] [Indexed: 03/24/2024]
Abstract
Affordable access to healthcare including medicines is a key social policy goal in Europe. However, it has rarely been addressed in comparative social policy research. Although the concept of decommodification has already been used in the context of healthcare and sickness benefits, we argue that the scope of such studies should be expanded to medicines to understand how welfare states protect their citizens from market forces in case of illness. We examine and compare the relationship between income, other characteristics, and subjective financial burden of medicines (FBM) across five countries with universal health systems pursuing egalitarian aims (Denmark, Finland, the Netherlands, Norway and Sweden). Analyses using 2017 EU-SILC microdata and linear probability models showed large differences in the level of FBM across countries, with the highest income quintile in Finland reporting FBM more frequently than the lowest income quintile in Denmark. Finland differed from the rest by increasing probability of FBM with age. In other countries, middle-aged adults tended to be the most affected, and older adults were well-protected. The association between income and FBM was strongest in the Netherlands; however, the higher probability of FBM was skewed towards the lower quintiles in all countries. FBM and financial burden of medical care were strongly associated although FBM tended to be more common. Unmet needs for medical examination were rare and lacked sensitivity in capturing manifestations of market risk. Decommodification literature has focused healthcare services as proxy of access; nevertheless, our study shows that further functions, and broader outcomes should be examined to capture market risk. Our evidence further highlights that important differences can be found even in countries with relatively similar health policy aims. The cost of medicines should be considered in comparative studies of health and welfare states.
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Affiliation(s)
- Katri Aaltonen
- INVEST Research Flagship Centre, University of Turku, Finland; Kela Research, Social Insurance Institution of Finland, Finland.
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Shelton RC, Brownson RC. Enhancing Impact: A Call to Action for Equitable Implementation Science. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:174-189. [PMID: 37878237 PMCID: PMC11133096 DOI: 10.1007/s11121-023-01589-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 10/26/2023]
Abstract
Despite investments in evidence-based interventions and Implementation Science, most evidence-based interventions are not widely or routinely adopted, delivered, or sustained in many real-world community and healthcare settings. This gap is even greater in settings and populations experiencing numerous social and structural barriers to health, with important implications for persistent patterns in health inequities. In this Viewpoint, as part of a Special Issue on Advancing the Adaptability of Chronic Disease Prevention and Management through Implementation Science, we outline seven calls to action for the field of Implementation Science, with the goal of encouraging researchers, practitioners, and funders to be more intentional and accountable in applying Implementation Science to have greater impact on promoting health equity. Calls to action include (1) enhance public health, community, and multi-sectoral partnerships to promote health equity and equitable implementation; (2) revisit and build the evidence base needed to promote health equity and impact at multiple levels; (3) prioritize focus on policy development, dissemination, and implementation; (4) be agile and responsive in application of Implementation Science frameworks, processes, and methods; (5) identify and redefine meaningful metrics for equity and impact; (6) disseminate scientific evidence and research to a diverse range of partners and potential beneficiaries; and (7) extend focus on de-implementation, mis-implementation, and sustainability which are central to enhancing health equity. Additionally, we outline why a focus on prevention and public health is essential to making progress towards health equity in Implementation Science, summarize important advancements that the field has made towards making equity more foundational, and pose important research questions to enhance equitable impact of work in this area.
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Affiliation(s)
- Rachel C Shelton
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, 722 W 168th Street, New York, NY, 10032, USA.
- Columbia University, Irving Institute for Clinical and Translational Research, New York, NY, 10032, USA.
| | - Ross C Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, 1 Brookings Drive, Campus, Box 1196, St. Louis, MO, 63130, USA
- Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, 63130, USA
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Gómez-García AR, Chang AH, Valenzuela-Mendieta RO, García-Arroyo JA. Leaving no-one behind in the workplace health promotion: towards regulatory equity in the Ecuadorian micro-enterprises. J Public Health Policy 2024; 45:152-163. [PMID: 38233505 DOI: 10.1057/s41271-023-00466-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/19/2024]
Abstract
The purpose of workplace public health programmes and regulations is to promote safety and health for the entire working population nationwide. Some countries limit the scope of such programmes to medium or big-sized companies, leaving out small and micro-enterprises, thus discriminating against many workers exposed to risks. This Viewpoint aims to identify inequalities in occupational health generated by the new Regulation for Workplace Health Promotion (WHP) in Ecuador. We showed how the regulation excludes all micro-enterprises and displayed the essential role of micro-enterprises in the business fabric and the Ecuadorian labour market. More than 93% of the registered companies are micro-enterprises and these include more than 25% of the employees in the formal economy. Integrating occupational health into the public health system will require deep analysis to improve protection for the working population.
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Affiliation(s)
| | - Alywin Hacay Chang
- Universidad Espíritu Santo UEES, Samborondón Avenue 5, Samborondón, 092301, Ecuador
- Universidad Politécnica de Valencia, Valencia, Spain
| | | | - José A García-Arroyo
- Universidad Espíritu Santo UEES, Samborondón Avenue 5, Samborondón, 092301, Ecuador.
- Universidad Internacional de la Rioja (UNIR), La Rioja, Spain.
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de Maack V, Tubeuf S, Desterbecq C, Dupras C. Beyond Advocacy: Human Health, the Environment, and Tradeoff Ethics. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:50-52. [PMID: 38394010 DOI: 10.1080/15265161.2024.2303164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
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Kim T. Quality of Life in Metabolic Syndrome Patients Based on the Risk of Obstructive Sleep Apnea. Behav Sci (Basel) 2024; 14:127. [PMID: 38392480 PMCID: PMC10885961 DOI: 10.3390/bs14020127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
Despite the impact of metabolic syndrome (MetS) and obstructive sleep apnea (OSA) on a sizeable proportion of the global population, the difference in the quality of life (QoL) between a group without risk factors for OSA and a group with risk factors for OSA among individuals with MetS is currently unclear. This study aimed to identify the determinants of QoL in patients with MetS with and without OSA risk factors and to analyze differences between these two groups. Data were extracted from the 2020 Korea National Health and Nutrition Examination Survey (KNHANES). The Rao-Scott χ2 test was performed to evaluate differences in baseline characteristics based on OSA risk factors. A t-test was performed to evaluate differences in the baseline QoL, and linear regression analysis was performed to identify the effect on the QoL of the two groups. The factors affecting QoL in the low-risk group included age, education level, and depression. The factors affecting QoL in the high-risk group were physical activity and depression. These results suggest that nursing interventions should be devised according to patients' characteristics to help improve their QoL.
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Affiliation(s)
- Taehui Kim
- Department of Nursing Science, Joongbu University, Chungnam 32713, Republic of Korea
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Macintyre AK, Shipton D, Sarica S, Scobie G, Craig N, McCartney G. Assessing the effects of population-level political, economic and social exposures, interventions and policies on inclusive economy outcomes for health equity in high-income countries: a systematic review of reviews. Syst Rev 2024; 13:58. [PMID: 38331910 PMCID: PMC10851517 DOI: 10.1186/s13643-023-02429-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/11/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND A fairer economy is increasingly recognised as crucial for tackling widening social, economic and health inequalities within society. However, which actions have been evaluated for their impact on inclusive economy outcomes is yet unknown. OBJECTIVE Identify the effects of political, economic and social exposures, interventions and policies on inclusive economy (IE) outcomes in high-income countries, by systematically reviewing the review-level evidence. METHODS We conducted a review of reviews; searching databases (May 2020) EconLit, Web of Science, Sociological Abstracts, ASSIA, International Bibliography of the Social Sciences, Public Health Database, Embase and MEDLINE; and registries PROSPERO, Campbell Collaboration and EPPI Centre (February 2021) and grey literature (August/September 2020). We aimed to identify reviews which examined social, political and/or economic exposures, interventions and policies in relation to two IE outcome domains: (i) equitable distribution of the benefits of the economy and (ii) equitable access to the resources needed to participate in the economy. Reviews had to include primary studies which compared IE outcomes within or between groups. Quality was assessed using a modified version of AMSTAR-2 and data synthesised informed by SWiM principles. RESULTS We identified 19 reviews for inclusion, most of which were low quality, as was the underlying primary evidence. Most reviews (n = 14) had outcomes relating to the benefits of the economy (rather than access to resources) and examined a limited set of interventions, primarily active labour market programmes and social security. There was limited high-quality review evidence to draw upon to identify effects on IE outcomes. Most reviews focused on disadvantaged groups and did not consider equity impacts. CONCLUSIONS Review-level evidence is sparse and focuses on 'corrective' approaches. Future reviews should examine a diverse set of 'upstream' actions intended to be inclusive 'by design' and consider a wider range of outcomes, with particular attention to socioeconomic inequalities.
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Affiliation(s)
- Anna K Macintyre
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK.
| | - Deborah Shipton
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK
| | - Shifa Sarica
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK
| | - Graeme Scobie
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK
| | - Neil Craig
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK
| | - Gerry McCartney
- School of Social & Political Sciences, University of Glasgow, Glasgow, UK
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Vaiciurgis VT, Clancy AK, Charlton KE, Stefoska-Needham A, Beck EJ. Food provision to support improved nutrition and well-being of people experiencing disadvantage - perspectives of service providers. Public Health Nutr 2024; 27:e36. [PMID: 38224164 PMCID: PMC10897568 DOI: 10.1017/s1368980024000132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/13/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVE Diet quality is significantly impacted by social and environmental factors. People experiencing socio-economic disadvantage face inequitable barriers to accessing nutritious foods and health services, resulting in significant health disparities. This study aimed to explore the barriers faced by organisations that provide food support to people experiencing disadvantage as well as to identify potential strategies to enhance this support for improved well-being of clients. DESIGN Semi-structured interviews using an exploratory approach and inductive thematic analysis. SETTING Australia. PARTICIPANTS Individuals from organisations involved in the provision of food support for people experiencing disadvantage aged ≥16 years. RESULTS Two major themes were identified from thirteen interviews. 'Dignity and respect for clients' serves as a guiding principle for food-related services across all organisations, while 'food' was a point of connection and a potential gateway to additional support pathways. Five additional subthemes included 'food as a platform to reduce social isolation, foster connection and promote participation', challenges with 'servicing clients with diverse experiences and needs', 'dependence on staff and volunteers with varying knowledge and skillsets', ensuring 'adequate access to services, resources and facilities' and 'necessity of community collaboration'. CONCLUSIONS This study highlights the unique position of organisations involved in food support to identify client-specific needs and implement broader holistic health support. Future interventions should prioritise dignity, respect and social connection in design. Organisations require an adequately trained, sustainable workforce, with shared or enhanced services, resources and facilities, and greater community coordination with other services to maximise effectiveness.
