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Grim K, Markström U. Mental health service user organizations in times of crises: adaptions, challenges and opportunities experienced by local associations during COVID-19. Int J Qual Stud Health Well-being 2024; 19:2380360. [PMID: 39010745 PMCID: PMC467096 DOI: 10.1080/17482631.2024.2380360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 07/11/2024] [Indexed: 07/17/2024] Open
Abstract
PURPOSE This study examines how local user associations of mental health service-user organizations were affected by the pandemic, in order to provide guidance to user organizations and surrounding actors on future advancements. The pandemic is used as a case to explore organizational resilience and digitalization during crisis. METHODS Data from focus group interviews and individual interviews with representatives of ten local associations were analysed using qualitative content analysis. A theoretical framework combining governance theory and organizational theory was applied. RESULTS Typically, associations swiftly restructured activities to support members to meet the urgent needs that arose, not least in relation to the digital transition. Simultaneously, face-to-face interactions was valued and some members became isolated. Public sector actors often did not prioritize collaboration, and the associations had limited agency and influence in advocacy activities. CONCLUSIONS User organizations can play an important role in times of crisis. Surrounding social systems should provide resources to counteract resource dependencies and allow organizations to develop operating reserves. They should value collaboration and establish collaborative practices to ensure a readiness to utilize the organizations' capacities when needed. User organizations should have control over future developments, both to harness the potential of digital connectivity and to prevent a digital divide.
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Affiliation(s)
- Katarina Grim
- Department of Social and Psychological Studies, Social work, Karlstad University, Karlstad, Sweden
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Sally S, Felicity B, Christina Z, Serene Y, Anna P, Kathryn B. A realist impact evaluation of a tool to strengthen equity in local government policy-making. Int J Equity Health 2024; 23:179. [PMID: 39252013 PMCID: PMC11385146 DOI: 10.1186/s12939-024-02266-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Accepted: 08/29/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Local governments have a critical role to play in addressing health inequities. Health equity impact assessments are recommended to help governments apply an equity lens to the development and implementation of policies and programs. Despite evidence of equity-positive benefits of such tools, adoption remains limited, prompting calls for evaluations to assess their impact and identify factors that will promote uptake across various contexts. METHODS We conducted a mixed method study to evaluate the impact of an equity impact assessment (EIA) tool and process on policies and organisational capacity in a local government in Victoria, Australia, and identify factors that influenced this impact. We analysed 33 documents related to 18 EIAs, and conducted surveys (n = 40) and in-depth interviews (n = 17) with staff involved in EIAs. RESULTS Almost all (17 of 18) EIAs resulted in equity-positive changes to policies and programs, most frequently addressing individual-level factors, such as making community communications and consultations more accessible to under-represented or under-served groups. Structural-level recommendations from one EIA, such as increasing diversity in decision-making panels, were found to impact both the current policy and a broad range of future, related projects and services. Improvements in equity-centric organisational culture and capacity (including staff awareness, skills and confidence) and increased engagement with under-represented communities were also reported. Factors perceived to influence the impact of EIA's related to organisational commitment and capacity to prioritise equity, process-level factors related to the type and timing of EIAs, and extent of implementation support. CONCLUSION Our study supports wider uptake of health equity impact assessments in local government policies and programs. Legislation, leadership and resources from upper-tiers of government can help increase the adoption of equity tools to reduce disparities in population health.
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Affiliation(s)
- Schultz Sally
- Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia.
| | - Beissmann Felicity
- City of Greater Bendigo, Galkangu Bendigo, VIC, 189-229 Lyttleton Terrace, Australia
| | - Zorbas Christina
- Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
| | - Yoong Serene
- Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
| | - Peeters Anna
- Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
| | - Backholer Kathryn
- Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
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Tumas N, Vega CDL, Navarro MGZ, Cash-Gibson L, Carreño P, Pericàs JM, Benach J. [Public policies and interventions to prevent excess weight in Mexico: analysis from an intersectional perspective]. CIENCIA & SAUDE COLETIVA 2024; 29:e04142023. [PMID: 39194103 DOI: 10.1590/1413-81232024299.04142023] [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: 03/27/2023] [Accepted: 09/18/2023] [Indexed: 08/29/2024] Open
Abstract
The scope of this article is to analyze public policies and interventions (PPI) prevailing in 2022 at the national level for the prevention of excess weight (overweight and obesity) in the adult population of Mexico, from an intersectional perspective. We performed documental analysis of PPI to prevent excess weight in Mexico in adulthood by applying a methodology for policy analysis based on intersectionality (Intersectionality-Based Policy Analysis Framework). A total of nine PPI were analyzed. The extent to which the PPI design considers an intersectional perspective is heterogeneous in the documents analyzed. In the definition of the problem, we identified two main tendencies, namely reductionist and holistic. Both are combined in a variable way in the PPI, revealing internal contradictions in their design. Most PPI consider relatively few cases of social inequality, and as an additive rather than an intersectional consideration. Overall, the PPI consider social inequalities predominantly in the definition of the problem and, to a far lesser extent, in the proposed solutions and in the consultation and negotiation processes. The consideration of the intersectional nature of the problem of excess weight in PPI is important to address the unequal epidemic of excess weight.
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Affiliation(s)
- Natalia Tumas
- Research Group on Health Inequalities, Environment - Employment Conditions Network (GREDS-EMCONET), JHU-UPF Public Policy Center, Departament de Ciències Polítiques i Socials, Universitat Pompeu Fabra (UPF). Ramon Trias Fargas 25-27. 08005 Barcelona España.
| | - Candela de la Vega
- Universidad Católica de Córdoba, Unidad Asociada a Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET). Córdoba Argentina
| | - Mariana Gutiérrez-Zamora Navarro
- Research Group on Health Inequalities, Environment - Employment Conditions Network (GREDS-EMCONET), JHU-UPF Public Policy Center, Departament de Ciències Polítiques i Socials, Universitat Pompeu Fabra (UPF). Ramon Trias Fargas 25-27. 08005 Barcelona España.
| | - Lucinda Cash-Gibson
- Research Group on Health Inequalities, Environment - Employment Conditions Network (GREDS-EMCONET), JHU-UPF Public Policy Center, Departament de Ciències Polítiques i Socials, Universitat Pompeu Fabra (UPF). Ramon Trias Fargas 25-27. 08005 Barcelona España.
| | - Paula Carreño
- Escuela de Nutrición, Facultad de Medicina, Universidad Nacional de Córdoba. Córdoba Argentina
| | - Juan M Pericàs
- Liver Unit, Vall d'Hebron University Hospital, VHIR, Universitat Autònoma de Barcelona, CIBERehd. Barcelona España
| | - Joan Benach
- Research Group on Health Inequalities, Environment - Employment Conditions Network (GREDS-EMCONET), JHU-UPF Public Policy Center, Departament de Ciències Polítiques i Socials, Universitat Pompeu Fabra (UPF). Ramon Trias Fargas 25-27. 08005 Barcelona España.
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Fisseha SE, López ML, Brummelaar MT, Hibiso HW. Sources of resilience for refugee youth in Ethiopia: Exploring the role of education, work, community, religion, and family. CHILD ABUSE & NEGLECT 2024:106978. [PMID: 39153937 DOI: 10.1016/j.chiabu.2024.106978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 06/14/2024] [Accepted: 07/31/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Young refugees' resilience is linked to involvement in socio-ecological systems that contribute to their well-being. OBJECTIVE This study aimed to understand the experiences and factors contributing to resilience among young Sudanese and South Sudanese refugees (aged 16, M = 16 years; N = 40; 21 males, 19 females) residing at the Sherkole refugee camp in Ethiopia's Benishangul-Gumuz region. METHOD Six focus groups (N = 40) and four key informant interviews with government officials, caregivers, and school teachers explored themes related to resilience using thematic analysis. Member checking ensured findings aligned with participants' perspectives. A socio-ecological framework guided the exploration of multidimensional factors. RESULTS Five themes emerged: (1) support systems, (2) work engagement, (3) access to education, (4) role of religion, and (5) community engagement. Work opportunities helped young refugees cope with challenges, but key informants raised concerns about potential risks to education. Social connection and community engagement fostered a harmonious relationship with the host community. Religion and education alleviated stress and worries. The themes interrelated - community engagement improved host community relationships, increasing job opportunities and income (leading to better support systems). Religious activities and education also benefited relationships and provided relaxation. CONCLUSION This study supports the dynamic and multi-systemic nature of resilience within a socio-ecological framework. Findings can inform future resilience-promoting interventions and policies for young refugees.
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Affiliation(s)
- Senper Elias Fisseha
- College of Education and Behavioural Science, School of Psychology, Addis Ababa University, Ethiopia; Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands.
| | - Mónica López López
- Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands.
| | - Mijntje Ten Brummelaar
- Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands
| | - Habtamu Wondimu Hibiso
- College of Education and Behavioural Science, School of Psychology, Addis Ababa University, Ethiopia
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Day G, Ecker AH, Amspoker AB, Dawson DB, Walder A, Hogan JB, Lindsay JA. Black veteran use of video telehealth for mental health care. Psychol Serv 2024; 21:478-488. [PMID: 38059987 PMCID: PMC11156787 DOI: 10.1037/ser0000827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Black veterans experience disparities in mental health (MH) care access and are disproportionately affected by COVID-19. Video telehealth to home (VTH) may reduce disparities by addressing barriers, particularly with pandemic-related shifts to remotely delivered care. Considering potential needs for tailored implementation across racial/ethnic groups, we examined differences in VTH use by non-Hispanic Black veterans versus all other races/ethnicities and among Black (Hispanic and non-Hispanic) veterans by age, rurality, and gender during the pandemic. We extracted a cohort of Veterans Health Administration-enrolled veterans receiving at least one MH encounter between October 2019 and September 2020 (n = 1,627,791) from electronic health records. Multilevel linear growth curve models examined the percentage of VTH use for non-Hispanic Black versus other races/ethnicities before and after pandemic onset. Black veteran-only subgroup analyses examined differences by ethnicity in percentage of VTH MH encounters since pandemic onset by age, rurality, and gender, using regression and analysis of covariance models. Despite significant increases in VTH during the pandemic, on average, VTH use was consistently lower for non-Hispanic Black veterans across both periods. During the pandemic, differences in VTH use between non-Hispanic Black and non-Black veterans accelerated over time. VTH use was greater during the pandemic for Black veterans who were Hispanic, younger, urban, and female. Adoption of VTH for MH was low for non-Hispanic Black veterans before COVID-19 and during COVID-19 compared to non-Black groups. Future VTH research and implementation efforts should question why adoption remains low, work to meet cultural needs, and promote equitable adoption for Black veterans. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Giselle Day
- VHA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center, a virtual center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Anthony H. Ecker
- VHA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center, a virtual center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Amber B. Amspoker
- VHA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Darius B. Dawson
- VHA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center, a virtual center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Annette Walder
- VHA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center, a virtual center, Houston, TX, USA
| | - Julianna B. Hogan
- VHA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center, a virtual center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Jan A. Lindsay
- VHA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medicine Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center, a virtual center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Baker Institute for Public Policy, Rice University, Houston, TX, USA
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Havers L, Bhui K, Shuai R, Fonagy P, Fazel M, Morgan C, Fancourt D, McCrone P, Smuk M, Hosang GM, Shakoor S. A cross-sectional investigation into the role of intersectionality as a moderator of the relation between youth adversity and adolescent depression/anxiety symptoms in the community. J Adolesc 2024; 96:1304-1315. [PMID: 38769710 DOI: 10.1002/jad.12347] [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: 02/21/2024] [Revised: 04/25/2024] [Accepted: 05/05/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Adolescents exposed to adversity show higher levels of depression and anxiety, with the strongest links seen in socially/societally disadvantaged individuals (e.g., females, low socioeconomic status [SES]), as well as neurodivergent individuals. The intersection of these characteristics may be important for the differential distribution of adversity and mental health problems, though limited findings pertain to the extent to which intersectional effects moderate this association. METHODS Combined depression/anxiety symptoms were measured using the emotional problems subscale of the Strengths and Difficulties Questionnaire in 13-14-year-olds in Cornwall, United Kingdom in 2017-2019. In a cross-sectional design (N = 11,707), multiple group structural equation modeling was used to estimate the effects of youth adversity on depression/anxiety symptoms across eight intersectionality profiles (based on gender [female/male], SES [lower/higher], and traits of hyperactivity/inattention [high/low]). Moderation effects of these characteristics and their intersections were estimated. RESULTS Youth adversity was associated with higher levels of depression/anxiety (compared to an absence of youth adversity), across intersectional profiles. This effect was moderated by gender (stronger in males; β = 0.22 [0.11, 0.36]), and SES (stronger in higher SES; β = 0.26 [0.14,0.40]); with indications of moderation attributable to the intersection between gender and hyperactivity/inattention (β = 0.21 [-0.02,0.44]). CONCLUSIONS Youth adversity is associated with heightened depression/anxiety across intersectional profiles in 13-14-year-olds. The stronger effects observed for males, and for higher SES, may be interpreted in terms of structural privilege. Preliminary findings suggest that vulnerability and resilience to the effects of youth adversity may partially depend on specific intersectional effects. Importantly, the current results invite further investigation in this emerging line of inquiry.
