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Pagaduan JE, Lazarescu C, Vallieres E, Skinner K, Zuckermann AM, Idzerda L. The impacts of the Nutrition North Canada program on the accessibility and affordability of perishable, nutritious foods among eligible communities: a scoping review. Int J Circumpolar Health 2024; 83:2313255. [PMID: 38346231 PMCID: PMC10863516 DOI: 10.1080/22423982.2024.2313255] [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: 08/23/2023] [Accepted: 01/29/2024] [Indexed: 02/15/2024] Open
Abstract
The Nutrition North Canada (NNC) program, introduced in April 2011 is a federal strategy to improve access to perishable, nutritious foods for remote and isolated communities in northern Canada by subsidising retailers to provide price reductions at the point of purchase. As of March 2023, 123 communities are eligible for the program. To evaluate existing evidence and research on the NNC program to inform policy decisions to improve the effectiveness of NNC. A scoping review of peer-reviewed articles was conducted in ten databases along with a supplemental grey literature search of government and non-government reports published between 2011 and 2022. The search yielded 172 publications for screening, of which 42 were included in the analysis. Narrative thematic evidence synthesis yielded 104 critiques and 341 recommendations of the NNC program across eight themes. The most-identified recommendations focus on transparency, communication, and support for harvesting, hunting, and community food initiatives. This review highlights recommendations informed by the literature to address critiques of the NNC program to improve food security, increase access to perishable and non-perishable items, and support community-based food initiatives among eligible communities. The review also identifies priority areas for future policy directions such as additional support for education initiatives, communication and transparency amidst program changes, and food price regulations.
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Affiliation(s)
- Jason Edward Pagaduan
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Calin Lazarescu
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Eric Vallieres
- Health Security and Regional Operations Branch, Public Health Agency of Canada, Montreal, Quebec, Canada
| | - Kelly Skinner
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Alexandra M.E. Zuckermann
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Leanne Idzerda
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
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McDowell K, Wetherill L, Pollock B, Halverson C, Ivanovich J. Exploring Genetic Counselors' Experiences with Indigenous Patient Populations. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02194-8. [PMID: 39382618 DOI: 10.1007/s40615-024-02194-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 09/22/2024] [Accepted: 09/24/2024] [Indexed: 10/10/2024]
Abstract
This study investigates the preparedness of genetic counselors in addressing the potentially unique elements and considerations of Indigenous patients in the United States and Canada. Considering the healthcare disparities Indigenous populations face, particularly in specialty care, this study aims to assess the preparedness of genetic counselors in addressing the unique needs and cultural considerations of Indigenous patients. An online survey was utilized, and a subset of participants was selected to be interviewed. Results reveal genetic counselors felt less competent with Indigenous patients compared to non-Indigenous patients, especially in specific aspects of genetic counseling such as responding to cultural issues or identifying resources. Factors such as increased years of experience and more exposure to Indigenous populations during graduate training correlated with higher self-rated competency. Despite a patient population that is on average 7% Indigenous by self-report, genetic counselors lacked exposure to Indigenous encounters in graduate programs and professional training. These findings underscore the importance of enhancing genetic counseling education and exposure to Indigenous training opportunities such as voluntary events or Indigenous guest speakers to improve cultural competency and address healthcare disparities for Indigenous communities.
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Affiliation(s)
- Kimberly McDowell
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, 975 W. Walnut Street IB130, Indianapolis, IN, 46202, USA
- Department of Maternal Fetal Health, Southcentral Foundation, Anchorage, USA
| | - Leah Wetherill
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, 975 W. Walnut Street IB130, Indianapolis, IN, 46202, USA
| | - Bethany Pollock
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, 975 W. Walnut Street IB130, Indianapolis, IN, 46202, USA
- Indiana University Health Physicians, Indianapolis, USA
| | - Colin Halverson
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
- Center for Bioethics, Indiana University School of Medicine, Indianapolis, USA
| | - Jennifer Ivanovich
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, 975 W. Walnut Street IB130, Indianapolis, IN, 46202, USA.