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Affiliation(s)
- Verena T Vaiciurgis
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, Building 41 Room 226, University of Wollongong, Wollongong, NSW2522, Australia
| | - A K Clancy
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, Building 41 Room 226, University of Wollongong, Wollongong, NSW2522, Australia
| | - K E Charlton
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, Building 41 Room 226, University of Wollongong, Wollongong, NSW2522, Australia
| | - A Stefoska-Needham
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, Building 41 Room 226, University of Wollongong, Wollongong, NSW2522, Australia
| | - E J Beck
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, Building 41 Room 226, University of Wollongong, Wollongong, NSW2522, Australia
- School of Health Sciences, University of New South Wales, Kensington, Australia
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Reuter M, Pischke CR, Rigo M, Diehl K, Spallek J, Richter M, Hövener C, Dragano N. Health inequalities among young workers: the mediating role of working conditions and company characteristics. Int Arch Occup Environ Health 2023; 96:1313-1324. [PMID: 37814035 PMCID: PMC10635983 DOI: 10.1007/s00420-023-02010-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/24/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE Few studies have investigated health inequalities among young workers. The objectives of this study are to assess the extent of health inequalities in a sample of job starters and to explore the contribution of job demands and organisational factors. METHODS We analyze data from the BIBB/BAuA Youth Employment Survey 2012. The cross-sectional survey includes a representative sample of 3214 German employees, apprentices, and trainees aged 15-24 years. Individuals were grouped by their years of schooling into low (< 12 years) and high levels of education (≥ 12 years). Regression analysis estimated the link between education and four health outcomes: self-rated health, number of health events, musculoskeletal symptoms, and mental health problems over the last 12 months. Counterfactual mediation analysis tested for indirect effects of education via working conditions (i.e., physical and psychosocial job demands) and company characteristics (i.e., company size, health prevention measures, financial situation, downsizing). All analyses were adjusted for age, sex, nationality, region, working hours, job tenure, employment relationship, and economic sector. RESULTS Highly educated workers reported better self-rated health (b = 0.24, 95% CI 0.18-0.31) and lower numbers of health events (Rate Ratio (RR) = 0.74, 95% CI 0.67-0.82), musculoskeletal symptoms (RR = 0.73, 95% CI 0.66-0.80) and mental health problems (RR = 0.84, 95% CI 0.76-0.93). Total job demands explained between 21.6% and 87.2% of the educational differences (depending on health outcome). Unfavourable company characteristics were associated with worse health, but showed no or only small mediation effects. CONCLUSIONS Health inequalities are already present at the early working career due to socio-economically stratified working hazards. To enhance prevention measures that aim at reducing inequalities in workplace health, we propose shifting attention towards earlier stages of life.
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Affiliation(s)
- Marvin Reuter
- Junior Professorship for Sociology, esp. Work and Health, Department of Sociology, University of Bamberg, Feldkirchenstraße 21, 96045, Bamberg, Germany.
| | - Claudia R Pischke
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Duesseldorf, 40225, Duesseldorf, Germany
| | - Mariann Rigo
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Duesseldorf, 40225, Duesseldorf, Germany
| | - Katharina Diehl
- Department of Medical Informatics, Biometry and Epidemiology, Chair of Epidemiology and Public Health, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University Cottbus-Senftenberg, 01968, Senftenberg, Germany
- Lausitz Center for Digital Public Health, Brandenburg University of Technology Cottbus-Senftenberg, 01968, Senftenberg, Germany
| | - Matthias Richter
- Department of Sport and Health Science, Technical University of Munich, 80992, Munich, Germany
| | - Claudia Hövener
- Unit of Social Determinants of Health, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Duesseldorf, 40225, Duesseldorf, Germany
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Junghans C, Antonacci G, Williams A, Harris M. Learning from the universal, proactive outreach of the Brazilian Community Health Worker model: impact of a Community Health and Wellbeing Worker initiative on vaccination, cancer screening and NHS health check uptake in a deprived community in the UK. BMC Health Serv Res 2023; 23:1092. [PMID: 37821938 PMCID: PMC10568890 DOI: 10.1186/s12913-023-10084-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Delays in preventative service uptake are increasing in the UK. Universal, comprehensive monthly outreach by Community Health and Wellbeing Workers (CHW), who are integrated at the GP practice and local authority, offer a promising alternative to general public health campaigns as it personalises health promotion and prevention of disease holistically at the household level. We sought to test the ability of this model, which is based on the Brazilian Family Health Strategy, to increase prevention uptake in the UK. METHODS Analysis of primary care patient records for 662 households that were allocated to five CHWWs from July 2021. Primary outcome was the Composite Referral Completion Indicator (CRCI), a measure of how many health promotion activities were received by members of a household relative to the ones that they were eligible for during the period July 2021-April 2022. The CRCI was compared between the intervention group (those who had received at least one visit) and the control group (allocated households that were yet to receive a visit). A secondary outcome was the number of GP visits in the intervention and control groups during the study period and compared to a year prior. RESULTS Intervention and control groups were largely comparable in terms of household occupancy and service eligibilities. A total of 2251 patients in 662 corresponding households were allocated to 5 CHWs and 160 households had received at least one visit during the intervention period. The remaining households were included in the control group. Overall service uptake was 40% higher in the intervention group compared to control group (CRCI: 0.21 ± 0.15 and 0.15 ± 0.19 respectively). Likelihood of immunisation uptake specifically was 47% higher and cancer screening and NHS Health Checks was 82% higher. The average number of GP consultations per household decreased by 7.4% in the intervention group over the first 10 months of the pilot compared to the 10 months preceding its start, compared with a 0.6% decrease in the control group. CONCLUSIONS Despite the short study period these are promising findings in this deprived, traditionally hard to reach community and demonstrates potential for the Brazilian community health worker model to be impactful in the UK. Further analysis is needed to examine if this approach can reduce health inequalities and increase cost effectiveness of health promotion approaches.
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Affiliation(s)
- Cornelia Junghans
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, 3Rd Floor Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
| | - Grazia Antonacci
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, 3Rd Floor Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
- Centre for Health Economics and Policy Innovation (CHEPI), Business School, Imperial College London, London, UK
| | - Alison Williams
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, 3Rd Floor Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
| | - Matthew Harris
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, 3Rd Floor Reynolds Building, St Dunstan's Road, London, W6 8RP, UK.
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Leopold L, van Valkengoed IGM, Engelhardt H. Education and age trajectories of chronic conditions: Are tests of the cumulative advantage and disadvantage hypothesis biased by underreporting? Soc Sci Med 2023; 334:116134. [PMID: 37690158 DOI: 10.1016/j.socscimed.2023.116134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/14/2023] [Accepted: 07/28/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE This study examined the impact of underreporting on tests of the cumulative advantage and disadvantage hypothesis (CAD), which predicts age-related increases in health disparities between individuals with higher and lower education. METHODS Using the English Longitudinal Study of Ageing (ELSA), we identified underreporting by comparing self-reported hypertension and diabetes with biomedically measured hypertension (systolic blood pressure≥140 mm Hg and/or diastolic blood pressure≥90 mm Hg) and diabetes (fasting glucose level≥7 mmol/l and/or HbA1c≥6.5%). In a sample of 11,859 respondents aged 50 to 85 (54% women, 97% White), we assessed the associations between underreporting and the main analytic constructs in tests of the CAD (education, age, sex, and cohort). RESULTS The results showed that self-reported measures underestimated the prevalence of hypertension and diabetes. Underreporting showed weak to moderate associations with the main constructs in tests of the CAD, being more pronounced in individuals with lower education, in older age, in more recent cohorts, and among men. When correcting for underreporting using biomedical measures, the overall prevalence of hypertension and diabetes increased substantially, but education differences in age trajectories of both conditions remained similar. CONCLUSIONS Underreporting affected conclusions about the prevalence of hypertension and diabetes, but it did not affect conclusions about the CAD hypothesis for either condition.
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Affiliation(s)
- Liliya Leopold
- Department of Sociology, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV, Amsterdam, the Netherlands.
| | - Irene G M van Valkengoed
- Department of Public and Occupational Health, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam Public Health Research Institute, the Netherlands
| | - Henriette Engelhardt
- Department of Sociology, Professorship of Demography, University of Bamberg, Germany
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Asada Y, Kroll-Desrosiers A, Chriqui JF, Curran GM, Emmons KM, Haire-Joshu D, Brownson RC. Applying hybrid effectiveness-implementation studies in equity-centered policy implementation science. FRONTIERS IN HEALTH SERVICES 2023; 3:1220629. [PMID: 37771411 PMCID: PMC10524255 DOI: 10.3389/frhs.2023.1220629] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023]
Abstract
Policy implementation science (IS) is complex, dynamic, and fraught with unique study challenges that set it apart from biomedical or clinical research. One important consideration is the ways in which policy interacts with local contexts, such as power and social disadvantage (e.g., based on ability, race, class, sexual identity, geography). The complex nature of policy IS and the need for more intentional integration of equity principles into study approaches calls for creative adaptations to existing implementation science knowledge and guidance. Effectiveness-implementation hybrid studies were developed to enhance translation of clinical research by addressing research questions around the effectiveness of an intervention and its implementation in the same study. The original work on hybrid designs mainly focused on clinical experimental trials; however, over the last decade, researchers have applied it to a wide range of initiatives and contexts, including more widespread application in community-based studies. This perspectives article demonstrates how effectiveness-implementation hybrid studies can be adapted for and applied to equity-centered policy IS research. We draw upon principles of targeted universalism and Equity in Implementation Research frameworks to guide adaptations to hybrid study typologies, and suggest research and engagement activities to enhance equity considerations; for example, in the design and testing of implementing strategies. We also provide examples of equity-centered policy IS studies. As the field of policy IS rapidly evolves, these adapted hybrid type studies are offered to researchers as a starting guide.
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Affiliation(s)
- Yuka Asada
- Community Health Sciences, School of Public Health, University of Illinois Chicago (UIC), Chicago, IL, United States
| | - Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Health Care System, Leeds, MA, United States
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
- Department of Health Policy and Promotion, School of Public Health and Health Sciences, UMass Amherst, Amherst, MA, United States
| | - Jamie F. Chriqui
- Health Policy Research, Institute for Health Research and Policy, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
- Department of Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Geoffrey M. Curran
- Departments of Pharmacy Practice and Psychiatry, Center for Implementation Research, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Debra Haire-Joshu
- Department is Public Health, Brown School at Washington University in St. Louis, St. Louis, MO, United States
| | - Ross C. Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, United States
- Division of Public Health Sciences, Department of Surgery, Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
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Hübelová D, Caha J, Janošíková L, Kozumplíková A. A holistic model of health inequalities for health policy and state administration: a case study in the regions of the Czech Republic. Int J Equity Health 2023; 22:183. [PMID: 37670373 PMCID: PMC10481637 DOI: 10.1186/s12939-023-01996-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/23/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Health inequities exist within and between societies at different hierarchical levels. Despite overall improvements in health status in European Union countries, disparities persist among socially, economically, and societally disadvantaged individuals. This study aims to develop a holistic model of health determinants, examining the complex relationship between various determinants of health inequalities and their association with health condition. METHODS Health inequalities and conditions were assessed at the territorial level of Local Administrative Units (LAU1) in the Czech Republic. A dataset of 57 indicators was created, categorized into seven determinants of health and one health condition category. The necessary data were obtained from publicly available databases. Comparisons were made between 2001-2003 and 2016-2019. Various methods were employed, including composite indicator creation, correlation analysis, the Wilcoxon test, aggregate index calculation, cluster analysis, and data visualization using the LISA method. RESULTS The correlation matrix revealed strong relationships between health inequality categories in both periods. The most significant associations were observed between Economic status and social protection and Education in the first period. However, dependencies weakened in the later period, approaching values of approximately 0.50. The Wilcoxon test confirmed variations in determinant values over time, except for three specific determinants. Data visualization identified persistently adverse or worsening health inequalities in specific LAU1, focusing on categories such as Economic status and social protection, Education, Demographic situation, Environmental status, Individual living status, and Road safety and crime. The health condition indices showed no significant change over time, while the aggregate index of health inequalities improved with widened differences. CONCLUSION Spatial inequalities in health persist in the Czech Republic, influenced by economic, social, demographic, and environmental factors, as well as local healthcare accessibility. Both inner and outer peripheries exhibit poor health outcomes, challenging the assumption that urban areas fare better. The combination of poverty and vulnerabilities exacerbates these inequalities. Despite the low rates of social exclusion and poverty, regional health inequalities persist in the long term. Effectively addressing health inequalities requires interdisciplinary collaboration and evidence-based policy interventions. Efforts should focus on creating supportive social and physical environments, strengthening the healthcare system, and fostering cooperation with non-medical disciplines.