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Affiliation(s)
- Laura Havers
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK
| | - Kamaldeep Bhui
- Department of Psychiatry, Nuffield Department of Primary Care Health Sciences, and Wadham College, University of Oxford, Oxford, UK
- Oxford Health and East London NHS Foundation Trusts, Oxford, London, UK
- World Psychiatric Association Collaborating Centre, Oxford, UK
| | - Ruichong Shuai
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK
| | - Peter Fonagy
- Anna Freud National Centre for Children and Families, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Craig Morgan
- Health Service and Population Research, Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, UK
| | - Paul McCrone
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Melanie Smuk
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary, University of London, London, UK
| | - Georgina M Hosang
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK
| | - Sania Shakoor
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK
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Irfan SD, Reza M, Khan MNM, Khan SI. Exploring and addressing the sexual and reproductive health and other related rights of transgender women in Bangladesh: A mixed methods protocol under the policy analysis framework. PLoS One 2024; 19:e0306051. [PMID: 39058707 PMCID: PMC11280239 DOI: 10.1371/journal.pone.0306051] [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: 05/16/2023] [Accepted: 06/07/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION Transgender women (hijra) in Bangladesh are declared as a separate gender category by the Government. However, research revealed that they experience transphobia, which could potentially affect their physical and mental health outcomes, and their access to SRHR-related care. This warrants an exploration of their SRHR-related rights issues, particularly using a community-engaged approach. Moreover, it is crucial to operationalize these findings into actionable policies and practice. This study aims to explore and address the SRHR and other rights-related challenges experienced by hijra under the framework of policy analysis. METHODS The study population will include hijra in four selected service centers in Dhaka, Bangladesh. In the first phase, evidence will be generated through desk review and mixed methods research. The desk review will consist of reading and analyzing literature to understand the difference between policy and reality. For the quantitative component, a first-come-first-serve sampling approach will be used on a total sample size of 296. This will be complemented by the qualitative component, which will entail in-depth interviews, focus groups and key informant interviews. Moreover, life case histories will be conducted for particularly compelling cases. These findings will be collectively analyzed through the policy analysis framework, to analyze the differences between the policy and reality, which will ultimately generate a lay summary for stakeholders. Univariate and multivariate analysis will be used for the quantitative component whereas thematic analysis will be used for the qualitative component. In the second phase, the findings from the lay summary will be shared with stakeholders and hijra community members through a series of discussions. DISCUSSION There are a few limitations of the study. In particular, this study consists of various activities which may require substantial time and effort to complete. Additionally, this study merely goes up to the policy recommendation formulation stage, as opposed to formulating an intervention design. Moreover, the findings will be disseminated through various platforms, including dissemination seminars, scientific articles and the study report.
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Affiliation(s)
- Samira Dishti Irfan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Masud Reza
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Mohammad Niaz Morshed Khan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Sharful Islam Khan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
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Borde E, Camelo LV, Pilecco FB. What the tragic floods in Southern Brazil tell us about health-centered climate-resilient development in Latin American cities. LANCET REGIONAL HEALTH. AMERICAS 2024; 35:100817. [PMID: 38988453 PMCID: PMC11234151 DOI: 10.1016/j.lana.2024.100817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 06/03/2024] [Indexed: 07/12/2024]
Affiliation(s)
- Elis Borde
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte, MG, Brazil
| | - Lidyane V. Camelo
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte, MG, Brazil
| | - Flávia B. Pilecco
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte, MG, Brazil
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Estupiñán Fdez de Mesa M, Marcu A, Ream E, Whitaker KL. Socioeconomic inequities in care experienced by women with breast cancer in England: An intersectional cross-sectional study. Eur J Oncol Nurs 2024; 72:102648. [PMID: 39106587 DOI: 10.1016/j.ejon.2024.102648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 05/28/2024] [Accepted: 06/22/2024] [Indexed: 08/09/2024]
Abstract
PURPOSE Guided by the Intersectionality Framework, we examined the differential in breast cancer care experience across population subgroups in England. METHODS Secondary data analysis using the 2017/2018 National Cancer Patient Experience Surveys. We used disaggregated descriptive statistics (mean, standard errors, 95% confidence interval) to analyse 26,030 responses from female breast cancer patients to a question relating to overall care experience categorised by age, ethnicity, and sexual orientation in their intersection with social position. We then used logistic regression to investigate the odds (Odds Ratio (OR), 95% confidence intervals) of reporting positive care experience adjusting for patient, clinical, and Trust level factors. RESULTS Poorer care experience was predominantly reported by the most deprived younger and minoritised ethnic groups. Statistically significant findings were observed in adjusted multivariable analyses. Compared to patients aged 65-74 years, younger respondents were less likely to rate their care favourably (16-34 years old ORadj. = 0.55 (0.36-0.84). Compared to White British, Asian (ORadj. = 0.51 (0.39-0.66)) and Black African women (ORadj. = 0.53 (0.33-0.88)) were less likely to rate their care favourably. The least affluent respondents were less likely to rate their care favourably (ORadj. = 0.79 (0.64-0.97)). CONCLUSION There is evidence of inequity in overall cancer care experience among female breast cancer patients in England, particularly among women living at the specific intersection of age, ethnicity, and socioeconomic position. Future research is necessary to understand the mechanisms underlying breast cancer inequities. Policymakers, commissioners, and providers should consider the existence of multiple forms of marginalisation to inform improvement initiatives targeting patients at higher risk of vulnerability.
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Affiliation(s)
| | - Afrodita Marcu
- School of Health Sciences, University of Surrey, Research Park, Guildford, Surrey, GU2 7YH, UK
| | - Emma Ream
- School of Health Sciences, University of Surrey, Research Park, Guildford, Surrey, GU2 7YH, UK
| | - Katriina L Whitaker
- School of Health Sciences, University of Surrey, Research Park, Guildford, Surrey, GU2 7YH, UK
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MacDonald SE, Dhungana M, Stagg V, McDonald S, McNeil D, Kellner JD, Tough S, Saini V. Impact of maternal depression and anxiety on immunization status of children: a prospective cohort study. Arch Public Health 2024; 82:89. [PMID: 38886808 PMCID: PMC11181576 DOI: 10.1186/s13690-024-01323-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 06/09/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Maternal depression and anxiety can have a detrimental impact on birth outcomes and healthy child development; there is limited knowledge on its influence on immunization schedule adherence. Therefore, the objectives of this study were to determine the impact of maternal depression and anxiety in the perinatal period on prolonged vaccine delay of childhood vaccines. METHODS In this prospective cohort study, we analyzed linked survey and administrative data of 2,762 pregnant women in Calgary, Alberta, Canada. Data were collected at two time-points: prenatal (< 25 weeks of gestation) and postpartum (4 months postpartum). We used multivariable logistic regression to examine the association between depression and anxiety with prolonged immunization delay, adjusting for covariates. RESULTS In multivariable analysis, maternal depression at either time point was not associated with prolonged delay for DTaP-IPV-Hib (OR 1.16, 95% CI 0.74-1.82), MMR/MMRV (OR 1.03, 95% CI 0.72-1.48), or all routine childhood vaccines combined (OR 1.32, 95% CI 0.86-2.04). Maternal anxiety at either time point was also not associated with prolonged delayed for DTaP-IPV-Hib (OR 1.08, 95% CI 0.77-1.53), MMR/MMRV (OR 1.07, 95% CI 0.82-1.40), or all vaccines combined (OR 1.00, 95% CI 0.80-1.26). In both the depression and anxiety models, children of Canadian-born mothers had higher odds of prolonged delay, as did those with low-income mothers. CONCLUSION Health care providers can be reassured that maternal depression and anxiety do not appear to influence maternal commitment to routine immunization. Findings suggested that low income and household moves may influence adherence to vaccine schedules and health care providers may want to provide anticipatory guidance to these families.
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Affiliation(s)
- Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, Canada.
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | | | - Victoria Stagg
- Research and Innovation, Public Health Evidence and Innovation, Alberta Health Services, Calgary, Canada
| | - Sheila McDonald
- Research and Innovation, Public Health Evidence and Innovation, Alberta Health Services, Calgary, Canada
| | - Deborah McNeil
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - James D Kellner
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Suzanne Tough
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Vineet Saini
- Research and Innovation, Public Health Evidence and Innovation, Alberta Health Services, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Griffith DM. Gender health equity: The case for including men's health. Soc Sci Med 2024; 351 Suppl 1:116863. [PMID: 38825381 DOI: 10.1016/j.socscimed.2024.116863] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 03/08/2024] [Accepted: 04/02/2024] [Indexed: 06/04/2024]
Abstract
United States' federal policy and infrastructure fail to explicitly consider the health of men, particularly the poor health of marginalized men. This inattention to men's health hinders the nation's ability to improve population health, to achieve gender health equity, and to achieve health equity more broadly. Expanding efforts to consider gender in federal policy and infrastructure to include men, naming men as a population whose poor health warrants policy attention, creating offices of men's health in federal agencies, and utilizing an intersectional lens to develop and analyze policies that affect health would likely yield critical improvements in population health and health equity in the United States. Using data from the Centers for Disease Control and Prevention, I illustrate the persistence of sex differences in mortality and leading causes of death, and how these patterns mask gender gaps in health that are driven largely by marginalized men. Given the common practice of presenting data by sex and race separately, it is difficult to recognize when the health of specific groups of men warrants attention. I utilize the case of Black men to illustrate the importance of an intersectional approach, and why men's health is critical to achieving gender and racial equity in health. While a gender mainstreaming approach has enhanced the nation's ability to consider and address the health of women and girls, it has not expanded to be inclusive of boys and men. Consequently, I argue that if our goal is to achieve health equity, it is critical to employ an intersectional approach that simultaneously considers the full range of factors that influence individual and population health and well-being. An intersectional approach would facilitate efforts to simultaneously explore strategies to achieve racial, ethnic, and gender health equity, which are driven by structural determinants beyond sex and gender related factors.
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Affiliation(s)
- Derek M Griffith
- Center for Men's Health Equity, Georgetown University, Washington, DC, USA; Racial Justice Institute, Georgetown University, Washington, DC, USA; Department of Health Management and Policy, School of Health, Georgetown University, Washington, DC, USA; Global Action on Men's Health, United Kingdom.