- Indiana University Health Physicians, Indianapolis, USA.
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Wang X, Li YJ, Zhou XY, Wu YJ, Huang HY, Zhang L, Mao AY, Chen W, Shi JF. Evaluation indicators for access to cancer screening services: a scoping review. Public Health 2024; 235:194-201. [PMID: 39153383 DOI: 10.1016/j.puhe.2024.07.003] [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: 01/11/2024] [Revised: 06/21/2024] [Accepted: 07/03/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVES Access to health services has received increasing attention, and the International Agency for Research on Cancer (IARC) includes 'availability' as one of the indicators to evaluate cancer screening. Evaluating, monitoring, and decision-making on cancer screening depends on systematic quantitative evidence on access to cancer screening, but indicators are currently inconsistently, if they are reported at all. This can be improved by developing systematic indicators for evaluating and reporting access to cancer screening. This requires a thorough understanding of current indicators of access to cancer screening. STUDY DESIGN Scoping review. METHODS We completed a scoping review of studies on access to cancer screening services from 2013 to 2022. The relevant indicators were extracted, quantified, and then matched to two widely used frameworks: a universal five-dimensional conceptual framework for access to healthcare ('U5D') and a cancer-specific framework/list on the availability/use of screening indicators endorsed by the IARC. RESULTS A total of 331 studies on access to cancer screening services were included. Based on the U5D framework, publications from supply side reported approachability (number of publications = 16), acceptability (6), availability and accommodation (44), affordability (30), and appropriateness (11); among this process, 17 sub-indicators were identified. Correspondingly, publications from demand side reported ability to perceive (170), ability to seek (85), ability to reach (58), ability to pay (59), and ability to engage (2); 26 sub-indicators were identified. More macroscopically, the publications of the IARC-endorsed indicators reported availability of policies and guidelines for screening (13), type of screening provided (3), extent of population coverage and participation rates (76), and demographic/behavioural related considerations (167). By integrating the universal and cancer-specific frameworks, a new adapted framework was proposed. CONCLUSIONS This study identified and collated indicators for evaluating access to cancer screening services, and determined the gaps in the current application of various indicators. The findings are anticipated to facilitate further development of an evaluation indicator system for access to cancer screening services.
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Affiliation(s)
- X Wang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Y-J Li
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - X-Y Zhou
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Y-J Wu
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - H-Y Huang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - L Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - A-Y Mao
- Department of Public Health Strategy Research, Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China
| | - W Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - J-F Shi
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
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4
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Ye J, Yang L, Axelin A, Likitalo S, Wen C, Li X. The implementation and strategy of triadic communication in pediatric oncology: a scoping review. Pediatr Res 2024:10.1038/s41390-024-03590-w. [PMID: 39304788 DOI: 10.1038/s41390-024-03590-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 09/04/2024] [Accepted: 09/09/2024] [Indexed: 09/22/2024]
Abstract
Triad child-parent-professional communication is considered a priority in evaluating and optimizing therapeutic alliance in pediatric oncology. This scoping review aimed to map the existing evidence in implementation, influencing factors, and strategies of triadic communication in pediatric oncology. Using Arksey and O'Malley's framework, we searched 5 databases and grey literature until June 15th, 2024. Two researchers selected studies and extracted data independently. The PAGER framework was employed to summarize the implications of existing research to inform future research and practice. A total of 24 articles were included. Healthcare professionals usually initiate triadic communication. Communication topics rarely focused on prognosis, emotions, and end-of-life care. The triad child-parent-professional exhibited similarities in language, emotional, and decision-making communication preferences but differed regarding skills and information preferences. The roles of the triad parts were unclear, especially nurses' role, responsibilities, and contributions were seldom specified. Factors influencing the implementation spanned individual, organizational, and socio-cultural levels. Five types including 21 specific suggested strategies were identified to facilitate implementation, yet few strategies were adopted by patients and caregivers, and limited effectiveness studies have evaluated specific strategies. Overall, while triadic communication has received considerable attention in the world, its practical implementation in real-world settings remains largely underdeveloped. IMPACT: Our research has mapped the global trajectories of triadic communication between child-parent-professional throughout the cancer journey. A precise delineation of roles and responsibilities within the triadic communication framework in pediatric oncology is crucial for augmenting collaborative efforts and achieving optimal coordination among stakeholders. Healthcare professionals could partner with families to comprehend individual communication preferences, cultivating a collaborative relationship that honors each participant's needs and enhances informed decision-making. The findings equip healthcare professionals with a range of strategies to navigate communication with children with cancer and their parents.