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Affiliation(s)
- Dana Hübelová
- Department of Social Studies, Mendel University in Brno, Zemedelska 1, Brno, 613 00, Czech Republic
| | - Jan Caha
- Department of Regional Development, Mendel University in Brno, Zemedelska 1, Brno, 613 00, Czech Republic
| | - Lenka Janošíková
- Department of Regional Development, Mendel University in Brno, Zemedelska 1, Brno, 613 00, Czech Republic
| | - Alice Kozumplíková
- Department of Social Studies, Mendel University in Brno, Zemedelska 1, Brno, 613 00, Czech Republic.
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Nguyen TM, Lin C, Raichur A, Patterson A, Hall M, Aldrich R, Robinson S. Prioritizing population oral health through public policy in Australia: the Victorian experience. Health Promot Int 2023; 38:daad086. [PMID: 37555701 PMCID: PMC10411047 DOI: 10.1093/heapro/daad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
Dental caries, a non-communicable disease, is one of the most prevalent diseases globally and share common modifiable risk factors with obesity such as excess sugar intake. However, prioritization by governments to improve population oral health has been limited and is typically excluded from the discourse of public health policy development. Therefore, interventions that target dental caries can have other co-benefits including obesity prevention. In Victoria, Australia, local government authorities have a regulatory requirement to develop their Municipal Health and Wellbeing Plans. The aim of this paper is to identify whether prioritization for oral health by local government authorities in Victoria has changed through the subsequent renewal of the Victorian Public Health and Wellbeing Plans 2011-2015 and 2019-2023. Three desktop audits for all publicly available Municipal Health and Wellbeing Plans by local government authorities in Victoria were conducted between 2014 and 2022. Key terms related to oral health was searched within these policy documents and categorized into six indicators: (i) included oral health as a priority, (ii) linked healthy eating and oral health, (iii) supported the Achievement Program, (iv) included the Smiles 4 Miles program, (v) advocated for fluoridated drinking water, and (vi) included other strategies related to oral health. Overall, there was statistically significant reduction in five of the six indicators, with the exception for prioritization of other strategies related to oral health such as targeting excess sugar intake and smoking. A multi-sectoral approach, that includes oral health would be advantageous to address the growing burden of non-communicable diseases.
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Affiliation(s)
- Tan Minh Nguyen
- Oral Health Economics Research Stream, Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Clare Lin
- Dental Health Services Victoria, Carlton, Victoria, Australia
| | - Anil Raichur
- Community Based Health Services Policy & Improvement, Commisioning and System Improvement, Victorian Department of Health, State Government of Victoria, Melbourne, Victoria, Australia
| | - Amy Patterson
- Dental Health Services Victoria, Carlton, Victoria, Australia
| | - Martin Hall
- Dental Health Services Victoria, Carlton, Victoria, Australia
| | | | - Suzanne Robinson
- Oral Health Economics Research Stream, Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
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Kite J, Chan L, MacKay K, Corbett L, Reyes-Marcelino G, Nguyen B, Bellew W, Freeman B. A Model of Social Media Effects in Public Health Communication Campaigns: Systematic Review. J Med Internet Res 2023; 25:e46345. [PMID: 37450325 PMCID: PMC10382952 DOI: 10.2196/46345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/27/2023] [Accepted: 04/19/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Social media platforms are frequently used in health communication campaigns. Common understandings of campaign effects posit a sequential and linear series of steps from exposure to behavior change, commonly known as the hierarchy of effects model (HOE). These concepts need to be reevaluated in the age of social media, which are interactional and communal. OBJECTIVE This review aims to update the traditional HOE for health communication campaigns in the context of social media, including identifying indicators of effectiveness and how these are conceptualized to lead to health-related outcomes. METHODS We conducted a systematic review of studies following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines reporting on the use of social media as part of health communication campaigns, extracting campaign information such as objectives, platforms used, and measures of campaign performance. We used these data, combined with our understanding of the HOE, to develop an updated conceptual model of social media campaign effects. RESULTS We identified 99 eligible studies reporting on 93 campaigns, published between 2012 and 2022. The campaigns were conducted in over 20 countries, but nearly half (n=42) were conducted in the United States. Campaigns targeted a variety of health issues and predominantly used Facebook, Twitter, Instagram, and YouTube. Most campaigns (n=81) set objectives targeting awareness or individual behavior change. Process measures (n=68; eg, reach and impressions) and engagement measures (n=73; eg, likes and retweets) were reported most frequently, while two-fifths (n=42) did not report any outcomes beyond engagement, such as changes in knowledge, behavior, or social norms. Most campaigns (n=55) collected measures that did not allow them to determine if the campaign objective had been met; that is, they were process evaluations only. Based on our review, our updated model suggests that campaign exposure can lead to individual behavior change and improved health outcomes, either through a direct or indirect pathway. Indirect pathways include exposure through social and policy changes. "Engagement" is positioned as critical to success, replacing awareness in the traditional HOE, and all types of engagement are treated as equal and good. No consideration is being given to potential negative engagement, such as the distribution of misinformation. Additionally, the process is no longer linear and sequential, with circular pathways evident, such as engagement not only influencing behavior change but also generating additional exposure to campaign messages. CONCLUSIONS Our review has highlighted a change in conventional understandings of how campaigns can influence health outcomes in the age of social media. The updated model we propose provides social media campaigners with a starting point to develop and tailor campaign messages and allows evaluators to identify critical assumptions to test, including the role and value of "engagement." TRIAL REGISTRATION PROSPERO CRD42021287257; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=287257.
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Affiliation(s)
- James Kite
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Camperdown, Australia
| | - Lilian Chan
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Camperdown, Australia
| | - Kathryn MacKay
- Sydney Health Ethics, Sydney School of Public Health, The University of Sydney, Camperdown, Australia
| | - Lucy Corbett
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Camperdown, Australia
| | - Gillian Reyes-Marcelino
- Sydney School of Public Health, The University of Sydney, Camperdown, Australia
- The Daffodil Centre, The University of Sydney and Cancer Council New South Wales, Camperdown, Australia
| | - Binh Nguyen
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Camperdown, Australia
| | - William Bellew
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Camperdown, Australia
| | - Becky Freeman
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Camperdown, Australia
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Mansukoski L, Lockyer B, Creaser A, Sheringham J, Sheard L, Garnett P, Yang T, Cookson R, Albert A, Islam S, Shore R, Khan A, Twite S, Dawson T, Iqbal H, Skarda I, Villadsen A, Asaria M, West J, Sheldon T, Wright J, Bryant M. Meta-evaluation of a whole systems programme, ActEarly: A study protocol. PLoS One 2023; 18:e0280696. [PMID: 37262082 PMCID: PMC10234514 DOI: 10.1371/journal.pone.0280696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/19/2023] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Living in an area with high levels of child poverty predisposes children to poorer mental and physical health. ActEarly is a 5-year research programme that comprises a large number of interventions (>20) with citizen science and co-production embedded. It aims to improve the health and well-being of children and families living in two areas of the UK with high levels of deprivation; Bradford in West Yorkshire, and the London Borough of Tower Hamlets. This protocol outlines the meta-evaluation (an evaluation of evaluations) of the ActEarly programme from a systems perspective, where individual interventions are viewed as events in the wider policy system across the two geographical areas. It includes investigating the programme's impact on early life health and well-being outcomes, interdisciplinary prevention research collaboration and capacity building, and local and national decision making. METHODS The ActEarly meta-evaluation will follow and adapt the five iterative stages of the 'Evaluation of Programmes in Complex Adaptive Systems' (ENCOMPASS) framework for evaluation of public health programmes in complex adaptive systems. Theory-based and mixed-methods approaches will be used to investigate the fidelity of the ActEarly research programme, and whether, why and how ActEarly contributes to changes in the policy system, and whether alternative explanations can be ruled out. Ripple effects and systems mapping will be used to explore the relationships between interventions and their outcomes, and the degree to which the ActEarly programme encouraged interdisciplinary and prevention research collaboration as intended. A computer simulation model ("LifeSim") will also be used to evaluate the scale of the potential long-term benefits of cross-sectoral action to tackle the financial, educational and health disadvantages faced by children in Bradford and Tower Hamlets. Together, these approaches will be used to evaluate ActEarly's dynamic programme outputs at different system levels and measure the programme's system changes on early life health and well-being. DISCUSSION This meta-evaluation protocol presents our plans for using and adapting the ENCOMPASS framework to evaluate the system-wide impact of the early life health and well-being programme, ActEarly. Due to the collaborative and non-linear nature of the work, we reserve the option to change and query some of our evaluation choices based on the feedback we receive from stakeholders to ensure that our evaluation remains relevant and fit for purpose.