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12
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Cole C, Raguet M, Rider GN, McMorris BJ. Predictors of Adolescent Intimate Partner Sexual Violence Victimization: Patterns of Intersectional Social Positions in a Statewide, School-based Sample. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:2576-2601. [PMID: 38229477 DOI: 10.1177/08862605231221504] [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: 01/18/2024]
Abstract
Intimate partner sexual violence (IPSV) is a substantial public health issue faced by youth, with disparities along lines of race, gender, and sexual orientation. Using an intersectional framework, the current study describes the prevalence of self-reported IPSV victimization across intersecting social positions among adolescents. High school students who completed the 2019 Minnesota Student Survey were asked whether they had ever experienced IPSV. Using exhaustive Chi-Square Automatic Interaction Detection (eCHAID), responses were modeled using five indicators: racial/ethnic identity, transgender/genderqueer/genderfluid identity, sex assigned at birth, sexual orientation, and school location. The prevalence of IPSV victimization within each end group identified by the eCHAID varied from 2.6% to 32.0%. The highest prevalence of IPSV among all students was observed in subgroups defined by multiple marginalized social positions; for example, 32.0% among lesbian, gay, bisexual, queer, pansexual, or questioning (LGBQ+) students of color who were transgender, genderqueer, genderfluid or unsure of their gender, and assigned male at birth; 22.8% among LGBQ+ students assigned female at birth and enrolled in a Greater Minnesota (outside of the Twin Cities) school; and 22.2% among Native+ or missing race LGBQ+ students assigned female at birth and enrolled in a metropolitan school. Within the eCHAID decision tree, several subsamples of students were split into two more subsamples with a twofold or greater statistically significant difference in IPSV victimization prevalence between them. Findings from this study highlight notable disparities in the prevalence of IPSV victimization among Minnesota youth and demonstrate the importance of detailing the distribution of interpersonal violence outcomes across youth with multiple marginalized identities. Findings suggest that disparities reported along one categorical axis only may miss important nuances in how risk for IPSV is distributed. Population health researchers should utilize methods that allow for the explication of complex intersections that characterize individuals' social positions in estimating the prevalence of sexual violence.
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Affiliation(s)
- Cory Cole
- Minnesota Department of Health, St. Paul, USA
| | | | - G Nic Rider
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, USA
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13
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Humphries D, Marotta P, Hu Y, Wang V, Gross G, Rucker D, Jones J, Alam F, Brown T, Carter CR, Spiegelman D. St. Louis Enhancing Engagement and Retention in HIV/AIDS Care (STEER): a participatory intersectional needs assessment for intervention and implementation planning. RESEARCH SQUARE 2024:rs.3.rs-4225131. [PMID: 38746123 PMCID: PMC11092814 DOI: 10.21203/rs.3.rs-4225131/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Background Missouri is one of seven priority states identified by the Ending the HIV Epidemic Initiative, and St. Louis contains almost half of the people living with HIV (PLWH) in Missouri. As St. Louis has a marked history of structural racism and economic inequities, we utilized the Intersectionality Based Policy Analysis (IBPA) framework to guide a participatory needs assessment for planning and program development. Methods The planning team included researchers, the lead implementer from our community partner, and two community representatives, and had biweekly 60-90 minute meetings for 18 months. The planning team discussed and approved all research materials, reviewed and interpreted results, and made decisions about outreach, recruitment, conduct of the needs assessment and development of the planned intervention. The needs assessment integrated information from existing data, (1) interviews with (a) PLWH (n=12), (b) community leaders (n=5), (c) clinical leaders (n=4), and (d) community health workers (CHWs) (n=3) and (e) CHW supervisors (n=3) who participated in a Boston University-led demonstration project on CHWs in the context of HIV and (2) focus groups (2 FG, 12 participants) with front line health workers such as peer specialists, health coaches and outreach workers. A rapid qualitative analysis approach was used for all interviews and focus groups. Results The IBPA was used to guide team discussions of team values, definition and framing of the problem, questions and topics in the key informant interviews, and implementation strategies. Applying the IBPA framework contributed to a focus on intersectional drivers of inequities in HIV services. The effective management of HIV faces significant challenges from high provider turnover, insufficient integration of CHWs into care teams, and organizational limitations in tailoring treatment plans. Increasing use of CHWs for HIV treatment and prevention also faces challenges. People living with HIV (PLWH) encounter multiple barriers such as stigma, lack of social support, co-morbidities, medication side effects and difficulties in meeting basic needs. Conclusions Addressing intersectional drivers of health inequities may require multi-level, structural approaches. We see the IBPA as a valuable tool for participatory planning while integrating community engagement principles in program and implementation design for improving HIV outcomes.
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Affiliation(s)
| | - Phillip Marotta
- Washington University In St Louis: Washington University in St Louis
| | | | | | - Greg Gross
- Washington University In St Louis: Washington University in St Louis
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14
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Chan WS, Funk L, Krawczyk M, Cohen SR, Cherba M, Dujela C, Stajduhar K. Community perspectives on structural barriers to dying well at home in Canada. Palliat Support Care 2024; 22:347-353. [PMID: 37503570 DOI: 10.1017/s1478951523001074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
OBJECTIVES To analyze how structural determinants and barriers within social systems shape options for dying well at home in Canada, while also shaping preferences for dying at home. METHODS To inform a descriptive thematic analysis, 24 Canadian stakeholders were interviewed about their views, experiences, and preferences about dying at home. Participants included compassionate community advocates, palliative care professionals, volunteers, bereaved family caregivers, residents of rural and remote regions, service providers working with structurally vulnerable populations, and members of francophone, immigrant, and 2SLGBTQ+ communities. RESULTS Analysis of stakeholders' insights and experiences led to the conceptualization of several structural barriers to dying well at home: inaccessible public and community infrastructure and services, a structural gap in death literacy, social stigma and discrimination, and limited access to relational social capital. SIGNIFICANCE OF RESULTS Aging in Canada, as elsewhere across the globe, has increased demand for palliative care and support, especially in the home. Support for people wishing to die at home is a key public health issue. However, while Canadian policy documents normalize dying in place as ideal, it is uncertain whether these fit with the real possibilities for people nearing the end of life. Our analysis extends existing research on health equity in palliative and end-of-life care beyond a focus on service provision. Results of this analysis identify the need to expand policymakers' structural imaginations about what it means to die well at home in Canada.
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Affiliation(s)
- Wing-Sun Chan
- Department of Sociology and Criminology, University of Manitoba, Winnipeg, MB, Canada
| | - Laura Funk
- Department of Sociology and Criminology, University of Manitoba, Winnipeg, MB, Canada
| | - Marian Krawczyk
- School of Interdisciplinary Studies, University of Glasgow, Dumfries, UK
| | | | - Maria Cherba
- Department of Communication, University of Ottawa, Ottawa, ON, Canada
| | - Carren Dujela
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada
| | - Kelli Stajduhar
- School of Nursing, University of Victoria, Victoria, BC, Canada
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15
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Cohen ES, Kouwenberg LHJA, Moody KS, Sperna Weiland NH, Kringos DS, Timmermans A, Hehenkamp WJK. Environmental sustainability in obstetrics and gynaecology: A systematic review. BJOG 2024; 131:555-567. [PMID: 37604701 DOI: 10.1111/1471-0528.17637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/04/2023] [Accepted: 07/29/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The healthcare sector is responsible for 4%-10% of global greenhouse gas emissions. Considering the broad range of care that obstetricians and gynaecologists provide, mitigation strategies within this specialty could result in significant reductions of the environmental footprint across the whole healthcare industry. OBJECTIVES The aim of this review was to identify for what services, procedures and products within obstetric and gynaecological care the environmental impact has been studied, to assess the magnitude of such impact and to identify mitigation strategies to diminish it. SEARCH STRATEGY The search strategy combined terms related to environmental impact, sustainability, climate change or carbon footprint, with the field of obstetrics and gynaecology. SELECTION CRITERIA Articles reporting on the environmental impact of any service, procedure or product within the field of obstetrics and gynaecology were included. Included outcomes covered midpoint impact categories, CO2 emissions, waste generation and energy consumption. DATA COLLECTION AND ANALYSIS A systematic literature search was conducted in the databases of MEDLINE (Ovid), Embase (Ovid) and Scopus, and a grey literature search was performed on Google Scholar and two websites of gynaecological associations. MAIN RESULTS The scope of the investigated studies encompassed vaginal births, obstetric and gynaecological surgical procedures, menstrual products, vaginal specula and transportation to gynaecological oncologic consultations. Among the highest yielding mitigation strategies were displacing disposable with reusable materials and minimising content of surgical custom packs. The lowest yielding mitigation strategy was waste optimisation, including recycling. CONCLUSIONS This systematic review highlights opportunities for obstetricians and gynaecologists to decrease their environmental footprint in many ways. More high-quality studies are needed to investigate the environmental impact of other aspects of women's and reproductive health care.
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Affiliation(s)
- Eva Sayone Cohen
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Quality of Care, Global Health, Amsterdam Public Health, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Lisanne H J A Kouwenberg
- Quality of Care, Global Health, Amsterdam Public Health, Amsterdam, The Netherlands
- Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Kate S Moody
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Nicolaas H Sperna Weiland
- Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Anaesthesiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Dionne Sofia Kringos
- Quality of Care, Global Health, Amsterdam Public Health, Amsterdam, The Netherlands
- Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Anne Timmermans
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Wouter J K Hehenkamp
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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16
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Eger H, Chacko S, El-Gamal S, Gerlinger T, Kaasch A, Meudec M, Munshi S, Naghipour A, Rhule E, Sandhya YK, Uribe OL. Towards a Feminist Global Health Policy: Power, intersectionality, and transformation. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002959. [PMID: 38451969 PMCID: PMC10919653 DOI: 10.1371/journal.pgph.0002959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/04/2024] [Indexed: 03/09/2024]
Abstract
In the realm of global health policy, the intricacies of power dynamics and intersectionality have become increasingly evident. Structurally embedded power hierarchies constitute a significant concern in achieving health for all and demand transformational change. Adopting intersectional feminist approaches potentially mitigates health inequities through more inclusive and responsive health policies. While feminist approaches to foreign and development policies are receiving increasing attention, they are not accorded the importance they deserve in global health policy. This article presents a framework for a Feminist Global Health Policy (FGHP), outlines the objectives and underlying principles and identifies the actors responsible for its meaningful implementation. Recognising that power hierarchies and societal contexts inherently shape research, the proposed framework was developed via a participatory research approach that aligns with feminist principles. Three independent online focus groups were conducted between August and September 2022 with 11 participants affiliated to the global-academic or local-activist level and covering all WHO regions. The qualitative content analysis revealed that a FGHP must be centred on considerations of intersectionality, power and knowledge paradigms to present meaningful alternatives to the current structures. By balancing guiding principles with sensitivity for context-specific adaptations, the framework is designed to be applicable locally and globally, whilst its adoption is intended to advance health equity and reproductive justice, with communities and policymakers identified as the main actors. This study underscores the importance of dismantling power structures by fostering intersectional and participatory approaches for a more equitable global health landscape. The FGHP framework is intended to initiate debate among global health practitioners, policymakers, researchers and communities. Whilst an undeniably intricate and time-consuming process, continuous and collaborative work towards health equity is imperative to translate this vision into practice.
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Affiliation(s)
- Hannah Eger
- School of Public Health, Bielefeld University, Bielefeld, Germany
- Faculty of Sociology, Bielefeld University, Bielefeld, Germany
| | | | | | - Thomas Gerlinger
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | | | - Marie Meudec
- Outbreak Research Team, Population Data Hub, Equity & Health Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Shehnaz Munshi
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- University of Limerick, Limerick, Ireland
| | - Awa Naghipour
- Department of Sex and Gender Sensitive Medicine, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany
| | - Emma Rhule
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
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Spencer S, Hollingbery T, Bodner A, Hedden L, Rudoler D, Christian E, Lavergne MR. Evaluating engagement with equity in Canadian provincial and territorial primary care policies: Results of a jurisdictional scan. Health Policy 2024; 140:104994. [PMID: 38242021 DOI: 10.1016/j.healthpol.2024.104994] [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: 08/22/2023] [Revised: 10/23/2023] [Accepted: 01/09/2024] [Indexed: 01/21/2024]
Abstract
Equitable access to primary care is essential to achieving more equitable health outcomes, yet evidence suggests that structurally marginalized populations are less likely to have benefited from varied primary care reforms in Canada. Our objective is to determine how equity is incorporated in public primary care policy and strategy documents across Canada. We conducted string term and snowball searches for provincial/territorial primary care policy documents published between 01 January 2018 and 30 June 2022, extracted the policy objective, and applied a rubric to evaluate each document's engagement with equity. We performed content analysis of the documents which acknowledged inequities and articulated a related policy response. Of the 224 identified documents that discussed primary care policy: 63 (28 %) identified one or more structurally marginalized group(s) experiencing inequities related to primary care, 64 (29 %) identified a structurally marginalized group and articulated a policy response, and 16 (7 %) articulated a detailed policy response to address inequities. Even where policy responses were articulated, in most cases these did not directly address the acknowledged inequities. The absence of measurable goals, meaningful community consultation, and tenuous connections between the policy response and inequities mentioned may help explain persistent inequities in primary care across Canada.