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Affiliation(s)
- Jinlin Ye
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
| | - Lei Yang
- School of Nursing, Shandong Xiehe University, Jinan, Shandong Province, China
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Susanna Likitalo
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Chuan Wen
- Department of Pediatrics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xianhong Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China.
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Potts B, Doran CM, Begg SJ. A Comparison of an Australian First Nations Primary Healthcare Data Specification with Potentially Preventable Hospitalisations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1192. [PMID: 39338075 PMCID: PMC11431243 DOI: 10.3390/ijerph21091192] [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: 07/02/2024] [Revised: 08/26/2024] [Accepted: 09/03/2024] [Indexed: 09/30/2024]
Abstract
Potentially Preventable Hospitalisations (PPH) is a widely used indicator of the effectiveness of non-hospital care. Specified using the International Classification of Diseases (ICD) coding, PPH comprises a suite of health conditions that could have potentially been prevented with appropriate care. The most recent edition of the National Guide to a Preventative Health Assessment for First Nations People documents the health conditions of interest to providers of primary care, many of which are not represented in PPH. Given the National Guide has been developed specifically with First Nations in mind, the aim of this research is twofold. The first aim is to formally posit the question of whether a summative measure of hospitalisations aligned diagnostically to the National Guide has value either as an alternative or complement to PPH in the context of First Nations primary health information. The second aim is to develop and present a prototype ICD-10 data specification for such a measure, referred to as the First Nations primary healthcare (FNPHC) data specification, and examine the age-standardised hospitalisation rates for FNPHC and PPH for correlations and/or differences. Age-standardised hospitalisation rates from 2016-17 to 2019-20 using both classifications were examined to assess the usefulness and relevance of summative measures of hospitalisations for informing primary care. Rates of FNPHC for principal diagnoses were between 1.5 and 2.5 times higher than those of PPH and approximately between 6 and 12 times higher for additional diagnoses. There was a strong correlation with PPH when rates were compared across all observations: jurisdictions with higher rates of PPH tended to have higher rates of hospitalisations according to the custom specification. Findings support its application as a summary measure for First Nations primary care providers. Given the policy landscape in Australia that aims to close the gap, it is imperative that measures of primary health take advantage of the concepts and application of First Nations data sovereignty and governance. The validity and cultural appropriateness of the First Nations primary health data specification needs to be further researched.
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Affiliation(s)
- Boyd Potts
- Cluster for Resilience and Wellbeing, Appleton and Manna Institutes, Central Queensland University, Brisbane, QLD 4701, Australia
| | - Christopher M Doran
- Cluster for Resilience and Wellbeing, Appleton and Manna Institutes, Central Queensland University, Brisbane, QLD 4701, Australia
| | - Stephen J Begg
- Violet Vines Marshman Centre for Rural Health Research, La Trobe University, Bendigo, VIC 3550, Australia
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6
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Naidoo T, Chamunyonga C, Burbery J, Rutledge P. Cultural safety in radiation therapy education: Identifying knowledge deficits to improve Indigenous health practice. J Med Radiat Sci 2024. [PMID: 39245952 DOI: 10.1002/jmrs.819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 08/14/2024] [Indexed: 09/10/2024] Open
Abstract
Reducing health disparities for Aboriginal and Torres Strait Islander peoples requires the integration of cultural safety into healthcare education. This commentary paper addresses cultural safety in the context of the radiation therapy profession and emphasises the importance of making practitioners aware of the knowledge gaps in healthcare practice. The educational strategies to improve cultural awareness amongst undergraduate students and qualified radiation therapists (RTs) are explored. The authors propose a range of recommendations to enhance cultural awareness amongst RTs in the context of Indigenous Australian care, aimed at promoting improved experiences for Aboriginal and Torres Strait Islander peoples receiving cancer care. Curriculum integration and development of initiatives such as workshops and interactive yarning groups are highlighted as pivotal platforms that foster continuous learning in radiation therapy.