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Affiliation(s)
- Liina Mansukoski
- Department of Health Sciences, University of York, York, United Kingdom
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Bridget Lockyer
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Amy Creaser
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Jessica Sheringham
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Laura Sheard
- Department of Health Sciences, University of York, York, United Kingdom
| | - Philip Garnett
- The School for Business and Society, University of York, York, United Kingdom
| | - Tiffany Yang
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Richard Cookson
- Centre for Health Economics, University of York, York, United Kingdom
| | | | - Shahid Islam
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Robert Shore
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Aiysha Khan
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Simon Twite
- Public Health Division, London Borough of Tower Hamlets, London, United Kingdom
| | - Tania Dawson
- The School for Business and Society, University of York, York, United Kingdom
| | - Halima Iqbal
- School of Nursing and Healthcare Leadership, University of Bradford, Bradford, United Kingdom
| | - Ieva Skarda
- Centre for Health Economics, University of York, York, United Kingdom
| | - Aase Villadsen
- Centre for Longitudinal Studies, University College London, London, United Kingdom
| | - Miqdad Asaria
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Jane West
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Trevor Sheldon
- Centre for Public Health & Policy, Queen Mary University of London, London, United Kingdom
| | - John Wright
- Bradford Institute for Health Research, Bradford, United Kingdom
| | - Maria Bryant
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
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23
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Giesbrecht GF, van de Wouw M, Rioux C, Lai BPY, King S, Tomfohr-Madsen L, Lebel C. Cumulative effects of pre-pandemic vulnerabilities and pandemic-related hardship on psychological distress among pregnant individuals. Gen Hosp Psychiatry 2023; 83:93-100. [PMID: 37156219 PMCID: PMC10154060 DOI: 10.1016/j.genhosppsych.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/21/2023] [Accepted: 04/30/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Our primary objective was to determine whether pre-existing vulnerabilities and resilience factors combined with objective hardship resulted in cumulative (i.e., additive) effects on psychological distress in pregnant individuals during the COVID-19 pandemic. A secondary objective was to determine whether any of the effects of pandemic-related hardship were compounded (i.e., multiplicative) by pre-existing vulnerabilities. METHOD Data are from a prospective pregnancy cohort study, the Pregnancy During the COVID-19 Pandemic study (PdP). This cross-sectional report is based upon the initial survey collected at recruitment between April 5, 2020 and April 30, 2021. Logistic regressions were used to evaluate our objectives. RESULTS Pandemic-related hardship substantially increased the odds of scoring above the clinical cut-off on measures of anxiety and depression symptoms. Pre-existing vulnerabilities had cumulative (i.e., additive) effects on the odds of scoring above the clinical cut-off on measures of anxiety and depression symptoms. There was no evidence of compounding (i.e., multiplicative) effects. Social support had a protective effect on anxiety and depression symptoms, but government financial aid did not. CONCLUSION Pre-pandemic vulnerability and pandemic-related hardship had cumulative effects on psychological distress during the COVID-19 pandemic. Adequate and equitable responses to pandemics and disasters may require more intensive supports for those with multiple vulnerabilities.
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Affiliation(s)
- G F Giesbrecht
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute (ACHRI), Calgary, Alberta, Canada.
| | - M van de Wouw
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute (ACHRI), Calgary, Alberta, Canada
| | - C Rioux
- Department of Psychology, University of Oklahoma, Norman, OK, United States
| | - B P Y Lai
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - S King
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Canada & Douglas Hospital Research Centre, Verdun, Quebec, Canada
| | - L Tomfohr-Madsen
- Department of Counselling Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - C Lebel
- Alberta Children's Hospital Research Institute (ACHRI), Calgary, Alberta, Canada; Department of Radiology, University of Calgary, Calgary, Alberta, Canada
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24
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Perafita X, Saez M. Housing Supply and How It Is Related to Social Inequalities-Air Pollution, Green Spaces, Crime Levels, and Poor Areas-In Catalonia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085578. [PMID: 37107859 PMCID: PMC10138561 DOI: 10.3390/ijerph20085578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023]
Abstract
We carried out a search of over 12,000 houses offered on the rental market in Catalonia and assessed the possibility of families below the poverty threshold being able to rent these homes. In this regard, we wanted to evaluate whether the economic situation of families is able to influence their social environment, surroundings, and safety. We observed how their economic situation can allow families the possibility of developing a life without exposure to health risks, and how economic constraints result in disadvantages in several areas of life. The results show how families at risk of poverty live in less favourable conditions and experience a widening of different gaps, with current prices leading to a possible poverty trap for the most disadvantaged groups. The higher the percentage of the population below the threshold, the lower the possibility of not being able to rent a house compared to areas with a lower prevalence of population below the threshold. This association was observed both when considering the risk linearly and non-linearly. Linearly, the probability of not renting a house was reduced by 8.36% for each 1% increase in the prevalence of population at risk of extreme poverty. In the second, third and fourth percentage quartiles, the probability of not being able to rent a house decreased by 21.13%, 48.61%, and 57.79%, respectively. In addition, the effect was different inside and outside of metropolitan areas, with the former showing a decrease of 19.05% in the probability of renting a house, whereas outside metropolitan areas the probability increased by 5.70%.
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Affiliation(s)
- Xavier Perafita
- Observatori—Organisme Autònom de Salut Pública de la Diputació de Girona (Dipsalut), 17003 Girona, Spain
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, 17003 Girona, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, 17003 Girona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Correspondence:
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25
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Mahdjoub S, Héron M, Gomajee R, Ducarroz S, Melchior M, El-Khoury Lesueur F. Evolution of smoking rates among immigrants in France in the context of comprehensive tobacco control measures, and a decrease in the overall prevalence. BMC Public Health 2023; 23:500. [PMID: 36922775 PMCID: PMC10015536 DOI: 10.1186/s12889-023-15339-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND The evolution of smoking rates according to migrant status has not been examined in France, despite a recent reduction in overall smoking rates. METHODS DePICT is a two waves (2016: n = 4356; 2017: n = 4114) nationwide telephone survey, representative of the French adult population. We compared smoking-related behaviors before and after implementation of tobacco-control measures (2017), according to the geographical region of birth. RESULTS Compared to 2016, individuals originating from Africa or the Middle East had a slightly higher smoking prevalence in 2017 (34.7% vs 31.3%), despite a higher intention to quit or attempt in the preceding year (adjusted OR(ORa) = 2.72[1.90; 3.90]) compared to non-immigrants. They were also less likely to experience an unsuccessful quit attempt (ORa = 1.76[1.18; 2.62]). CONCLUSION Tobacco-control measures could have widened smoking inequalities related to migrant status. The evolution of smoking-related behaviors among immigrants should be examined when studying the long-term effects of such policies.
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Affiliation(s)
- Sarah Mahdjoub
- Sorbonne Université, INSERM UMR_S 1136, Institut Pierre Louis d'Épidémiologie Et de Santé Publique IPLESP, 27 Rue Chaligny, 75012, Paris, France
| | - Mégane Héron
- Sorbonne Université, INSERM UMR_S 1136, Institut Pierre Louis d'Épidémiologie Et de Santé Publique IPLESP, 27 Rue Chaligny, 75012, Paris, France
| | - Ramchandar Gomajee
- Sorbonne Université, INSERM UMR_S 1136, Institut Pierre Louis d'Épidémiologie Et de Santé Publique IPLESP, 27 Rue Chaligny, 75012, Paris, France
| | - Simon Ducarroz
- Sorbonne Université, INSERM UMR_S 1136, Institut Pierre Louis d'Épidémiologie Et de Santé Publique IPLESP, 27 Rue Chaligny, 75012, Paris, France
| | - Maria Melchior
- Sorbonne Université, INSERM UMR_S 1136, Institut Pierre Louis d'Épidémiologie Et de Santé Publique IPLESP, 27 Rue Chaligny, 75012, Paris, France
| | - Fabienne El-Khoury Lesueur
- Sorbonne Université, INSERM UMR_S 1136, Institut Pierre Louis d'Épidémiologie Et de Santé Publique IPLESP, 27 Rue Chaligny, 75012, Paris, France.
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26
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Tsakos G, Watt RG, Guarnizo-Herreño CC. Reflections on oral health inequalities: Theories, pathways and next steps for research priorities. Community Dent Oral Epidemiol 2023; 51:17-27. [PMID: 36744970 DOI: 10.1111/cdoe.12830] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 02/07/2023]
Abstract
Health inequalities, including those in oral health, are a critical problem of social injustice worldwide, while the COVID-19 pandemic has magnified previously existing inequalities and created new ones. This commentary offers a summary of the main frameworks used in the literature of oral health inequalities, reviews the evidence and discusses the potential role of different pathways/mechanisms to explain inequalities. Research in this area needs now to move from documenting oral health inequalities, towards explaining them, understanding the complex mechanisms underlying their production and reproduction and looking at interventions to tackle them. In particular, the importance of interdisciplinary theory-driven research, intersectionality frameworks and the use of the best available analytical methodologies including qualitative research is discussed. Further research on understanding the role of structural determinants on creating and shaping inequalities in oral health is needed, such as a focus on political economy analysis. The co-design of interventions to reduce oral health inequalities is an area of priority and can highlight the critical role of context and inform decision-making. The evaluation of such interventions needs to consider their public health impact and employ the wider range of methodological tools available rather than focus entirely on the traditional approach, based primarily on randomized controlled trials. Civil society engagement and various advocacy strategies are also necessary to make progress in the field.
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Affiliation(s)
- Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
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27
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Wilderink L, Visscher A, Bakker I, Schuit AJ, Seidell JC, Renders CM. Mechanisms and contextual factors related to key elements of a successful integrated community-based approach aimed at reducing socioeconomic health inequalities in the Netherlands: A realist evaluation perspective. PLoS One 2023; 18:e0284903. [PMID: 37195985 DOI: 10.1371/journal.pone.0284903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/11/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Reducing health inequalities is a challenge for policymakers and civil society. A multisectoral and multilevel approach is most promising to reduce those inequalities. Previous research showed what key elements of Zwolle Healthy City, an integrated community-based approach aimed at reducing socioeconomic health inequalities, are. To fully understand approaches that are complex and context dependent, questions as 'how does the intervention work' and 'in what context does it work' are just as important as 'what works'. The current study aimed to identify mechanisms and contextual factors associated with the key elements of Zwolle Healthy City, using a realist evaluation perspective. METHODS Transcripts of semi-structured interviews with a wide range of local professionals were used (n = 29). Following realist evaluation logic in the analysis of this primary data, context-mechanism-outcome configurations were identified and thereafter discussed with experts (n = 5). RESULTS How mechanisms (M) in certain contexts (C) were of influence on the key elements (O) of the Zwolle Healthy City approach are described. For example, how, in the context of the responsible aldermen embracing the approach (C), regular meetings with the aldermen (M) increased support for the approach among involved professionals (O). Or, how, in the context of available financial resources (C), assigning a program manager (M) contributed positively to coordination and communication (O). All 36 context-mechanism-outcome configurations can be found in the repository. CONCLUSION This study showed what mechanisms and contextual factors are associated with the key elements of Zwolle Healthy City. By applying realist evaluation logic in the analysis of primary qualitative data we were able to disentangle the complexity of processes of this whole system approach and show this complexity in a structured manner. Also, by describing the context in which the Zwolle Healthy City approach is implemented, we contribute to the transferability of this approach across different contexts.