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Affiliation(s)
- Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Tai Hollingbery
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa ON, L1G 0C5, Canada
| | - Aidan Bodner
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto ON, M5T 3M6, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - David Rudoler
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa ON, L1G 0C5, Canada
| | - Erin Christian
- IWK Health Centre, 5850/5980 University Avenue, Halifax NS, B3K 6R8, Canada
| | - M Ruth Lavergne
- Department of Family Medicine, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax NS, B3J 3T4, Canada.
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18
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Gustafsson PE, Fonseca-Rodríguez O, Castel Feced S, San Sebastián M, Bastos JL, Mosquera PA. A novel application of interrupted time series analysis to identify the impact of a primary health care reform on intersectional inequities in avoidable hospitalizations in the adult Swedish population. Soc Sci Med 2024; 343:116589. [PMID: 38237285 DOI: 10.1016/j.socscimed.2024.116589] [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: 08/30/2023] [Revised: 12/07/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024]
Abstract
Primary health care (PHC) systems are a crucial instrument for achieving equitable population health, but there is little evidence of how PHC reforms impact equities in population health. In 2010, Sweden implemented a reform that promoted marketization and privatization of PHC. The present study uses a novel integration of intersectionality-informed and evaluative epidemiological analytical frameworks to disentangle the impact of the 2010 Swedish PHC reform on intersectional inequities in avoidable hospitalizations. The study population comprised the total Swedish population aged 18-85 years across 2001-2017, in total 129 million annual observations, for whom register data on sociodemographics and hospitalizations due to ambulatory care sensitive conditions were retrieved. Multilevel Analysis of Individual Heterogeneity and Discriminatory Analyses (MAIHDA) were run for the pre-reform (2001-2009) and post-reform (2010-2017) periods to provide a mapping of inequities. In addition, random effects estimates reflecting the discriminatory accuracy of intersectional strata were extracted from a series MAIHDAs run per year 2001-2017. The estimates were re-analyzed by Interrupted Time Series Analysis (ITSA), in order to identify the impact of the reform on measures of intersectional inequity in avoidable hospitalizations. The results point to a complex reconfiguration of social inequities following the reform. While the post-reform period showed a reduction in overall rates of avoidable hospitalizations and in age disparities, socioeconomic inequities in avoidable hospitalizations, as well as the importance of interactions between complex social positions, both increased. Socioeconomically disadvantaged groups born in the Nordic countries seem to have benefited the least from the reform. The study supports a greater attention to the potentially complex consequences that health reforms can have on inequities in health and health care, which may not be immediate apparent in conventional evaluations of either population-average outcomes, or by simple evaluations of equity impacts. Methodological approaches for evaluation of complex inequity impacts need further development.
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Affiliation(s)
- Per E Gustafsson
- Department of Epidemiology and Global Health, Umeå University, Sweden.
| | | | - Sara Castel Feced
- Department of Microbiology, Pediatrics, Radiology, and Public Health, University of Zaragoza, Spain
| | | | | | - Paola A Mosquera
- Department of Epidemiology and Global Health, Umeå University, Sweden
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19
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Mac-Seing M, Di Ruggiero E. The Intersections of COVID-19 Global Health Governance and Population Health Priorities: Equity-Related Lessons Learned From Canada and Selected G20 Countries. Public Health Rev 2024; 45:1606052. [PMID: 38348131 PMCID: PMC10859516 DOI: 10.3389/phrs.2024.1606052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 01/15/2024] [Indexed: 02/15/2024] Open
Abstract
Background: COVID-19-related global health governance (GHG) processes and public health measures taken influenced population health priorities worldwide. We investigated the intersection between COVID-19-related GHG and how it redefined population health priorities in Canada and other G20 countries. We analysed a Canada-related multilevel qualitative study and a scoping review of selected G20 countries. Findings show the importance of linking equity considerations to funding and accountability when responding to COVID-19. Nationalism and limited coordination among governance actors contributed to fragmented COVID-19 public health responses. COVID-19-related consequences were not systematically negative, but when they were, they affected more population groups living and working in conditions of vulnerability and marginalisation. Policy options and recommendations: Six policy options are proposed addressing upstream determinants of health, such as providing sufficient funding for equitable and accountable global and public health outcomes and implementing gender-focused policies to reduce COVID-19 response-related inequities and negative consequences downstream. Specific programmatic (e.g., assessing the needs of the community early) and research recommendations are also suggested to redress identified gaps. Conclusion: Despite the consequences of the COVID-19 pandemic, programmatic and research opportunities along with concrete policy options must be mobilised and implemented without further delay. We collectively share the duty to act upon global health justice.
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Affiliation(s)
- Muriel Mac-Seing
- Department of Social and Preventive Medicine, School of Public Health & Centre de Recherche en Santé Publique, Université de Montréal, Montreal, QC, Canada
- Behavioural Health Sciences Division, Centre for Global Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Erica Di Ruggiero
- Centre for Global Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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20
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Singh D, Nasir S, Sharma J, Giménez-Llort L, Shahnawaz MG. Psychological Distress in Low-Income and Economically Marginalized Populations in India: Protective and Risk Factors. Behav Sci (Basel) 2024; 14:92. [PMID: 38392445 PMCID: PMC10886196 DOI: 10.3390/bs14020092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Studies at the juncture of development economics and public health take on considerable responsibility in addressing inequality and related mental health distress. Mental healthcare in economically marginalized populations requires depicting the linkages between socioeconomic status and psychological distress. In the present work, a sequential mixed-methods design was used to study 190 people in such communities in India. Gender-dependent psychological distress was found according to the Kessler Psychological Distress Scale (K-10) with moderate distress in women (M = 26.30, SD = 9.15) and mild distress in men (M = 21.04, SD = 8.35). Regression analysis indicated that gender significantly predicted psychological distress, followed by age, marital status, and the level of education of the head of the family. The Interpretative Phenomenological Analysis of semi-structured interviews of the six women who scored the highest on the distress scale unveiled three master themes: (1) manifestation of psychological distress, (2) contextual challenges, and (3) sources of strength and resilience. Overall, participants reported a lack of resources, community violence, gender discrimination, and widespread substance use as major contributors to the ongoing distress. These findings can pave the way for future studies to expand beyond independent economic indicators and curate clinical interventions for culturally competent mental healthcare.
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Affiliation(s)
- Dipti Singh
- Department of Psychology, Jamia Millia Islamia, New Delhi 110025, India
| | - Shagufta Nasir
- Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Juhi Sharma
- Light Up-Emotions Matter Foundation, New Delhi 110096, India
| | - Lydia Giménez-Llort
- Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Institut de Neurociències, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
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21
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Van Tuyl R. Improving access, understanding, and dignity during miscarriage recovery in British Columbia, Canada: A patient-oriented research study. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057231224180. [PMID: 38239002 PMCID: PMC10798063 DOI: 10.1177/17455057231224180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/01/2023] [Accepted: 12/15/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Approximately 15%-25% of clinical pregnancies end in miscarriage, with more than 15,000 miscarriages occurring annually in British Columbia, Canada. Despite the significant rates of loss, research and health care services for pregnancy loss remain scarce in British Columbia. OBJECTIVES This study aimed to (1) aid miscarriage recovery through the identification and sharing of equitable pregnancy loss care practices and supports and (2) present policy recommendations to improve prenatal care guidelines and employment standards for pregnancy loss. DESIGN This research took a patient-oriented methodological approach alongside people with lived/living experience(s) of miscarriage recovery in British Columbia to evaluate access to health care during pregnancy loss, societal understanding of miscarriage, and treatment options that foreground dignity. METHODS The mixed-methods design of this research included policy research on prenatal care guidelines, policy research on provincial and territorial employment legislation for bereavement leave, semi-structured interviews (n = 27), and a discovery action dialogue (n = 4). RESULTS The findings of this research demonstrate the need for improved prenatal care guidelines for early pregnancy loss, follow-up care after a miscarriage, mental health screening and supports, and bereavement leave legislation. CONCLUSION This article includes recommendations to improve equitable access to pregnancy loss care, bereavement leave legislation, and future research in this area.
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Bohren MA, Iyer A, Barros AJ, Williams CR, Hazfiarini A, Arroyave L, Filippi V, Chamberlain C, Kabakian-Khasholian T, Mayra K, Gill R, Vogel JP, Chou D, George AS, Oladapo OT. Towards a better tomorrow: addressing intersectional gender power relations to eradicate inequities in maternal health. EClinicalMedicine 2024; 67:102180. [PMID: 38314054 PMCID: PMC10837533 DOI: 10.1016/j.eclinm.2023.102180] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 08/03/2023] [Accepted: 08/10/2023] [Indexed: 02/06/2024] Open
Abstract
An equity lens to maternal health has typically focused on assessing the differences in coverage and use of healthcare services and critical interventions. While this approach is important, we argue that healthcare experiences, dignity, rights, justice, and well-being are fundamental components of high quality and person-centred maternal healthcare that must also be considered. Looking at differences across one dimension alone does not reflect how fundamental drivers of maternal health inequities-including racism, ethnic or caste-based discrimination, and gendered power relations-operate. In this paper, we describe how using an intersectionality approach to maternal health can illuminate how power and privilege (and conversely oppression and exclusion) intersect and drive inequities. We present an intersectionality-informed analysis on antenatal care quality to illustrate the advantages of this approach, and what is lost in its absence. We reviewed and mapped equity-informed interventions in maternal health to existing literature to identify opportunities for improvement and areas for innovation. The gaps and opportunities identified were then synthesised to propose recommendations on how to apply an intersectionality lens to maternal health research, programmes, and policies.
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Affiliation(s)
- Meghan A. Bohren
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Aditi Iyer
- Ramalingaswami Centre on Equity & Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Aluisio J.D. Barros
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Caitlin R. Williams
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Mother and Child Health, Institute for Clinical Effectiveness and Health Policy (IECS-Argentina), Buenos Aires, Argentina
| | - Alya Hazfiarini
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Luisa Arroyave
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Veronique Filippi
- London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
| | - Catherine Chamberlain
- Indigenous Health Equity Unit, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Tamar Kabakian-Khasholian
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Kaveri Mayra
- Birth Place Lab, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Roopan Gill
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada
- Vitala Global Foundation, Vancouver, British Columbia, Canada
| | - Joshua P. Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Doris Chou
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Asha S. George
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, Western Cape, South Africa
- South African Medical Research Council, South Africa
| | - Olufemi T. Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Patterson S, Jehan K. Love (and) ageing well: A qualitative study of sexual health in the context of ageing well among women aged 50 and over. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241247747. [PMID: 38682301 PMCID: PMC11057352 DOI: 10.1177/17455057241247747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 03/08/2024] [Accepted: 03/29/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND The United Nations has declared 2021-2030 the 'Decade of Healthy Ageing' and identified the need to strengthen the evidence base on interpretations and determinants of healthy ageing to inform policy. OBJECTIVES This study sought to interrogate a 'policy blind spot' and examine interpretations and experiences of sexuality and sexual health within the context of ageing well among women aged 50+. DESIGN The qualitative study design was underpinned by an interpretivist epistemology. Research was guided by principles of feminist scholarship and located in an affirmative ageing framework. METHODS Semi-structured individual interviews were conducted between April-June 2019 with 21 English-speaking women aged 52-76. Women were recruited through community organizations in North West England. Transcripts were analysed using a framework approach to thematic analysis, applying an inductive approach to theme generation. RESULTS Narratives encompassed six broad themes: reflections on 'ageing well'; age alone does not define sexuality and sexual health; interpretations of sexual health and sexuality; vulnerability and resistance in later-life sexual health; narratives of (in)visibility; and reimagining services to promote sexual health in later life. There was a dominant belief that sexual health represents a component of ageing well, despite a broad spectrum of sexual expression and health challenges. Sexual expression was diversely shaped by conflicting societal expectations within an evolving digitized environment. In clinical settings, however, sexual health discussions were often muted or framed from a disease-focussed lens. Women expressed a preference for holistic, person-centred sexual health provision from an orientation of wellness to support varied sexual expression, sensitive to wider health, life and relationship realities. CONCLUSION This work strengthens calls to disentangle sexual health from disease-centred narratives and legitimize sexual health as part of the healthy ageing agenda.