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Affiliation(s)
- Thashmira Naidoo
- Faculty of Health, School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Radiation Oncology Princess Alexandra Hospital Raymond Terrace, South Brisbane, Queensland, Australia
| | - Crispen Chamunyonga
- Faculty of Health, School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Julie Burbery
- Faculty of Health, School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peta Rutledge
- Faculty of Health, School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
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7
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Wiens D, Smolik IA, MacKay D, Fowler-Woods A, Robinson DB, Barnabe C, El-Gabalawy HS, O'Neil LJ. Perceived Access to Healthcare of Indigenous Peoples in Canada With Rheumatoid Arthritis and Their First-Degree Relatives. J Rheumatol 2024; 51:654-662. [PMID: 38428959 DOI: 10.3899/jrheum.2023-1080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE There are complex and interrelated factors that lead to inequitable healthcare delivery in Canada. Many of the factors that underlie these inequities for Canada's geographically dispersed Indigenous peoples remain underexamined. METHODS A cohort of 831 First Nations (FN) individuals from urban and remote communities were recruited into a longitudinal study of rheumatoid arthritis (RA) risk from 2005 to 2017. Data from each participant's initial enrollment visit were assessed using a survey that captured concerns with healthcare access. RESULTS We found that remote participants with RA reported poor access compared to remote first-degree relatives (FDRs; P < 0.001); this difference was not observed for urban participants with RA. We observed substantial differences based on sex; female participants perceived access to care to be more difficult than male participants in both urban and remote cohorts (P < 0.001). We also observed that male participants with RA reported poor access to care compared to male FDRs. Importantly, access to care in remote communities appeared to improve over the duration of the study (P = 0.01). In a logistic regression analysis, female sex, remote location, and older age were independent predictors of poor access to care. Predictors of poor access in participants with RA also included female sex, remote location, and older age. CONCLUSION FN peoples living in remote communities, particularly those with an established RA diagnosis, report more problems accessing health care. Sex-based inequities exist, with FN female individuals reporting greater difficulties in accessing appropriate health care, regardless of RA diagnosis. Addressing these sex-based inequities should be a high priority for improving healthcare delivery.
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Affiliation(s)
- Dana Wiens
- D. Wiens, BSc, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba
| | - Irene A Smolik
- I.A. Smolik, PhD, D.B. Robinson, MD, H.S. El-Gabalawy, MD, L.J. O'Neil, MD, MHSc, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba
| | - Dylan MacKay
- D. MacKay, PhD, Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Amanda Fowler-Woods
- A. Fowler-Woods, PhD, Ongomiizwin Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - David B Robinson
- I.A. Smolik, PhD, D.B. Robinson, MD, H.S. El-Gabalawy, MD, L.J. O'Neil, MD, MHSc, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba
| | - Cheryl Barnabe
- C. Barnabe, MD, MSc, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Hani S El-Gabalawy
- I.A. Smolik, PhD, D.B. Robinson, MD, H.S. El-Gabalawy, MD, L.J. O'Neil, MD, MHSc, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba
| | - Liam J O'Neil
- I.A. Smolik, PhD, D.B. Robinson, MD, H.S. El-Gabalawy, MD, L.J. O'Neil, MD, MHSc, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba;
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8
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Kenny M, Raos R, Ahmad F, Gonzalez A. Assessing Health Equity in Partnership with Children's Mental Health Organizations: Considerations Before the Implementation of Parenting Programs. Health Equity 2024; 8:419-425. [PMID: 39015219 PMCID: PMC11250835 DOI: 10.1089/heq.2023.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 07/18/2024] Open
Abstract