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Affiliation(s)
- Lisa Wilderink
- Department of Health Sciences, Faculty of Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Healthy Society, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Annemijn Visscher
- Research Department of the Municipal Public Health Service Organization Flevoland, Lelystad, The Netherlands
| | - Ingrid Bakker
- Department of Healthy Society, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Albertine J Schuit
- School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Jacob C Seidell
- Department of Health Sciences, Faculty of Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Carry M Renders
- Department of Health Sciences, Faculty of Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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28
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Asada Y, Lin S, Siegel L, Kong A. Facilitators and Barriers to Implementation and Sustainability of Nutrition and Physical Activity Interventions in Early Childcare Settings: a Systematic Review. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:64-83. [PMID: 36198924 DOI: 10.1007/s11121-022-01436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 02/01/2023]
Abstract
A stronger understanding of the factors influencing implementation of interventions in community-based early childcare settings is needed. The purpose of this systematic review was to synthesize existing research on facilitators and barriers to implementation and sustainability of nutrition and physical activity interventions in early childcare settings targeting 2-5-year-old children, including considerations for equitable implementation. This review adhered to PRISMA 2020 guidelines. Peer-reviewed literature was searched in PubMed, EMBASE, CINAHL, ERIC, and PsycINFO databases up to September 2020. Primary research studies that examined facilitators and barriers (or related synonyms) to the implementation and sustainability of nutrition and physical activity interventions in early childcare settings were eligible for inclusion. The search yielded 8092 records that were screened by four analysts in Covidence software with a final review of 24 studies. Two independent reviewers conducted study selection, data extraction, and quality appraisal (Mixed Methods Appraisal Tool). A "best fit" framework was applied using the Consolidated Framework for Implementation Research (CFIR) constructs to code barriers and facilitators. The most salient constructs were (1) "Available Resources," which was composed of time, staffing, space, and staff trainings; (2) adaptability; and (3) compatibility, the latter two indicating that easily modifiable interventions facilitated a smoother "fit" and were more likely to be successful, given adequate site-level resources. Only nine (28%) reported the use of a theory, model, or framework to guide evaluation; six studies (24%) included factors related to sustainability; and nine studies (38%) conducted their interventions with low-income or minoritized groups. The findings point to the need for intervention evaluations examining nutrition and physical activity to more consistently consider (a) sustainability factors early on in design and adoption phases; (b) use of theory, model, or framework to guide evaluation; and (c) equity-related frameworks and considerations for how equitable implementation.
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Affiliation(s)
- Yuka Asada
- School of Public Health, Community Health Sciences, University of Illinois Chicago, 1603 W Taylor St, Chicago, IL, 60612, USA.
| | - Shuhao Lin
- College of Applied Health Science, Department of Kinesiology and Nutrition, University of Illinois Chicago, 1919 W Taylor St, Chicago, IL, 60612, USA
| | - Leilah Siegel
- 4-H Youth Development, University of Illinois Extension, 535 S. Randall Road, St., Charles, IL, 60174, USA
| | - Angela Kong
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois Chicago, 833 S. Wood St., Chicago, IL, 60612, USA
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29
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Belmon LS, Van Stralen MM, Harmsen IA, Den Hertog KE, Ruiter RAC, Chinapaw MJM, Busch V. Promoting children's sleep health: Intervention Mapping meets Health in All Policies. Front Public Health 2022; 10:882384. [PMID: 36466483 PMCID: PMC9709501 DOI: 10.3389/fpubh.2022.882384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background To design a comprehensive approach to promote children's sleep health in Amsterdam, the Netherlands, we combined Intervention Mapping (IM) with the Health in All Policies (HiAP) perspective. We aimed to create an approach that fits local infrastructures and policy domains across sectors. Methods First, a needs assessment was conducted, including a systematic review, two concept mapping studies, and one cross-sectional sleep diary study (IM step 1). Subsequently, semi-structured interviews with stakeholders from policy, practice and science provided information on potential assets from all relevant social policy sectors to take into account in the program design (HiAP and IM step 1). Next, program outcomes and objectives were specified (IM step 2), with specific objectives for policy stakeholders (HiAP). This was followed by the program design (IM step 3), where potential program actions were adapted to local policy sectors and stakeholders (HiAP). Lastly, program production (IM step 4) focused on creating a multi-sector program (HiAP). An advisory panel guided the research team by providing tailored advice during all steps throughout the project. Results A blueprint was created for program development to promote children's sleep health, including a logic model of the problem, a logic model of change, an overview of the existing organizational structure of local policy and practice assets, and an overview of policy sectors, and related objectives and opportunities for promoting children's sleep health across these policy sectors. Furthermore, the program production resulted in a policy brief for the local government. Conclusions Combining IM and HiAP proved valuable for designing a blueprint for the development of an integrated multi-sector program to promote children's sleep health. Health promotion professionals focusing on other (health) behaviors can use the blueprint to develop health promotion programs that fit the local public service infrastructures, culture, and incorporate relevant policy sectors outside the public health domain.
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Affiliation(s)
- Laura S. Belmon
- Department of Public and Occupational Health, Amsterdam University Medical Centers (UMC), Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands,Sarphati Amsterdam, Public Health Service (GGD), Amsterdam, Netherlands,Department of Healthy Living, Public Health Service (GGD), Amsterdam, Netherlands,*Correspondence: Laura S. Belmon
| | - Maartje M. Van Stralen
- Department of Health Sciences, Faculty of Science and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Irene A. Harmsen
- Sarphati Amsterdam, Public Health Service (GGD), Amsterdam, Netherlands
| | - Karen E. Den Hertog
- Department of Healthy Living, Public Health Service (GGD), Amsterdam, Netherlands
| | - Robert A. C. Ruiter
- Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
| | - Mai J. M. Chinapaw
- Department of Public and Occupational Health, Amsterdam University Medical Centers (UMC), Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Vincent Busch
- Sarphati Amsterdam, Public Health Service (GGD), Amsterdam, Netherlands,Vincent Busch
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30
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Kondo MC, McIntire RK, Bilal U, Schinasi LH. Reduction in socioeconomic inequalities in self-reported mental health conditions with increasing greenspace exposure. Health Place 2022; 78:102908. [PMID: 36193582 PMCID: PMC11151689 DOI: 10.1016/j.healthplace.2022.102908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Michelle C Kondo
- USDA Forest Service, Northern Research Station, 100 North 20th Street, Suite 205, Philadelphia, PA, 19103, USA.
| | - Russell K McIntire
- Jefferson College of Population Health, Thomas Jefferson University, 901 Walnut St., 10th Floor, Philadelphia, PA, USA.
| | - Usama Bilal
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, PA, USA; Urban Health Collaborative, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
| | - Leah H Schinasi
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Environmental and Occupational Health, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
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31
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McHugh N. Eliciting public values on health inequalities: missing evidence for policy windows? EVIDENCE & POLICY : A JOURNAL OF RESEARCH, DEBATE AND PRACTICE 2022; 18:733-745. [PMID: 36865399 PMCID: PMC7614257 DOI: 10.1332/174426421x16286783870175] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND There is a widening health divide in the UK despite health inequalities being a long-standing subject of policy and research. New types of evidence are needed. KEY POINTS FOR DISCUSSION Knowledge of public values for non-health policies and their associated (non-)health outcomes is currently missing from decision-making processes. Eliciting public values using stated preference techniques can provide insights on what the general public would be willing to give-up for different distributions of (non-)health outcomes and the policies that can achieve them. To understand the role this evidence could have in decision-making processes, Kingdon's multiple streams analysis (MSA) is used as a policy lens to explore how evidence of public values could affect policy processes for ways to tackle health inequalities. CONCLUSIONS AND IMPLICATIONS This paper outlines how evidence of public values could be elicited through the use of stated preference techniques and suggests this could facilitate the creation of policy windows for tackling health inequalities. Additionally, Kingdon's MSA helps make explicit six cross-cutting issues when generating this new form of evidence. This suggests the need to explore reasons for public values and how decision-makers would use such evidence. With an awareness of these issues, evidence on public values has the potential to support upstream policies to tackle health inequalities.
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Affiliation(s)
- Neil McHugh
- Glasgow Caledonian University, United Kingdom
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32
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Sud A, Hodgson K, Bloch G, Upshur R. A Conceptual Framework for Continuing Medical Education and Population Health. TEACHING AND LEARNING IN MEDICINE 2022; 34:541-555. [PMID: 34459333 DOI: 10.1080/10401334.2021.1950540] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
ISSUE Health systems have been increasingly called upon to address population health concerns and continuing medical education (CME) is an important means through which clinical practices can be improved. This manuscript elaborates on existing conceptual frameworks in order to support CME practitioners, funders, and policy makers to develop, implement, and evaluate CME vis-a-vis population health concerns. EVIDENCE Existing CME conceptual models and conceptions of CME effectiveness require elaboration in order to meet goals of population health improvement. Frameworks for the design, implementation and evaluation of CME consistently reference population health, but do not adequately conceptualize it beyond the aggregation of individual patient health. As a pertinent example, opioid prescribing CME programs use the opioid epidemic to justify their programs, but evaluation approaches are inadequate for demonstrating population health impacts. CME programs that are built to have population health outcomes using frameworks intended primarily for physician performance and patient health outcomes are thus not able to recognize either non-linear associations or negative unintended consequences. IMPLICATIONS This proposed conceptual framework draws on the fields of clinical population medicine, the social determinants of health, health equity, and philosophies of population health to build conceptual bridges between the CME outcome levels of physician performance and patient health to population health. The authors use their experience developing, delivering, and evaluating opioid prescribing- and poverty-focused CME programs to argue that population health-focused CME must be re-oriented in at least five ways. These include: 1) scaling effective CME programs while evaluating at population health levels; 2) (re)interpreting evidence for program content from a population perspective; 3) incorporating social determinants of health into clinically-oriented CME activities; 4) explicitly building fluency in population health concepts and practices among health care providers and CME planners; and 5) attending to social inequity in every aspect of CME programs.
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Affiliation(s)
- Abhimanyu Sud
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kate Hodgson
- Continuing Professional Development, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary Bloch
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ross Upshur
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Sevilla JP. The value of vaccines. Curr Opin Immunol 2022; 78:102243. [PMID: 36156412 DOI: 10.1016/j.coi.2022.102243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/24/2022] [Accepted: 08/11/2022] [Indexed: 01/28/2023]
Abstract
Optimizing vaccine spending depends on recognizing the full value of vaccination (VoV). Existing taxonomies of such value are not comprehensive because they are not guided by general theories. I rely on two such theories: subjective-value theory claims that what has value is determined by what people actually or ideally want in life. A welfarist theory of government states that a fundamental objective of government is to promote social value (or social welfare). These jointly imply that any aspect of life that individuals actually or ideally value and that could be negatively affected by vaccine-preventable diseases (and therefore positively affected by preventive vaccines) is an element of VoV. I build a more comprehensive-value taxonomy than currently exists based on this implication.
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Affiliation(s)
- J P Sevilla
- Data for Decisions, LLC, Harvard T. H. Chan School of Public Health, USA.