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Affiliation(s)
- Sophie Patterson
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Kate Jehan
- Department of Public Health and Policy, Liverpool University, Liverpool, UK
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Jindal M, Chaiyachati KH, Fung V, Manson SM, Mortensen K. Eliminating health care inequities through strengthening access to care. Health Serv Res 2023; 58 Suppl 3:300-310. [PMID: 38015865 PMCID: PMC10684044 DOI: 10.1111/1475-6773.14202] [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: 11/30/2023] Open
Abstract
OBJECTIVE To provide a research agenda and recommendations to address inequities in access to health care. DATA SOURCES AND STUDY SETTING The Agency for Healthcare Research and Quality (AHRQ) organized a Health Equity Summit in July 2022 to evaluate what equity in access to health care means in the context of AHRQ's mission and health care delivery implementation portfolio. The findings are a result of this Summit, and subsequent convenings of experts on access and equity from academia, industry, and the government. STUDY DESIGN Multi-stakeholder input from AHRQ's Health Equity Summit, author consensus on a framework and key knowledge gaps, and summary of evidence from the supporting literature in the context of the framework ensure comprehensive recommendations. DATA COLLECTION/EXTRACTION METHODS Through a stakeholder-engaged process, themes were developed to conceptualize access with a lens toward health equity. A working group researched the most appropriate framework for access to care to classify limitations identified during the Summit and develop recommendations supported by research in the context of the framework. This strategy was intentional, as the literature on inequities in access to care may itself be biased. PRINCIPAL FINDINGS The Levesque et al. framework, which incorporates multiple dimensions of access (approachability, acceptability, availability, accommodation, affordability, and appropriateness), is the backdrop for framing research priorities for AHRQ. However, addressing inequities in access cannot be done without considering the roles of racism and intersectionality. Recommendations include funding research that not only measures racism within health care but also tests burgeoning anti-racist practices (e.g., co-production, provider training, holistic review, discrimination reporting, etc.), acting as a convener and thought leader in synthesizing best practices to mitigate racism, and forging the path forward for research on equity and access. CONCLUSIONS AHRQ is well-positioned to develop an action plan, strategically fund it, and convene stakeholders across the health care spectrum to employ these recommendations.
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Affiliation(s)
- Monique Jindal
- Department of Academic Internal MedicineUniversity of Illinois ChicagoChicagoIllinoisUSA
| | - Krisda H. Chaiyachati
- Verily, Inc.South San FranciscoCaliforniaUSA
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Vicki Fung
- Department of Medicine, Harvard Medical School, Mongan InstituteMassachusetts General HospitalBostonMassachusettsUSA
| | - Spero M. Manson
- Centers for American Indian and Alaska Native HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Karoline Mortensen
- Department of Health Management and PolicyMiami Herbert Business SchoolCoral GablesFloridaUSA
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Sukhera J, Goez H, Brown A, Haddara W, Razack S. Codesigning Policy-Based Solutions to Discrimination and Harassment in Academic Medicine: An Inclusive Approach. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:1356-1359. [PMID: 37801596 DOI: 10.1097/acm.0000000000005466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
ABSTRACT Academic medicine institutions have historically employed policies as a means to tackle various types of discrimination and harassment within educational and professional settings, thereby affirming their dedication to promoting diversity, equity, and inclusion. However, the implementation and effectiveness of policies are constrained by limitations, including a lack of awareness and barriers to reporting. Due to concerns about accountability and transparency, many groups and individuals experiencing discrimination have lost trust in policy-based solutions to address equity in academic medicine. To address such challenges, the authors offer an evidence-informed policy framework with actionable recommendations. First, policy should be cowritten through meaningful and participatory engagement. Second, organizations should publicly report on metrics of policy effectiveness. Third, to ensure accountability, external organizations or adjudicators should be involved in oversight of policy-based processes. Fourth, leadership commitment is essential for success. Overall, policy can be an effective mechanism to address discrimination and harassment; however, a more inclusive approach is needed.
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Butler H, Gott M, Prebble DK, Fortune DS, Robinson DJ. Palliative care research utilising intersectionality: a scoping review. BMC Palliat Care 2023; 22:189. [PMID: 38012662 PMCID: PMC10683236 DOI: 10.1186/s12904-023-01310-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Access to palliative care is recognised as a human right, yet clear disparities exist. There have been recent appeals to examine people's contexts and interactions with social systems which for many, adversely influence their utilisation of palliative care. Intersectionality provides a way to understand these drivers of inequity and ultimately advocate for change. AIM To identify and describe published studies utilising intersectionality in relation to need, access and experience of palliative care. DESIGN A scoping review. DATA SOURCES Medline, PsycINFO, CINAHL and Google Scholar databases and a manual search were undertaken for studies published up to January 2023. Included studies were evidence based articles where palliative or end of life care was the focus and intersectionality was identified and/or applied to the research that was undertaken. RESULTS Ten published studies were included. An analytic framework was developed to identify the extent that intersectionality was utilised in each study. A wide range of different groups were researched across the studies, with most focusing on aspects of their participant's identity in relation to palliative care access and experience. Common topics of power, heterogeneity of people within the health system and barriers to palliative care were illuminated across the studies. CONCLUSIONS Very limited research to date has utilised intersectionality to understand access, utilisation and experience of palliative care. This scoping review demonstrates intersectionality can provide a way to illuminate rich understandings of inequity in palliative care. It is imperative that future palliative research incorporates an intersectionality focus to further clarify the needs and experiences of structurally marginalised groups.
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Affiliation(s)
- Helen Butler
- School of Nursing, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
| | - Merryn Gott
- School of Nursing, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Doctor Kate Prebble
- School of Nursing, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Doctor Sarah Fortune
- School of Population Health, University of Auckland, 28 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Doctor Jackie Robinson
- School of Nursing, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
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Mac-Seing M. La crise climatique : décryptage des implications intersectionnelles de « ne laisser personne de côté ». Glob Health Promot 2023; 30:51-53. [PMID: 37823816 DOI: 10.1177/17579759231199936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- Muriel Mac-Seing
- Département de médecine sociale et préventive, École de santé publique Université de Montréal, et le Centre de recherche en santé publique, Québec, Canada
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Rodriguez JM, Koo C, Di Pasquale G, Assari S. Black-White differences in perceived lifetime discrimination by education and income in the MIDUS Study in the U.S. J Biosoc Sci 2023; 55:795-811. [PMID: 36352755 DOI: 10.1017/s0021932022000360] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is growing evidence on the negative effects of perceived discrimination on health outcomes and their interactions with indicators of socioeconomic status. However, less has been studied on whether income and education lead individuals of a different race to encounter different discriminatory experiences in their lifetime. Using data from the national survey of the Midlife Development in the United States-MIDUS 1 (1995-1996) and MIDUS Refresher (2011-2014)-on eight measures of perceived lifetime discrimination, this study compares discriminatory experiences of Black and White persons in two time periods. We applied generalized structural equation models and generalized linear models to test multiplicative effects of income and education by race on lifetime discrimination. In both periods, we find substantive disparities between White and Black people in all types of lifetime discrimination, with Black people reporting much higher levels of discrimination. Such disparities exacerbated in the top cohorts of society, yet these associations have changed in time, with White individuals reporting increasing levels of discrimination. Results show that, for Black people in the mid-1990s, perceived discrimination increased as education and income increased. This finding persisted for education by the early 2010s; income effects changed as now both, low- and high-income Black people, reported the highest levels of discrimination. These findings highlight a policy conundrum, given that increasing income and education represent a desirable course of action to improve overall discrimination and health outcomes. Yet, we show that they may unintendingly exacerbate racial disparities in discrimination. We also show that the U.S. is moving toward a stagnation period in health outcomes improvement, with racial disparities in discrimination shrinking at the expense of a deterioration of whites' lifetime discriminatory experiences. Our results highlight the need for a multi-systems policy approach to prevent all forms of discrimination including those due to historical, institutional, legal, and sociopolitical structures.
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Affiliation(s)
- Javier M Rodriguez
- Claremont Graduate University, Department of Politics and Government, Claremont, United States
| | - Chungeun Koo
- Gachon University, Korea Inequality Research Lab, Seongnam, Republic of Korea
| | | | - Shervin Assari
- Charles R Drew University of Medicine and Science, Department of Family Medicine, Los Angeles, United States
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Mac-Seing M. La crisis climática: revelación de las implicaciones interseccionales de 'no dejar a nadie atrás'. Glob Health Promot 2023; 30:58-60. [PMID: 37823817 DOI: 10.1177/17579759231199935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- Muriel Mac-Seing
- Departamento de Medicina Social y Preventiva, Escuela de Salud Pública, Universidad de Montreal, Quebec, Canadá
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Humphries DL, Sodipo M, Jackson SD. The intersectionality-based policy analysis framework: demonstrating utility through application to the pre-vaccine U.S. COVID-19 policy response. Front Public Health 2023; 11:1040851. [PMID: 37655290 PMCID: PMC10466398 DOI: 10.3389/fpubh.2023.1040851] [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: 09/09/2022] [Accepted: 07/28/2023] [Indexed: 09/02/2023] Open
Abstract
Few guidelines exist for the development of socially responsible health policy, and frameworks that balance considerations of data, strategy, and equity are limited. The Intersectionality-Based Policy Analysis (IBPA) framework utilizes a structured questioning process to consider problems and policies, while applying guiding principles of equity, social justice, power, intersectionality, and diversity of knowledge and input. We apply the IBPA framework's guiding principles and questions to the pre-vaccine U.S. COVID-19 policy response. Results suggest the IBPA approach is a promising tool for integrating equity considerations in the development of policy solutions to urgent US public health challenges, including the COVID-19 pandemic. We found the IBPA framework particularly useful in differentiating between problems or policies and representations of problems or policies, and in considering the impacts of representations on different groups. The explicit inclusion of short-, medium- and long-term solutions is a reminder of the importance of holding a long-term vision of the equitable public health system we want while working towards immediate change.
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Affiliation(s)
| | - Michelle Sodipo
- Yale School of Public Health, New Haven, CT, United States
- Harvard T.H. Chan School of Public Health, Cambridge, MA, United States
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Tinner L, Holman D, Ejegi-Memeh S, Laverty AA. Use of Intersectionality Theory in Interventional Health Research in High-Income Countries: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6370. [PMID: 37510601 PMCID: PMC10379482 DOI: 10.3390/ijerph20146370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/12/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Intersectionality theory posits that considering a single axis of inequality is limited and that considering (dis)advantage on multiple axes simultaneously is needed. The extent to which intersectionality has been used within interventional health research has not been systematically examined. This scoping review aimed to map out the use of intersectionality. It explores the use of intersectionality when designing and implementing public health interventions, or when analysing the impact of these interventions. METHODS We undertook systematic searches of Medline and Scopus from inception through June 2021, with key search terms including "intersectionality", "interventions" and "public health". References were screened and those using intersectionality and primary data from high-income countries were included and relevant data synthesised. RESULTS After screening 2108 studies, we included 12 studies. Six studies were qualitative and focused on alcohol and substance abuse (two studies), mental health (two studies), general health promotion (one study) and housing interventions (one study). The three quantitative studies examined mental health (two studies) and smoking cessation (one study), while the three mixed-method studies examined mental health (two studies) and sexual exploitation (one study). Intersectionality was used primarily to analyse intervention effects (eight studies), but also for intervention design (three studies), and one study used it for both design and analysis. Ethnicity and gender were the most commonly included axes of inequality (11 studies), followed by socio-economic position (10 studies). Four studies included consideration of LGBTQ+ and only one considered physical disability. Intersectional frameworks were used by studies to formulate specific questions and assess differences in outcomes by intersectional markers of identity. Analytical studies also recommended intersectionality approaches to improve future treatments and to structure interventions to focus on power and structural dynamics. CONCLUSIONS Intersectionality theory is not yet commonly used in interventional health research, in either design or analysis. Conditions such as mental health have more studies using intersectionality, while studies considering LGBTQ+ and physical disability as axes of inequality are particularly sparse. The lack of studies in our review suggests that theoretical and methodological advancements need to be made in order to increase engagement with intersectionality in interventional health.
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Affiliation(s)
- Laura Tinner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK
| | - Daniel Holman
- Department of Sociological Studies, The University of Sheffield, The Wave, 2 Whitham Road, Sheffield S10 2AH, UK
| | - Stephanie Ejegi-Memeh
- Department of Sociological Studies, The University of Sheffield, The Wave, 2 Whitham Road, Sheffield S10 2AH, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation, School of Public Health, Imperial College London, London SW7 2BX, UK
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Hull SJ, Massie JS, Holt SL, Bowleg L. Intersectionality Policymaking Toolkit: Key Principles for an Intersectionality-Informed Policymaking Process to Serve Diverse Women, Children, and Families. Health Promot Pract 2023; 24:623-635. [PMID: 36960782 PMCID: PMC10445436 DOI: 10.1177/15248399231160447] [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: 03/25/2023]
Abstract
Health and economic inequities among U.S. racial/ethnic minority women and children are staggering. These inequities underscore a dire need for intersectionality-informed, social-justice-oriented maternal and child (MCH) policies and programs for U.S. women and children. In response, we developed the "Intersectionality Policymaking Toolkit: Key Principles for an Intersectionality Informed Policymaking Process to Serve Diverse Women, Children and Families" to assist U.S. policymakers/aides, practitioners, and other stakeholders in developing more equitable MCH policies/programs. This article describes the Toolkit development process and initial assessments of acceptability and feasibility for use in MCH policymaking. Between 2018 and 2021, we utilized the process that the World Health Organization (WHO) used to develop its WHO Surgical Safety Checklist to develop the content (e.g., case studies) and format (i.e., structure), make strategic decisions (e.g., core items, primary audiences, timing of utilization), test concepts, and receive feedback. We convened a 2-day planning meeting with experts (n = 8) in intersectionality, policymaking, and MCH to draft the Toolkit. Next, we convened half-day workshops with policymaking and program leadership and staff in Washington, DC, New Orleans, LA, and Santa Fe, NM, to refine the Toolkit (n = 37). Then we conducted an initial assessment of the Toolkits' acceptability and feasibility using surveys (n = 21), followed by focus groups (n = 7). The resulting Toolkit distills Critical Race Theory's and intersectionality's most critical elements into a user-friendly modality to promote and enhance equitable MCH policies and programs for diverse U.S. women and families.
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Affiliation(s)
- Shawnika J. Hull
- Corresponding Author: Department of Communication, Rutgers University, 4 Huntington St. New Brunswick, NJ, 08901.
| | | | | | - Lisa Bowleg
- Department of Psychology, The George Washington University
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Kehoe MacLeod K, Flores KN, Chandra K. Identifying facilitators and barriers to integrated and equitable care for community-dwelling older adults with high emergency department use from historically marginalized groups. Int J Equity Health 2023; 22:97. [PMID: 37208757 DOI: 10.1186/s12939-023-01900-y] [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: 11/04/2022] [Accepted: 04/27/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND High rates of emergency department (ED) use by older adults persist despite attempts to improve accessibility of appropriate and comprehensive care. Understanding the drivers of ED visits from the perspective of older adults from historically marginalized groups could help reduce ED use by patients with needs that are preventable or could have been treated in a more appropriate setting. This interpretivist, feminist study aims to explore the unmet care needs of older adults (age 65 +) with high ED use and belonging to historically marginalized groups to better understand how social and structural inequities reinforced by neoliberalism; federal and provincial governance structures and policy frameworks; and regional processes and local institutional practices, shape the experiences of these older adults, particularly those at risk of poor health outcomes based on the social determinants of health (SDH). METHODS/DESIGN This mixed methods study will employ an integrated knowledge translation (iKT) approach, starting with a quantitative phase followed by a qualitative phase. Older adults self-identifying as belonging to a historically marginalized group, having visited an ED three or more times in the past 12 months, and living in a private dwelling, will be recruited using flyers posted at two emergency care sites and by an on-site research assistant. Data obtained through surveys, short answer questions, and chart review will be used to compile case profiles of patients from historically marginalized groups with potentially avoidable ED visits. Descriptive and inferential statistical analyses and inductive thematic analysis will be conducted. Findings will be interpreted using the Intersectionality-Based Policy Analysis Framework to identify the interconnections between unmet care needs, potentially avoidable ED admissions, structural inequalities, and the SDH. Semi-structured interviews will be conducted with a subset of older adults at risk of poor health outcomes based on SDH, family care partners, and health care professionals to validate preliminary findings and collect additional data on perceived facilitators and barriers to integrated and accessible care. DISCUSSION Exploring the linkages between potentially avoidable ED visits by older adults from marginalized groups and how their care experiences have been shaped by inequities in the systems, policies, and institutions that structure health and social care provision will enable researchers to offer recommendations for equity-focused policy and clinical practice reforms to improve patient outcomes and system integration.
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Affiliation(s)
- Krystal Kehoe MacLeod
- Bruyère Research Institute, Ottawa, Ontario, Canada.
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
- Horizon Health Network, Saint John, New Brunswick, Canada.
| | - Karyle Nama Flores
- Horizon Health Network, Saint John, New Brunswick, Canada
- Faculty of Health Sciences and Nursing, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Kavish Chandra
- Horizon Health Network, Saint John, New Brunswick, Canada
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
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Oblea PN, Adams AR, Nguyen-Wu ED, Hawley-Molloy JS, Balsam K, Badger TA, Witwer AR, Cartwright J. Lesbian Gay Bisexual Transgender and Queer Health-Care Experiences in a Military Population. JOURNAL OF HOMOSEXUALITY 2023; 70:1098-1118. [PMID: 35007488 DOI: 10.1080/00918369.2021.2015952] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
ABTRACTThis study aimed to understand the experiences of lesbian, gay, bisexual, transgender, and queer of former military service members. Data for this analysis was collected from the two open-ended survey questions as part of a larger online survey. The analysis was performed using the web-based data analysis application Dedoose. Eighty-eight qualitative responses were used. Analysis of the responses revealed five main themes: (1) identity, (2) negative experiences, (3) impact of experiences, (4) policy, and (5) positive experiences. These findings can influence future military research by focusing on the effects of the Don't Ask Don't Tell policy, negative and positive experiences, and the impact of those experiences.
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Affiliation(s)
- Pedro N Oblea
- Department of Inpatient Services, Center for Nursing Science and Clinical Inquiry, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Ashley R Adams
- Clinical Investigation Department, Naval Medical Center Camp Lejeune, Camp Lejeune, North Carolina, USA
| | - Elizabeth D Nguyen-Wu
- Department of Inpatient Services, Center for Nursing Science and Clinical Inquiry, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | | | - Kimberly Balsam
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Terry A Badger
- College of Nursing, Division of Community and Systems Health, University of Arizona, Tucson, Arizona, USA
| | - Amanda R Witwer
- School of Criminal Justice, Michigan State University, East Lansing, Michigan, USA
| | - Joel Cartwright
- Department of Behavioral Sciences and Leadership, United States Military Academy, West Point, New York, USA
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Goodyear T, Ferlatte O, Fast D, Salway T, Jenkins E, Robinson S, Knight R. Using photovoice to understand experiences of opioid use among sexual and gender minority youth in Vancouver, Canada. CULTURE, HEALTH & SEXUALITY 2023; 25:599-616. [PMID: 35622430 PMCID: PMC9701249 DOI: 10.1080/13691058.2022.2079153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/15/2022] [Indexed: 05/10/2023]
Abstract
In Canada, sexual and gender minority youth use opioids at disproportionately high rates. Yet, little is known about the distinct contexts of opioid use within this group, challenging capacity to develop well founded policy and practice supports. This case study aims to examine - in depth - the experiences and contexts of opioid use among a sample of four sexual and gender minority youth in Vancouver, Canada. Qualitative data from photovoice methods and in-depth, semi-structured interviews were collected in 2019. Analysis adopted a reflexive thematic approach from a critical interpretive standpoint, informed by minority stress theory. Three interconnected themes were constructed: (i) minoritised contexts of entry into and continuation of opioid use; (ii) mental health-maintaining and stress-mitigating effects of opioid use in the context of minoritisation; and (iii) intersections of stigma, violence and poverty with opioid use and minoritisation. Findings suggest that the health of sexual and gender minority youth who use opioids is shaped by minority stress and overlapping forms of structural marginalisation. They signal the need for responsive strategies that hold promise in supporting this population, including advancing integrated approaches to substance use and mental health care alongside interventions targeted towards the social and structural determinants of health.
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Affiliation(s)
- Trevor Goodyear
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Olivier Ferlatte
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- École de Santé Publique de l’Université de Montréal, Montreal, QC, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, QC, Canada
| | - Danya Fast
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Travis Salway
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Emily Jenkins
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Samantha Robinson
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Fort MP, Manson SM, Glasgow RE. Applying an equity lens to assess context and implementation in public health and health services research and practice using the PRISM framework. FRONTIERS IN HEALTH SERVICES 2023; 3:1139788. [PMID: 37125222 PMCID: PMC10137153 DOI: 10.3389/frhs.2023.1139788] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 03/13/2023] [Indexed: 05/02/2023]
Abstract
Dissemination and implementation science seeks to enhance the uptake, successful implementation, and sustainment of evidence-based programs and policies. While a focus on health equity is implicit in many efforts to increase access to and coverage of evidence-based programs and policies, most implementation frameworks and models do not explicitly address it. Disparities may in fact be increased by emphasizing high intensity interventions or ease of delivery over meeting need within the population, addressing deep-rooted structural inequities, and adapting to local context and priorities. PRISM (Practical, Robust Implementation and Sustainability Model), the contextual expansion of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework has several elements that address health equity, but these have not been explicated, integrated, or illustrated in one place. We present guidance for applying PRISM with an equity lens across its four context domains (external environment; multi-level perspectives on the intervention; characteristics of implementers and intended audience; and the implementation and sustainability infrastructure-as well as the five RE-AIM outcome dimensions. We then present an example with health equity considerations and discuss issues of representation and participation, representativeness and the importance of ongoing, iterative assessment of dynamic context and structural drivers of inequity. We also elaborate on the importance of a continuous process that requires addressing community priorities and responding to capacity and infrastructure needs and changes. We conclude with research and practice recommendations for applying PRISM with an increased emphasis on equity.
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Affiliation(s)
- Meredith P. Fort
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, United States
- Department of Health Systems, Management and Policy, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, United States
| | - Spero M. Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, United States
| | - Russell E. Glasgow
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Anschutz Medical Campus, and Eastern Colorado Veterans Administration, Aurora, CO, United States
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Horstmann S, Hartig C, Kraus U, Palm K, Jacke K, Dandolo L, Schneider A, Bolte G. Consideration of sex/gender in publications of quantitative health-related research: Development and application of an assessment matrix. Front Public Health 2023; 11:992557. [PMID: 37081952 PMCID: PMC10110874 DOI: 10.3389/fpubh.2023.992557] [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: 07/12/2022] [Accepted: 03/06/2023] [Indexed: 04/07/2023] Open
Abstract
During the last years the need to integrate sex and gender in health-related research for better and fairer science became increasingly apparent. Various guidelines and checklists were developed to encourage and support researchers in considering the entangled dimensions of sex/gender in their research. However, a tool for the assessment of sex/gender consideration and its visualization is still missing. We aim to fill this gap by introducing an assessment matrix that can be used as a flexible instrument for comprehensively evaluating the sex/gender consideration in quantitative health-related research. The matrix was developed through an iterative and open process based on the interdisciplinary expertise represented in our research team and currently published guidelines. The final matrix consists of 14 different items covering the whole research process and the publication of results. Additionally, we introduced a method to graphically display this evaluation. By developing the matrix, we aim to provide users with a tool to systematically compare sex/gender consideration qualitatively between different publications and even different fields of study. This way, the assessment matrix represents a tool to identify research gaps and a basis for future research. In the long term, the implementation of this tool to evaluate the consideration of sex/gender should contribute to more sex/gender equitable health-related research.