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Wilderink L, Bakker I, Schuit AJ, Seidell JC, Pop IA, Renders CM. A Theoretical Perspective on Why Socioeconomic Health Inequalities Are Persistent: Building the Case for an Effective Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8384. [PMID: 35886234 PMCID: PMC9317352 DOI: 10.3390/ijerph19148384] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 12/10/2022]
Abstract
Despite policy intentions and many interventions aimed at reducing socioeconomic health inequalities in recent decades in the Netherlands and other affluent countries, these inequalities have not been reduced. Based on a narrative literature review, this paper aims to increase insight into why socioeconomic health inequalities are so persistent and build a way forward for improved approaches from a theoretical perspective. Firstly, we present relevant theories focusing on individual determinants of health-related behaviors. Thereafter, we present theories that take into account determinants of the individual level and the environmental level. Lastly, we show the complexity of the system of individual determinants, environmental determinants and behavior change for low socioeconomic position (SEP) groups and describe the next steps in developing and evaluating future effective approaches. These steps include systems thinking, a complex whole-system approach and participation of all stakeholders in system change.
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Affiliation(s)
- Lisa Wilderink
- Department of Health Sciences, Faculty of Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (J.C.S.); (C.M.R.)
- Department of Healthy Society, Windesheim University of Applied Sciences, 8017 CA Zwolle, The Netherlands;
| | - Ingrid Bakker
- Department of Healthy Society, Windesheim University of Applied Sciences, 8017 CA Zwolle, The Netherlands;
| | - Albertine J. Schuit
- School of Social and Behavioral Sciences, Tilburg University, 5037 AB Tilburg, The Netherlands; (A.J.S.); (I.A.P.)
| | - Jacob C. Seidell
- Department of Health Sciences, Faculty of Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (J.C.S.); (C.M.R.)
| | - Ioana A. Pop
- School of Social and Behavioral Sciences, Tilburg University, 5037 AB Tilburg, The Netherlands; (A.J.S.); (I.A.P.)
| | - Carry M. Renders
- Department of Health Sciences, Faculty of Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (J.C.S.); (C.M.R.)
- Department of Healthy Society, Windesheim University of Applied Sciences, 8017 CA Zwolle, The Netherlands;
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Greenwald HP, Tao E, Tilley G. Farmers' Market Incentives for Low-Income Families: Who Uses, How Much, and Why. Am J Prev Med 2022; 62:864-871. [PMID: 35597565 DOI: 10.1016/j.amepre.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/22/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Focusing on participation and utilization, this research helps to assess the potential impact and contributions of farmers' market incentive programs, often seen as means for improving nutrition and preventing disease among low-income families. METHODS Evaluating the largest farmers' market incentive program in the U.S. (California Market Match), this study used (1) 3 administrative databases (n=1,469, 6,799, and 30,506), (2) a participant survey (n=2,723), and (3) longitudinal interviews (n=163) with active and former participants. Quantitative data were analyzed with contingency tables and multiple regression. Qualitative data were coded into analytically significant themes. Data were collected in 2015-2018 and analyzed in 2018-2021. RESULTS Participation was typically low and varied across localities (3.7%-19.8% of eligible families in a sample of ZIP codes). According to administrative records, market visits by participants in 2 California regions averaged 2.18 and 3.12 per season. However, 77.1% of participants in the shopper survey indicated that they were repeat customers, and 51.0% indicated that they were regular utilizers. Deterrents to utilization included perceptions of inconvenience and high prices but not availability of produce in the community or travel time to markets. Utilization was most frequent among Asian shoppers and residents of Southern California outside Los Angeles County. CONCLUSIONS Farmers' market incentive programs such as Market Match appear likely to benefit population health through a core of committed shoppers. Improvement in participation and utilization may be attained through a better understanding of the communities that the markets are intended to serve.
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Affiliation(s)
- Howard P Greenwald
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California.
| | - Ernie Tao
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Gabrielle Tilley
- The Los Angeles Trust for Children's Health, Los Angeles, California
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Brownson RC, Shelton RC, Geng EH, Glasgow RE. Revisiting concepts of evidence in implementation science. Implement Sci 2022; 17:26. [PMID: 35413917 PMCID: PMC9004065 DOI: 10.1186/s13012-022-01201-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 04/04/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Evidence, in multiple forms, is a foundation of implementation science. For public health and clinical practice, evidence includes the following: type 1 evidence on etiology and burden; type 2 evidence on effectiveness of interventions; and type 3: evidence on dissemination and implementation (D&I) within context. To support a vision for development and use of evidence in D&I science that is more comprehensive and equitable (particularly for type 3 evidence), this article aims to clarify concepts of evidence, summarize ongoing debates about evidence, and provide a set of recommendations and tools/resources for addressing the "how-to" in filling evidence gaps most critical to advancing implementation science. MAIN TEXT Because current conceptualizations of evidence have been relatively narrow and insufficiently characterized in our opinion, we identify and discuss challenges and debates about the uses, usefulness, and gaps in evidence for implementation science. A set of questions is proposed to assist in determining when evidence is sufficient for dissemination and implementation. Intersecting gaps include the need to (1) reconsider how the evidence base is determined, (2) improve understanding of contextual effects on implementation, (3) sharpen the focus on health equity in how we approach and build the evidence-base, (4) conduct more policy implementation research and evaluation, and (5) learn from audience and stakeholder perspectives. We offer 15 recommendations to assist in filling these gaps and describe a set of tools for enhancing the evidence most needed in implementation science. CONCLUSIONS To address our recommendations, we see capacity as a necessary ingredient to shift the field's approach to evidence. Capacity includes the "push" for implementation science where researchers are trained to develop and evaluate evidence which should be useful and feasible for implementers and reflect community or stakeholder priorities. Equally important, there has been inadequate training and too little emphasis on the "pull" for implementation science (e.g., training implementers, practice-based research). We suggest that funders and reviewers of research should adopt and support a more robust definition of evidence. By critically examining the evolving nature of evidence, implementation science can better fulfill its vision of facilitating widespread and equitable adoption, delivery, and sustainment of scientific advances.
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Affiliation(s)
- Ross C. Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO 63130 USA
- Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63130 USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY 10032 USA
| | - Elvin H. Geng
- Division of Infectious Diseases, Department of Medicine and Center for Dissemination and Implementation in the Institute for Public Health, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110 USA
| | - Russell E. Glasgow
- Department of Family Medicine and Adult & Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045 USA
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Bojcic R, Todoric M, Puljak L. Adopting AMSTAR 2 critical appraisal tool for systematic reviews: speed of the tool uptake and barriers for its adoption. BMC Med Res Methodol 2022; 22:104. [PMID: 35399051 PMCID: PMC8996416 DOI: 10.1186/s12874-022-01592-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In 2007, AMSTAR (A MeaSurement Tool to Assess systematic Reviews), a critical appraisal tool for systematic reviews (SRs), was published, and it has since become one of the most widely used instruments for SR appraisal. In September 2017, AMSTAR 2 was published as an updated version of the tool. This mixed-methods study aimed to analyze the extent of the AMSTAR 2 uptake and explore potential barriers to its uptake.
Methods
We analyzed the frequency of AMSTAR or AMSTAR 2 use in articles published in 2018, 2019 and 2020. We surveyed authors who have used AMSTAR but not AMSTAR 2 in the analyzed time frame to identify their reasons and barriers. The inclusion criterion for those authors was that the month of manuscript submission was after September 2017, i.e. after AMSTAR 2 was published.
Results
We included 871 studies. The majority (N = 451; 52%) used AMSTAR 2, while 44% (N = 382) used AMSTAR, 4% (N = 31) used R-AMSTAR and others used a combination of tools. In 2018, 81% of the analyzed studies used AMSTAR, while 16% used AMSTAR 2. In 2019, 52% used AMSTAR, while 44% used AMSTAR 2. Among articles published in 2020, 28% used AMSTAR, while AMSTAR 2 was used by 69%.
An author survey indicated that the authors did not use AMSTAR 2 mostly because they were not aware of it, their protocol was already established, or data collection completed at the time when the new tool was published. Barriers towards AMSTAR 2 use were lack of quantitative assessment, insufficient awareness, length, difficulties with a specific item.
Conclusion
In articles published in 2018-2020, that were submitted to a journal after AMSTAR 2 tool was published, almost half of the authors (44%) still used AMSTAR, the old version of the tool. However, the use of AMSTAR has been declining in each subsequent year. Our survey indicated that editors and peer-reviewers did not ask the authors to use the new version of the tool. Few barriers towards using AMSTAR 2 were identified, and thus it is anticipated that the use of the old version of AMSTAR will continue to decline.
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Ayomide Oluwaseyi O, Chanimbe T, Shirley Anaduaka U. Effect of public health expenditure on health outcomes in Nigeria and Ghana. HEALTH POLICY OPEN 2022. [DOI: 10.1016/j.hpopen.2022.100072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Løvhaug AL, Granheim SI, Djojosoeparto SK, Harrington JM, Kamphuis CBM, Poelman MP, Roos G, Sawyer A, Stronks K, Torheim LE, Twohig C, Vandevijvere S, van Lenthe FJ, Terragni L. The potential of food environment policies to reduce socioeconomic inequalities in diets and to improve healthy diets among lower socioeconomic groups: an umbrella review. BMC Public Health 2022; 22:433. [PMID: 35246074 PMCID: PMC8895543 DOI: 10.1186/s12889-022-12827-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 02/14/2022] [Indexed: 12/19/2022] Open
Abstract
Socioeconomic inequalities in diets need to be tackled to improve population diets and prevent obesity and diet-related non-communicable diseases. The potential of food environment policies to reduce such inequalities has to date however not been appraised. The objective of this umbrella review was to assess the impact of food environment policies on socioeconomic inequalities in diets and to identify knowledge gaps in the existing literature, using the Healthy Food Environment Policy Index as a conceptual framework. The policies considered in the umbrella review are within six domains: 1) food composition 2) food labelling 3) food promotion 4) food provision 5) food retail 6) food pricing. A systematic search for systematic literature reviews on the effect of food environment policies on dietary-related outcomes across socioeconomic groups and published in English between 2004 and 2019 was conducted. Sixteen systematic literature reviews encompassing 159 primary studies were included, covering food composition (n = 2), food labelling (n = 3), food provision (n = 2), food prices (n = 13) and food in retail (n = 4). Quality assessment using the “Assessing the Methodological Quality of Systematic Reviews” quality rating scale showed that review quality was mainly low or critically low. Results suggest that food taxation may reduce socioeconomic inequalities in diets. For all other policy areas, the evidence base was poor. Current research largely fails to provide good quality evidence on impacts of food environment policies on socioeconomic inequalities in diets. Research to fill this knowledge gap is urgently needed.