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Affiliation(s)
- Sophie Horstmann
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
- *Correspondence: Sophie Horstmann,
| | - Christina Hartig
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Ute Kraus
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
| | - Kerstin Palm
- Gender and Science Research Unit, Institute of History, Humboldt University of Berlin, Berlin, Germany
| | - Katharina Jacke
- Gender and Science Research Unit, Institute of History, Humboldt University of Berlin, Berlin, Germany
| | - Lisa Dandolo
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Alexandra Schneider
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
| | - Gabriele Bolte
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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Redmond M, Martin B. All in the (Definition of) Family: Transnational Parent-Child Relationships, Rights to Family Life, and Canadian Immigration Law. JOURNAL OF FAMILY ISSUES 2023; 44:766-784. [PMID: 36798515 PMCID: PMC9923200 DOI: 10.1177/0192513x211054461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
International human rights conventions, Canadian law and academic research all support the right to family life. Internationally and domestically, multiple definitions of family are recognized, acknowledging that long-term interpersonal commitments can be based on biological relationships as well as co-residential, legal, and emotional ties. Yet, the Canadian immigration system's limited and exclusionary understanding of parent-child relationships complicates migrant family reunification. Drawing on qualitative interview and survey data from separated families and key informants who support them, we analyze national status and class assumptions embedded in Canadian immigration standards. We argue that Canadian immigration policies disproportionately deny the right to family life to transnational Canadians and their children who hail from the Global South and/or who are socio-economically disadvantaged. Immigration policies neither recognize the globally accepted "best interests of the child" welfare standard nor the human right to family life. We offer suggestions for addressing these inequities in practice and policy.
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Affiliation(s)
- Melissa Redmond
- Carleton School of Social Work,
Carleton
University, Ottawa, ON, Canada
| | - Beth Martin
- Carleton School of Social Work,
Carleton
University, Ottawa, ON, Canada
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Peterson K, Ryan A, Antonelli M. Critical Reflection Practice in Nursing Health Care Policy Education. J Nurs Educ 2023; 62:312-315. [PMID: 36701131 DOI: 10.3928/01484834-20230105-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND A call to action is in effect for nurses to be change agents and bridge the gaps between the delivery of health care and the social needs of individuals, families, and communities. Response to this charge requires nurses to address long-standing inequity in health care policy and practice realms. METHOD This article describes the creative teaching-learning approach of critical reflection practice as a first step in developing skills and attitude for nurses to do this work. RESULTS Early observations of the effect of critical reflection practice on learners show improved appreciation for the intersection of social, economic, and political dimensions operating in health care policy and practice that influence health inequities. CONCLUSION When nurses engage in a practice of critical reflection, they are more likely to identify offensive social determinants, act to ameliorate disparities, and advance the agenda for health equity. [J Nurs Educ. 2023;62(X):XXX-XXX.].
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Estupiñán Fdez de Mesa M, Marcu A, Ream E, Whitaker KL. Relationship between intersectionality and cancer inequalities: a scoping review protocol. BMJ Open 2023; 13:e066637. [PMID: 36707112 PMCID: PMC9884887 DOI: 10.1136/bmjopen-2022-066637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Persistent inequalities in cancer care and cancer outcomes exist within and between countries. However, the evidence pertaining to the root causes driving cancer inequalities is mixed. This may be explained by the inadequate attention paid to experiences of patients with cancer living at the intersection of multiple social categories (eg, social class, ethnicity). This is supported by the intersectionality framework. This framework offers an alternative lens through which to analyse and understand how these interlocking systems of oppression uniquely shape the experiences of patients with cancer and drive inequalities. In this protocol, we outline a scoping review that will systematically map what is known about the relationship between intersectionality and inequalities in care experience and cancer outcomes of patients with cancer; and to determine how the intersectionality framework has been applied in studies across the cancer care pathway and across countries. METHODS AND ANALYSIS This study will be guided by Arksey and O'Malley's, and Levac et al's frameworks for scoping reviews. We will identify and map the evidence on cancer inequalities and intersectionality from 1989 to present date. Electronic databases (EMBASE, PsychINFO, CINAHL, Medline, Web of Science, ProQuest) and a systematic search strategy using a combination of keywords and Boolean operators AND/OR will be used to identify relevant studies. Screening of eligible papers and data extraction will be conducted by two independent reviewers, and disagreements resolved by discussion with the research team. We will use an iterative process to data charting using a piloted form. Findings will be collated into a narrative report. ETHICS AND DISSEMINATION Ethical approval is not required since data used are from publicly available secondary sources. Findings will be disseminated through peer-reviewed journals, conferences and stakeholder meetings. Further, findings will inform the next phases of a multistage research project aimed at understanding inequalities among patients with breast cancer.
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Affiliation(s)
| | - Afrodita Marcu
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Emma Ream
- School of Health Sciences, University of Surrey, Guildford, UK
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Lemkow–Tovías G, Lemkow L, Cash‐Gibson L, Teixidó‐Compañó E, Benach J. Impact of COVID-19 inequalities on children: An intersectional analysis. SOCIOLOGY OF HEALTH & ILLNESS 2023; 45:145-162. [PMID: 36181484 PMCID: PMC9538856 DOI: 10.1111/1467-9566.13557] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 08/31/2022] [Indexed: 05/07/2023]
Abstract
Societal concerns about the effects of the COVID-19 pandemic have largely focussed on the social groups most directly affected, such as the elderly and health workers. However, less focus has been placed on understanding the effects on other collectives, such as children. While children's physical health appears to be less affected than the adult population, their mental health, learning and wellbeing is likely to have been significantly negatively affected during the pandemic due to the varying policy restrictions, such as withdrawal from face to face schooling, limited peer-to-peer interactions and mobility and increased exposure to the digital world amongst other things. Children from vulnerable social backgrounds, and especially girls, will be most negatively affected by the impact of COVID-19, given their different intersecting realities and the power structures already negatively affecting them. To strengthen the understanding of the social determinants of the COVID-19 crisis that unequally influence children's health and wellbeing, this article presents a conceptual framework that considers the multiple axes of inequalities and power relations. This understanding can then be used to inform analyses and impact assessments, and in turn inform the development of effective and equitable mitigation strategies as well as assist to be better prepared for future pandemics.
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Affiliation(s)
- Gabriel Lemkow–Tovías
- Facultat de Ciències Socials de ManresaUniversitat Vic‐Universitat Central de Catalunya (UVic‐UCC)ManresaSpain
| | - Louis Lemkow
- Institut de Ciència i Tecnologia AmbientalsUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Lucinda Cash‐Gibson
- Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS‐EMCONET), Department of Political and Social SciencesUniversitat Pompeu FabraBarcelonaCataloniaSpain
- Johns Hopkins University ‐ Pompeu Fabra University Public Policy Center (UPF‐BSM)BarcelonaCataloniaSpain
- Pompeu Fabra University‐UPF Barcelona School of Management (UPF‐BSM)BarcelonaSpain
| | - Ester Teixidó‐Compañó
- Facultat de Ciències de la Salut de ManresaUniversitat Vic‐Universitat Central de Catalunya (UVic‐UCC)ManresaSpain
| | - Joan Benach
- Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS‐EMCONET), Department of Political and Social SciencesUniversitat Pompeu FabraBarcelonaCataloniaSpain
- Johns Hopkins University ‐ Pompeu Fabra University Public Policy Center (UPF‐BSM)BarcelonaCataloniaSpain
- Pompeu Fabra University‐UPF Barcelona School of Management (UPF‐BSM)BarcelonaSpain
- Ecological Humanities Research Group (GHECO)Universidad AutónomaMadridSpain
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Quinn S, Richards N, Gott M. Dying at home for people experiencing financial hardship and deprivation: How health and social care professionals recognise and reflect on patients’ circumstances. Palliat Care Soc Pract 2023; 17:26323524231164162. [PMID: 37025502 PMCID: PMC10071150 DOI: 10.1177/26323524231164162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/27/2023] [Indexed: 04/03/2023] Open
Abstract
Background: International palliative care policy often views home as the most desirable location for end-of-life care. However, people living in more deprived areas can worry about dying in poor material circumstances and report more benefits from hospital admission at the end of life. There is increasing recognition of inequities in the experience of palliative care, particularly for people living in more deprived areas. Promoting an equity agenda in palliative care means building healthcare professionals’ capacity to respond to the social determinants of health when working with patients near the end of their life. Objectives: The purpose of this article is to present data which reveal how some health and social care professionals view home dying for people experiencing financial hardship and deprivation. Design: This work was framed by social constructionist epistemology. Methods: Semi-structured qualitative interviews ( n = 12) were conducted with health and social care professionals who support people at the end of life. Participants were recruited from one rural and one urban health board area in Scotland, UK. Data collection occurred between February and October 2021. Analysis: Thematic analysis was used to analyse the interview data. Discussion: Our findings suggest that healthcare staff relied on physical clues in the home environment to identify if people were experiencing financial hardship, found discussions around poverty challenging and lacked awareness of how inequities intersect at the end of life. Health professionals undertook ‘placing’ work to try and make the home environment a suitable space for dying, but some barriers were seen as insurmountable. There was recognition that increased partnership working and education could improve patient experiences. We argue further research is needed to capture the perspectives of individuals with direct lived experience of end-of-life care and financial hardship.
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Affiliation(s)
| | - Naomi Richards
- End of Life Studies Group, School of
Interdisciplinary Studies, Dumfries Campus, University of Glasgow, Dumfries,
UK
| | - Merryn Gott
- Te Ārai Research Group – Palliative Care &
End of Life, School of Nursing, University of Auckland, Auckland, New
Zealand
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Public health services and intersectional stigma: a social sciences perspective with implications for HIV service design and delivery. Curr Opin HIV AIDS 2023; 18:18-26. [PMID: 36444656 DOI: 10.1097/coh.0000000000000769] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
PURPOSE OF REVIEW Understanding stigma is important for improving HIV care services and gaps in HIV service delivery have been attributed to stigma. This review article synthesizes recent evidence on stigma and its implications for HIV service design and delivery. Given the intersectional nature of stigma, we will focus on HIV stigma as well as related forms of stigma based on one's race, sexual identity, gender identity and other identities. RECENT FINDINGS Stigma remains a barrier to achieving equity in HIV services. Individualistic measures of stigma remain influential and are associated with barriers to accessing HIV health services. Recent work also highlights stigma measured at a structural level and its impact on HIV services contexts. Individuals situated at intersections of marginalized identities continue to face greatest injustices, and although intersectional approaches have been adapted to design services at a micro level, few focus on structural change. Recent evidence for mitigating stigma indicates some success for psychosocial interventions that target internalized stigma. Furthermore, community-led approaches show promise in addressing stigma that manifests in HIV health services settings. SUMMARY Interventions that address individual-level stigma and structural stigma are needed. Theoretical and applied antistigma research is needed to make HIV services more equitable.
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Nguse S. Intersectionality in South African health care – what is to be done? SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2022. [DOI: 10.1177/00812463221141528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The World Health Organization established a 2005 commission that sought to investigate the Social Determinants of Health and develop mitigating strategies and policies. This marked a shift from the individualized understanding of health and focused on systemic and socioeconomic factors that determine access to health care services and the quality of the available services. This is primarily important in low- and middle-income countries like South Africa, where poverty, unemployment, inequality, and other historical factors play a significant role in health care. Furthermore, the lingering impact of the apartheid system continues to define the social engineering of the South African society, and the availability of resources between the rich and the poor, and between different racial groups, with the Black majority receiving subpar services compared to the White minority. The post-1994 dispensation, which is characterized by corruption, mismanagement of funds, continued health service deficits, and other factors exacerbate the inadequate services that poor Black people receive. Therefore, this article proposes the application of the intersectional theoretical framework in understanding and addressing public health challenges. According to Crenshaw, the theoretical framework may be defined as the prism through which to understand the constellation of factors that affect one's identity in relation to systems of oppression, discrimination, and marginalization.
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Affiliation(s)
- Siphelele Nguse
- College of Humanities, University of KwaZulu-Natal, South Africa
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Lederer V, Messing K, Sultan-Taïeb H. How Can Quantitative Analysis Be Used to Improve Occupational Health without Reinforcing Social Inequalities? An Examination of Statistical Methods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:19. [PMID: 36612341 PMCID: PMC9819275 DOI: 10.3390/ijerph20010019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/15/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
Taking account of sex and gender in occupational health studies poses statistical challenges. Other sociodemographic variables, such as racialization, class, and age, also affect the relations between workplace exposures and health and interact with sex and gender. Our objective was to perform a critical review of conventional and emerging statistical tools, examining whether each analysis takes account of sociodemographic variables (1) in a way that contributes to identification of critical occupational determinants of health (2) while taking account of relevant population characteristics to reflect intersectional approaches to health and (3) using sample sizes and population characteristics available to researchers. A two-step search was conducted: (1) a scientific watch concerning the statistical tools most commonly used in occupational health over the past 20 years; (2) a screening of the 1980-2022 literature with a focus on emerging tools. Our examination shows that regressions with adjustment for confounders and stratification fail to reveal the sociodemographic mechanisms that interact with occupational health problems, endangering the identification of occupational risks. Multilevel (notably MAIHDA) analyses, decision tree, cluster, and latent analyses are useful methods to consider when seeking to orientate prevention. Researchers should consider methods that adequately reveal the mechanisms connecting sociodemographic variables and occupational health outcomes.
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Affiliation(s)
- Valérie Lederer
- Department of Industrial Relations, Université du Québec en Outaouais, Gatineau, QC J8X 3X7, Canada
| | - Karen Messing
- Department of Biological Sciences, Université du Québec à Montréal, Montreal, QC H3C 3P8, Canada
| | - Hélène Sultan-Taïeb
- Department of Organization and Human Resources, School of Management (ESG-UQAM), Université du Québec à Montréal, Montreal, QC H3C 3P8, Canada
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Husain L, Greenhalgh T, Hughes G, Finlay T, Wherton J. Desperately Seeking Intersectionality in Digital Health Disparity Research: Narrative Review to Inform a Richer Theorization of Multiple Disadvantage. J Med Internet Res 2022; 24:e42358. [PMID: 36383632 PMCID: PMC9773024 DOI: 10.2196/42358] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/20/2022] [Accepted: 11/16/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Digital consultations between patients and clinicians increased markedly during the COVID-19 pandemic, raising questions about equity. OBJECTIVE This study aimed to review the literature on how multiple disadvantage-specifically, older age, lower socioeconomic status, and limited English proficiency-has been conceptualized, theorized, and studied empirically in relation to digital consultations. We focused mainly on video consultations as they have wider disparities than telephone consultations and relevant data on e-consultations are sparse. METHODS Using keyword and snowball searching, we identified relevant papers published between 2012 and 2022 using Ovid MEDLINE, Web of Science, Google Scholar, and PubMed. The first search was completed in July 2022. Papers meeting the inclusion criteria were analyzed thematically and summarized, and their key findings were tabulated using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative Research criteria. Explanations for digital disparities were critically examined, and a search was undertaken in October 2022 to identify theoretical lenses on multiple disadvantage. RESULTS Of 663 articles from the initial search, 27 (4.1%) met our inclusion criteria. In total, 37% (10/27) were commentaries, and 63% (17/27) were peer-reviewed empirical studies (11/27, 41% quantitative; 5/27, 19% qualitative; 1/27, 4% mixed methods; 1/27, 4% systematic reviews; and 1/27, 4% narrative reviews). Empirical studies were mostly small, rapidly conducted, and briefly reported. Most studies (25/27, 93%) identified marked digital disparities but lacked a strong theoretical lens. Proposed solutions focused on identifying and removing barriers, but the authors generally overlooked the pervasive impact of multiple layers of disadvantage. The data set included no theoretically informed studies that examined how different dimensions of disadvantage combined to affect digital health disparities. In our subsequent search, we identified 3 theoretical approaches that might help account for these digital disparities. Fundamental cause theory by Link and Phelan addresses why the association between socioeconomic status and health is pervasive and persists over time. Digital capital theory by Ragnedda and Ruiu explains how people mobilize resources to participate in digitally mediated activities and services. Intersectionality theory by Crenshaw states that systems of oppression are inherently bound together, creating singular social experiences for people who bear the force of multiple adverse social structures. CONCLUSIONS A limitation of our initial sample was the sparse and undertheorized nature of the primary literature. The lack of attention to how digital health disparities emerge and play out both within and across categories of disadvantage means that solutions proposed to date may be oversimplistic and insufficient. Theories of multiple disadvantage have bearing on digital health, and there may be others of relevance besides those discussed in this paper. We call for greater interdisciplinary dialogue between theoretical research on multiple disadvantage and empirical studies on digital health disparities.
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Affiliation(s)
- Laiba Husain
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gemma Hughes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Teresa Finlay
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Funk LM, Mackenzie CS, Cherba M, Del Rosario N, Krawczyk M, Rounce A, Stajduhar K, Cohen SR. Where would Canadians prefer to die? Variation by situational severity, support for family obligations, and age in a national study. Palliat Care 2022; 21:139. [PMID: 35909120 PMCID: PMC9340714 DOI: 10.1186/s12904-022-01023-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Death at home has been identified as a key quality indicator for Canadian health care systems and is often assumed to reflect the wishes of the entire Canadian public. Although research in other countries has begun to question this assumption, there is a dearth of rigorous evidence of a national scope in Canada. This study addresses this gap and extends it by exploring three factors that moderate preferences for setting of death: situational severity (entailing both symptoms and supports), perceptions of family obligation, and respondent age.
Methods
Two thousand five hundred adult respondents from the general population were recruited using online panels between August 2019 and January 2020. The online survey included three vignettes, representing distinct dying scenarios which increased in severity based on symptom management alongside availability of formal and informal support. Following each vignette respondents rated their preference for each setting of death (home, acute/intensive care, palliative care unit, nursing home) for that scenario. They also provided sociodemographic information and completed a measure of beliefs about family obligations for end-of-life care.
Results
Home was the clearly preferred setting only for respondents in the mild severity scenario. As the dying scenario worsened, preferences fell for home death and increased for the other options, such that in the severe scenario, most respondents preferred a palliative care or hospice setting. This pattern was particularly distinct among respondents who also were less supportive of family obligation norms, and for adults 65 years of age and older.
Conclusions
Home is not universally the preferred setting for dying. The public, especially older persons and those expressing lower expectations of families in general, express greater preference for palliative care settings in situations where they might have less family or formal supports accompanied by more severe and uncontrolled symptoms. Findings suggest a) the need for public policy and health system quality indicators to reflect the nuances of public preferences, b) the need for adequate investment in hospices and palliative care settings, and c) continuing efforts to ensure that home-based formal services are available to help people manage symptoms and meet their preferences for setting of death.
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Dotti Sani GM, Molteni F, Sarti S. Boys Do Cry: Age and Gender Differences in Psycho-Physiological Distress during the COVID-19 Pandemic in Italy. APPLIED RESEARCH IN QUALITY OF LIFE 2022; 18:931-956. [PMID: 36405033 PMCID: PMC9664431 DOI: 10.1007/s11482-022-10120-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/21/2022] [Indexed: 05/11/2023]
Abstract
This article contributes to the quality of life literature by investigating gender and age gaps in psycho-physiological distress during the COVID-19 pandemic in Italy. Specifically, we investigate whether women experienced higher levels of distress than men, and if such gap can be explained by a greater negative reaction of women in the experience of a negative COVID-19 related event, such as the illness or death of a relative. Moreover, we explore whether age moderated or amplified the effect of a negative event on distress among women and men. To do so we rely on an ad hoc survey carried out between April 2020 and June 2021 in Italy, the first European country to be hit by the pandemic. Our results indicate that subjects who experienced the hospitalization or, more so, the death of a family member during the pandemic were more exposed to psycho-psychological distress compared to subjects who were not directly touched by COVID-19. Moreover, our results show that while women were on average more likely to express feelings of distress than men in absence of evident stressors, this gap disappeared among subjects who experience the death of a relative. Furthermore, our results indicate that experiencing a negative COVID-19 related event led to an increase in distress among all respondents except older men, who appeared to be the most resilient to the manifestation of any sign of distress. These results speak to important age and gender differences in the feelings and externalization of grief in the Italian context.
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Affiliation(s)
| | - Francesco Molteni
- Department of Social and Political Sciences, University of Milan, Milan, Italy
| | - Simone Sarti
- Department of Social and Political Sciences, University of Milan, Milan, Italy
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Al-Hamad A, Forchuk C, Oudshoorn A, Mckinley GP. Listening to the Voices of Syrian Refugee Women in Canada: an Ethnographic Insight into the Journey from Trauma to Adaptation. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2022; 24:1-21. [PMID: 36186909 PMCID: PMC9510543 DOI: 10.1007/s12134-022-00991-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2022] [Indexed: 11/15/2022]
Abstract
Syrian refugee women face many obstacles when accessing health services in host countries that are influenced by various cultural, structural, and practical factors. This paper is based on critical ethnographic research undertaken in Canada, to explore Syrian refugee women migration experiences. Also, we aim at critically examining how the intersection of gender, trauma, and violence, and the political and economic conditions of Syrian refugee women shapes their everyday lives and health. The study also investigates the strategies and practices by which Syrian refugee women are currently addressing their healthcare needs and the models of care that are suggested for meeting their physical and mental health needs. Findings show that these women experienced constant worries, hardship, vulnerability, and intrusion of dignity. These experiences and challenges were aggravated by the structure of the Canadian social and healthcare system. This study offers a better understanding of the impact of migration and trauma on Syrian refugee women's roles, responsibilities, gender dynamics, and interaction with Ontario's healthcare system to improve interaction and outcomes. Healthcare models should address these challenges among Syrian refugee families in Canada.
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Affiliation(s)
- Areej Al-Hamad
- Daphne Cockwell School of Nursing, Faculty of Community Services, DCC544, Toronto Metropolitan University, 288 Church St., Toronto, M5B 1Z5 Canada
| | - Cheryl Forchuk
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, FIMS & Nursing Building Room 2356, London, ON N6A 5B9 Canada
| | - Abe Oudshoorn
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, FIMS & Nursing Building Room 2356, London, ON N6A 5B9 Canada
| | - Gerald Patrick Mckinley
- Western Centre for Public Health and Family Medicine, Western University, Room 4115, London, ON N6A 5B9 Canada
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50
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Bindley K, Lewis J, Travaglia J, DiGiacomo M. Bureaucracy and burden: An Intersectionality-Based Policy Analysis of social welfare policy with consequences for carers of people with life-limiting illness. Palliat Med 2022; 37:543-557. [PMID: 36114642 DOI: 10.1177/02692163221122289] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND For informal carers of people with life-limiting illness, social welfare policy related to income support and housing has been associated with varied psychosocial issues, yet remains relatively under-explored. An intersectional approach offers potential to illuminate diverse experiences and implications. AIM To explore the way in which caring in the context of life-limiting illness is framed within welfare policy, to articulate inequities encountered by carers, and to identify policy and practice recommendations. DESIGN The Intersectionality-Based Policy Analysis (IBPA) Framework was used to situate findings of a broader qualitative study. SETTING/PARTICIPANTS Data were collected via semi-structured interviews with participants who were bereaved carers (n = 12), welfare workers (n = 14) and palliative care workers (n = 7), between November 2018 and April 2020, in an Australian region associated with socioeconomic disadvantage. Five elements of IBPA were applied to the products of analysis of this data. RESULTS Use of the IBPA Framework revealed that representations of carers and causes of their welfare needs in policy were underpinned by several assumptions; including that caring and grieving periods are temporary or brief, and that carers have adequate capacity to navigate complex systems. Policy and processes had differentiated consequences for carers, with those occupying certain social locations prone to accumulating disadvantage. CONCLUSIONS This intersectional analysis establishes critical exploration of the framing and consequences of welfare policy for carers of people with life-limiting illness, presented in a novel conceptual model. Implications relate to intersectoral development of structural competency, responsiveness to structurally vulnerable carers in clinical practice, and needed policy changes.
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Affiliation(s)
- Kristin Bindley
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,Supportive and Palliative Care, Western Sydney Local Health District, Mount Druitt, NSW, Australia
| | - Joanne Lewis
- School of Nursing and Health, Avondale University, Wahroonga, NSW, Australia.,School of Nursing and Midwifery, University of Technology Sydney, Ultimo, NSW, Australia
| | - Joanne Travaglia
- Health Services Management, School of Public Health, The University of Technology Sydney, Ultimo, NSW, Australia
| | - Michelle DiGiacomo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
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