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Affiliation(s)
- Anne Lene Løvhaug
- Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, Oslo, Norway.
| | - Sabrina Ionata Granheim
- Department of Public Health and Sport Sciences, Inland Norway University of Applied Sciences, Hamar, Norway
| | - Sanne K Djojosoeparto
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, Netherlands
| | - Janas M Harrington
- HRB Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, Netherlands
| | - Maartje P Poelman
- Chair group Consumption and Healthy Lifestyles, Wageningen University and Research, Wageningen, Netherlands
| | - Gun Roos
- Consumption Research Norway (SIFO), OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Alexia Sawyer
- Department of Public and Occupational Health, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, Netherlands
| | - Liv Elin Torheim
- Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Cliona Twohig
- HRB Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
| | | | - Frank J van Lenthe
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, Netherlands.,Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Laura Terragni
- Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, Oslo, Norway
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Walker SC, White J, Rodriguez V, Turk E, Gubner N, Ngo S, Bekemeier B. Cocreating evidence-informed health equity policy with community. Health Serv Res 2022; 57 Suppl 1:137-148. [PMID: 35239188 PMCID: PMC9108222 DOI: 10.1111/1475-6773.13940] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To explore the feasibility of a rapid, community‐engaged strategy to prioritize health equity policy options as informed by research evidence, community‐voiced needs, and public health priorities. Data Sources Data came from residents in a midsized, demographically, and geographically diverse county over a period of 8 months in 2020 and an evidence review of the health equity policy literature during the same time period. Study Design A descriptive case study is used to explore the feasibility and potential value of a community codesigned approach to establish community priorities for health equity policy. Data Collection/Extraction Methods Evidence synthesis of health equity policy was conducted parallel to 15 community listening sessions across the county to elicit information on health needs. We used scoping review methods to obtain literature from academic databases and scholarly public health and policy organizations. This information was cross walked with themes from the listening sessions to identify 10 priority policy areas, which were taken back to the community for 15 participatory discussion and ranking sessions. Principal Findings The process appeared to authentically engage the input of 200 community members representative of minoritized groups while identifying 99 evidence‐informed policy levers to promote health equity. Discussion and ranking activities were successful in facilitating community discussion and policy decision making. Remote platforms may have limited the engagement of some residents while promoting the participation of others. Conducting information integration within the research team prior to community policy ranking sessions limited the community ownership over how policies were interpreted and communicated. Conclusions A combination of information integration and community ranking activities can be used to achieve community‐engaged policy prioritization of options in a fairly rapid period of time. While this process provides an example of authentic community ownership of policy prioritization, the compressed timeline limited the community's engagement in the information integration phase.
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Affiliation(s)
- Sarah Cusworth Walker
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Johnna White
- Tacoma-Pierce County Health Department, Tacoma, Washington, USA
| | | | - Emily Turk
- Department of Psychiatry and Behavioral Sciences, University of Washington Seattle Campus, Seattle, Washington, USA
| | - Noah Gubner
- Department of Psychiatry and Behavioral Sciences, University of Washington Seattle Campus, Seattle, Washington, USA
| | - Sally Ngo
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Betty Bekemeier
- School of Public Health, University of Washington, Seattle, Washington, USA
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Lutein and Zeaxanthin Intake during Pregnancy and Visual Function in Offspring at 11–12 Years of Age. Nutrients 2022; 14:nu14040872. [PMID: 35215522 PMCID: PMC8876686 DOI: 10.3390/nu14040872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/03/2022] [Accepted: 02/16/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Background: Lutein and zeaxanthin (L&Z) are essential dietary nutrients that are a crucial component of the human macula, contributing to visual functioning. They easily cross the placental barrier, so that retinal deposition commences during foetal development. This study aims to assess associations between maternal L&Z intake during pregnancy and offspring visual function at 11–12 years. (2) Methods: Using the Spanish INfancia y Medio Ambiente project (INMA) Sabadell birth cohort, 431 mother–child pairs were analysed. L&Z data were obtained from food frequency questionnaires (FFQ) at week 12 and 32 of pregnancy, alongside other nutritional and sociodemographic covariates. Contrast vision (CS) and visual acuity (VA) were assessed using the automated Freiburg Acuity and Contrast Testing (FRACT) battery. Low CS and VA were defined as being below the 20th cohort centile. Associations were explored using multiple logistic regression. (3) Results: After controlling for potential confounders, L&Z intake during the 1st and 3rd trimester did not reveal any statistically significant association with either CS or VA in offspring at age 11/12 years. (4) Conclusions: No evidence of a long-term association between L&Z intake during pregnancy and visual function in offspring was found. Further larger long-term studies including blood L&Z levels are required to confirm this result.
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Woodward EN, Willging C, Landes SJ, Hausmann LRM, Drummond KL, Ounpraseuth S, Ball IA, Kirchner JE. Determining feasibility of incorporating consumer engagement into implementation activities: study protocol of a hybrid effectiveness-implementation type II pilot. BMJ Open 2022; 12:e050107. [PMID: 35042705 PMCID: PMC8768923 DOI: 10.1136/bmjopen-2021-050107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Implementation researchers could draw from participatory research to engage patients (consumers of healthcare) in implementation processes and possibly reduce healthcare disparities. There is a little consumer involvement in healthcare implementation, partially because no formal guidance exists. We will create and pilot a toolkit of methods to engage consumers from the US' Veterans Health Administration (VHA) in selecting and tailoring implementation strategies. This toolkit, Consumer Voice, will provide guidance on what, when, where, how and why an implementer might engage consumers in implementing treatments. We will pilot the toolkit by implementing Safety Planning Intervention for suicide prevention with rural veterans, a population with suicide disparities. Safety Planning Intervention is effective for reducing suicidal behaviours. METHODS AND ANALYSIS In Aim 1, we will use participatory approaches and user-centred design to develop Consumer Voice and its methods. In Aim 2, we will pilot Consumer Voice by implementing the Safety Planning Intervention in two clinics serving rural VHA patients. One site will receive a current implementation strategy (Implementation Facilitation) only; the second will receive Implementation Facilitation plus Consumer Voice. We will use mixed methods to assess feasibility and acceptability of Consumer Voice. We will compare sites on preliminary implementation (reach, adoption, fidelity) and clinical outcomes (depression severity, suicidal ideation, suicidal behaviour). In Aim 3, we will evaluate Aim 2 outcomes at 20 months to assess sustained impact. We will gather qualitative data on sustainability of the Safety Planning Intervention. ETHICS AND DISSEMINATION These studies are overseen by the Institutional Review Board at the Central Arkansas Veterans Healthcare System. We plan to use traditional academic modalities of dissemination (eg, conferences, publications). We plan to disseminate findings through meetings with other trainers in implementation practice so they may adopt Consumer Voice. We plan to share results with local community boards.
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Affiliation(s)
- Eva N Woodward
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Cathleen Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
| | - Sara J Landes
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
| | - Leslie R M Hausmann
- Department of Medicine, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Karen L Drummond
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Songthip Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Irenia A Ball
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
| | - JoAnn E Kirchner
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
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Welch V, Dewidar O, Tanjong Ghogomu E, Abdisalam S, Al Ameer A, Barbeau VI, Brand K, Kebedom K, Benkhalti M, Kristjansson E, Madani MT, Antequera Martín AM, Mathew CM, McGowan J, McLeod W, Park HA, Petkovic J, Riddle A, Tugwell P, Petticrew M, Trawin J, Wells GA. How effects on health equity are assessed in systematic reviews of interventions. Cochrane Database Syst Rev 2022; 1:MR000028. [PMID: 35040487 PMCID: PMC8764740 DOI: 10.1002/14651858.mr000028.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Enhancing health equity is endorsed in the Sustainable Development Goals. The failure of systematic reviews to consider potential differences in effects across equity factors is cited by decision-makers as a limitation to their ability to inform policy and program decisions. OBJECTIVES: To explore what methods systematic reviewers use to consider health equity in systematic reviews of effectiveness. SEARCH METHODS We searched the following databases up to 26 February 2021: MEDLINE, PsycINFO, the Cochrane Methodology Register, CINAHL, Education Resources Information Center, Education Abstracts, Criminal Justice Abstracts, Hein Index to Foreign Legal Periodicals, PAIS International, Social Services Abstracts, Sociological Abstracts, Digital Dissertations and the Health Technology Assessment Database. We searched SCOPUS to identify articles that cited any of the included studies on 10 June 10 2021. We contacted authors and searched the reference lists of included studies to identify additional potentially relevant studies. SELECTION CRITERIA We included empirical studies of cohorts of systematic reviews that assessed methods for measuring effects on health inequalities. We define health inequalities as unfair and avoidable differences across socially stratifying factors that limit opportunities for health. We operationalised this by assessing studies which evaluated differences in health across any component of the PROGRESS-Plus acronym, which stands for Place of residence, Race/ethnicity/culture/language, Occupation, Gender or sex, Religion, Education, Socioeconomic status, Social capital. "Plus" stands for other factors associated with discrimination, exclusion, marginalisation or vulnerability such as personal characteristics (e.g. age, disability), relationships that limit opportunities for health (e.g. children in a household with parents who smoke) or environmental situations which provide limited control of opportunities for health (e.g. school food environment). DATA COLLECTION AND ANALYSIS Two review authors independently extracted data using a pre-tested form. Risk of bias was appraised for included studies according to the potential for bias in selection and detection of systematic reviews. MAIN RESULTS: In total, 48,814 studies were identified and the titles and abstracts were screened in duplicate. In this updated review, we identified an additional 124 methodological studies published in the 10 years since the first version of this review, which included 34 studies. Thus, 158 methodological studies met our criteria for inclusion. The methods used by these studies focused on evidence relevant to populations experiencing health inequity (108 out of 158 studies), assess subgroup analysis across PROGRESS-Plus (26 out of 158 studies), assess analysis of a gradient in effect across PROGRESS-Plus (2 out of 158 studies) or use a combination of subgroup analysis and focused approaches (20 out of 158 studies). The most common PROGRESS-Plus factors assessed were age (43 studies), socioeconomic status in 35 studies, low- and middle-income countries in 24 studies, gender or sex in 22 studies, race or ethnicity in 17 studies, and four studies assessed multiple factors across which health inequity may exist. Only 16 studies provided a definition of health inequity. Five methodological approaches to consider health equity in systematic reviews of effectiveness were identified: 1) descriptive assessment of reporting and analysis in systematic reviews (140 of 158 studies used a type of descriptive method); 2) descriptive assessment of reporting and analysis in original trials (50 studies); 3) analytic approaches which assessed differential effects across one or more PROGRESS-Plus factors (16 studies); 4) applicability assessment (25 studies) and 5) stakeholder engagement (28 studies), which is a new finding in this update and examines the appraisal of whether relevant stakeholders with lived experience of health inequity were included in the design of systematic reviews or design and delivery of interventions. Reporting for both approaches (analytic and applicability) lacked transparency and was insufficiently detailed to enable the assessment of credibility. AUTHORS' CONCLUSIONS There is a need for improvement in conceptual clarity about the definition of health equity, describing sufficient detail about analytic approaches (including subgroup analyses) and transparent reporting of judgments required for applicability assessments in order to consider health equity in systematic reviews of effectiveness.
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Affiliation(s)
- Vivian Welch
- Methods Centre, Bruyère Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Omar Dewidar
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | | | | | | | - Kevin Brand
- Telfer School of Management, University of Ottawa, Ottawa, Canada
| | | | | | | | | | | | | | - Jessie McGowan
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | | | | | - Alison Riddle
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Marmora, Canada
| | - Peter Tugwell
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Mark Petticrew
- Department of Social & Environmental Health Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
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Abstract
In a context where epidemiologic research has been heavily influenced by a biomedical and individualistic approach, the naming of “social epidemiology” allowed explicit emphasis on the social production of disease as a powerful explanatory paradigm and as critically important for interventions to improve population health. This review briefly highlights key substantive areas of focus in social epidemiology over the past 30 years, reflects on major advances and insights, and identifies challenges and possible future directions. Future opportunities for social epidemiology include grounding research in theoretically based and systemic conceptual models of the fundamental social drivers of health; implementing a scientifically rigorous yet realistic approach to drawing conclusions about social causes; using complementary methods to generate valid explanations and identify effective actions; leveraging the power of harmonization, replication, and big data; extending interdisciplinarity and diversity; advancing emerging critical approaches to understanding the health impacts of systemic racism and its policy implications; going global; and embracing a broad approach to generating socially useful research. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Ana V. Diez Roux
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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45
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Are healthful behavior change policies ever unethical? J Public Health Policy 2022; 43:685-695. [PMID: 36289325 PMCID: PMC9750897 DOI: 10.1057/s41271-022-00372-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2022] [Indexed: 01/15/2023]
Abstract
Public health experts often assume that any policy promoting healthful behavior change is inherently and self-evidently ethical. This assumption is incorrect. This Viewpoint describes why evaluating the ethics of a policy to promote healthful behavior change should require (1) valuing consequences for wellbeing proportionately to consequences for health, (2) valuing changes to the distributional equity of health and wellbeing together with their aggregate improvement, and (3) anticipating and surveilling for unintended consequences sufficiently important to offset benefits. I illustrate these three requirements through a hypothetical salt restriction policy, which is unethical if it evokes strong preferences that detract from wellbeing, disproportionately confers health benefits to those who are already healthy, or elicits unintended consequences that offset health benefits. I discuss why analogies of salt restriction mandates are inappropriate. In summary, public health decision-makers should employ more structured, explicit and comprehensive criteria when considering the ethical consequences of policies.
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Erkoyun E, Mackenbach JP. Occupational class and educational level inequalities in major cardiovascular risk factors in Turkey: 2008-2016. J Public Health (Oxf) 2021; 43:e584-e592. [PMID: 32617567 DOI: 10.1093/pubmed/fdaa073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We aimed to investigate the magnitude of occupational class (OC) and educational level (EL) inequalities in cardiovascular risk factors in Turkey from 2008 to 2016 and compare these inequalities with neighbouring European countries. METHODS We used the Turkey Health Survey among a representative sample of the Turkish population. We estimated relative index of inequality (RII) for four cardiovascular risk factors (obesity/overweight, hypertension, diabetes, smoking) by OC/EL with an interaction term for survey year and compared selected results with neighbouring countries. RESULTS Men with lower OC and EL smoked more (e.g. RII for EL = 1.40 [1.26-1.55]); however, the remaining risk factors were mostly lower in these groups. Women in lower socio-economic groups smoked less (e.g. RII for EL = 0.36 [0.29-0.44]), however, had higher prevalence of the remaining risk factors. Significant interactions with survey year were only found in a few cases. The pattern of inequalities in Turkey is largely similar to neighbouring countries. CONCLUSIONS Inequalities in cardiovascular risk factors are less systematic in Turkey than in most high-income countries, but ongoing trends suggest that this may change in the future.
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Affiliation(s)
- Erdem Erkoyun
- Department of Public Health, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - J P Mackenbach
- Department of Public Health, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
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47
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McGowan VJ, Buckner S, Mead R, McGill E, Ronzi S, Beyer F, Bambra C. Examining the effectiveness of place-based interventions to improve public health and reduce health inequalities: an umbrella review. BMC Public Health 2021; 21:1888. [PMID: 34666742 PMCID: PMC8524206 DOI: 10.1186/s12889-021-11852-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/21/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Locally delivered, place-based public health interventions are receiving increasing attention as a way of improving health and reducing inequalities. However, there is limited evidence on their effectiveness. This umbrella review synthesises systematic review evidence of the health and health inequalities impacts of locally delivered place-based interventions across three elements of place and health: the physical, social, and economic environments. METHODS Systematic review methodology was used to identify recent published systematic reviews of the effectiveness of place-based interventions on health and health inequalities (PROGRESS+) in high-income countries. Nine databases were searched from 1st January 2008 to 1st March 2020. The quality of the included articles was determined using the Revised Assessment of Multiple Systematic Reviews tool (R-AMSTAR). RESULTS Thirteen systematic reviews were identified - reporting 51 unique primary studies. Fifty of these studies reported on interventions that changed the physical environment and one reported on changes to the economic environment. Only one primary study reported cost-effectiveness data. No reviews were identified that assessed the impact of social interventions. Given heterogeneity and quality issues, we found tentative evidence that the provision of housing/home modifications, improving the public realm, parks and playgrounds, supermarkets, transport, cycle lanes, walking routes, and outdoor gyms - can all have positive impacts on health outcomes - particularly physical activity. However, as no studies reported an assessment of variation in PROGRESS+ factors, the effect of these interventions on health inequalities remains unclear. CONCLUSIONS Place-based interventions can be effective at improving physical health, health behaviours and social determinants of health outcomes. High agentic interventions indicate greater improvements for those living in greater proximity to the intervention, which may suggest that in order for interventions to reduce inequalities, they should be implemented at a scale commensurate with the level of disadvantage. Future research needs to ensure equity data is collected, as this is severely lacking and impeding progress on identifying interventions that are effective in reducing health inequalities. TRIAL REGISTRATION PROSPERO CRD42019158309.
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Affiliation(s)
- V J McGowan
- Population Health Sciences Institute, Newcastle University, 5th Floor, Ridley 1, Newcastle Upon Tyne, NE1 7RU UK
- Fuse – The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - S. Buckner
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - R. Mead
- Department of Health Research, Lancaster University, Lancaster, UK
- LiLaC – Liverpool and Lancaster Universities Collaboration for Public Health Research, Lancaster, UK
| | - E. McGill
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - S. Ronzi
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - F. Beyer
- Population Health Sciences Institute, Newcastle University, 5th Floor, Ridley 1, Newcastle Upon Tyne, NE1 7RU UK
- Fuse – The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - C. Bambra
- Population Health Sciences Institute, Newcastle University, 5th Floor, Ridley 1, Newcastle Upon Tyne, NE1 7RU UK
- Fuse – The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
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48
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Dunn M, Rushton AB, Mistry J, Soundy A, Heneghan NR. Which biopsychosocial factors are associated with the development of chronic musculoskeletal pain? Protocol for an umbrella review of systematic reviews. BMJ Open 2021; 11:e053941. [PMID: 34635532 PMCID: PMC8506872 DOI: 10.1136/bmjopen-2021-053941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Recent systematic reviews have identified many biopsychosocial factors associated with the development of chronic musculoskeletal pain (CMP). Despite often being specific to a particular musculoskeletal condition, findings are similar across systematic reviews. Research is needed to aggregate these findings to identify consistent factors across musculoskeletal disorders that are associated with the development of CMP. The objective of this study is to provide a meta-level synthesis of all biopsychosocial factors associated with the development of CMP. METHODS AND ANALYSIS An umbrella review and meta-level narrative synthesis±meta-analysis has been designed informed by Joanna Briggs Institute and Cochrane guidance. This protocol is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-P. Sources will include Ovid Medline, Embase, Web of Science Core Collection, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, PsycINFO, CINAHL, PEDro, PROSPERO, Google Scholar and grey literature. INCLUSION CRITERIA any systematic review which investigates biopsychosocial factors which may be associated with the development of CMP through prospective longitudinal methods. The outcome is musculoskeletal pain lasting beyond 3 months. Two independent reviewers will be involved in all stages; screening, selection, data extraction and risk of bias evaluation using the Assessing the Methodological Quality of Systematic Reviews-2 guidelines. A meta-level narrative synthesis will be conducted based on (a) factors associated with development of CMP, (b) the range of musculoskeletal disorders for which the same/similar findings have been established and (c) the quality of studies informing these findings. Where possible, meta-analysis will be performed. The Grading of Recommendations, Assessment, Development and Evaluation guidelines will be followed to determine the level of evidence for each biopsychosocial factor. ETHICS AND DISSEMINATION This umbrella review does not require ethical approval. Findings will be presented at conferences and published in a peer reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020193081.
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Affiliation(s)
- Michael Dunn
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Musculoskeletal Physiotherapy, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Alison B Rushton
- School of Physical Therapy, Western University Faculty of Health Sciences, London, Ontario, Canada
| | - Jai Mistry
- Musculoskeletal Physiotherapy, St George's University Hospitals NHS Foundation Trust, London, UK
- School of Physical Therapy, Western University Faculty of Health Sciences, London, Ontario, Canada
| | - Andrew Soundy
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Nicola R Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Nambiema A, Fouquet J, Guilloteau J, Descatha A. La revue systématique et autres types de revue de la littérature : qu’est-ce que c’est, quand, comment, pourquoi ? ARCH MAL PROF ENVIRO 2021. [DOI: 10.1016/j.admp.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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50
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Fenelon A, Boudreaux M, Slopen N, Newman SJ. The Benefits of Rental Assistance for Children's Health and School Attendance in the United States. Demography 2021; 58:1171-1195. [PMID: 33970240 PMCID: PMC8561436 DOI: 10.1215/00703370-9305166] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Programs that provide affordable and stable housing may contribute to better child health and thus to fewer missed days of school. Drawing on a unique linkage of survey and administrative data, we use a quasi-experimental approach to examine the impact of rental assistance programs on missed days of school due to illness. We compare missed school days due to illness among children receiving rental assistance with those who will enter assistance within two years of their interview, the average length of waitlists for federal rental assistance. Overall, we find that children who receive rental assistance miss fewer days of school due to illness relative to those in the pseudo-waitlist group. We demonstrate that rental assistance leads to a reduction in the number of health problems among children and thus to fewer days of school missed due to illness. We find that the effect of rental assistance on missed school days is stronger for adolescents than for younger children. Additionally, race-stratified analyses reveal that rental assistance leads to fewer missed days due to illness among non-Hispanic White and Hispanic/Latino children; this effect, however, is not evident for non-Hispanic Black children, the largest racial/ethnic group receiving assistance. These findings suggest that underinvestment in affordable housing may impede socioeconomic mobility among disadvantaged non-Hispanic White and Hispanic/Latino children. In contrast, increases in rental assistance may widen racial/ethnic disparities in health among disadvantaged children, and future research should examine why this benefit is not evident for Black children.
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Affiliation(s)
- Andrew Fenelon
- School of Public Policy and Department of Sociology and Criminology, Penn State University, University Park, PA, USA
| | - Michel Boudreaux
- Department of Health Policy and Management, University of Maryland, College Park, MD, USA
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Sandra J Newman
- Department of Health Policy & Management, Johns Hopkins University, Baltimore, MD, USA
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