Objectives Understanding and addressing how an individual's social, political, economic, and cultural context affects their ability to achieve optimal health is essential to designing and implementing interventions. Before evaluating two parenting programs, in partnership with four children's mental health organizations, we used the Health Equity Impact Assessment tool (HEIA) to identify groups that may experience unintended health impacts, as well as generated mitigation strategies to address these impacts. Methods HEIA activities included a review of the published literature, a review of organizational documents, key informant interviews with staff (n = 12) and other related community service providers (n = 7), and a geographic information systems analysis. All sources of evidence were considered and analyzed using reflective thematic analysis. Summary reports were shared with all partners. Results A range of groups were identified as at risk of experiencing unintended health impacts, including caregivers who are racialized, immigrants, Indigenous, living with mental health issues or addictions, dealing with intellectual challenges and/or low literacy levels, survivors of childhood trauma, single parent families, or families experiencing financial difficulties. Unintended health impacts were sorted into 6 main themes which fell under the overarching themes of accessibility of the programs and cultural appropriateness. Mitigation strategies as well as innovative strategies already being applied by participating organizations are discussed. Conclusion Although this HEIA focused on parenting programs, the findings address equity issues applicable to the provision of a wide spectrum of children's mental health services.
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Affiliation(s)
- Meghan Kenny
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
| | - Rob Raos
- Geographic Information Systems Analyst, McMaster University, Hamilton, Canada
| | - Fatima Ahmad
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
- Offord Centre for Child Studies, Hamilton, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
- Offord Centre for Child Studies, Hamilton, Canada
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9
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Tootell N, McGaw J, Patten UH, Vance A. 'Doing culture' in contemporary south-eastern Australia: how Indigenous people are creating and maintaining strong cultural identities for improved health and wellbeing. BMC Public Health 2024; 24:1707. [PMID: 38926813 PMCID: PMC11210033 DOI: 10.1186/s12889-024-19146-w] [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: 11/13/2023] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Indigenous people in Australia experience far poorer health than non-Indigenous Australians. A growing body of research suggests that Indigenous people who are strong in their cultural identity experience better health than those who are not. Yet little is known about how Indigenous people create and maintain strong cultural identities in the contemporary context. This paper explores how Indigenous people in south-eastern Australia create and maintain strong cultural identities to support their health and wellbeing. METHODS Data were collected from 44 Indigenous people living in the south-eastern Australian state of Victoria via yarning. Yarning is a cultural mode of conversation that privileges Indigenous ways of knowing, doing and being. Yarning participants were selected for their prominence within Victorian Indigenous health services and/or their prominence within the Victorian Indigenous community services sector more broadly. Due to the restrictions of COVID-19, yarns were conducted individually online via Zoom. Data were analysed employing constructivist grounded theory, which was the overarching qualitative research methodology. RESULTS All yarning participants considered maintaining a strong cultural identity as vital to maintaining their health and wellbeing. They did this via four main ways: knowing one's Mob and knowing one's Country; connecting with one's own Mob and with one's own Country; connecting with Community and Country more broadly; and connecting with the more creative and/or expressive elements of Culture. Importantly, these practices are listed in order of priority. Indigenous people who either do not know their Mob or Country, or for whom the connections with their own Mob and their own Country are weak, may therefore be most vulnerable. This includes Stolen Generations survivors, their descendants, and others impacted by historical and contemporary child removal practices. CONCLUSIONS The yarns reveal some of the myriad practical ways that Indigenous people maintain a strong cultural identity in contemporary south-eastern Australia. While programs designed to foster connections to Community, Country and/or Culture may benefit all Indigenous participants, those most disconnected from their Ancestral roots may benefit most. Further research is required to determine how best to support Indigenous Victorians whose connections to their own Mob and their own Country are unable to be (re)built.
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Affiliation(s)
| | - Janet McGaw
- University of Melbourne, Melbourne, Australia
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10
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Marchand M, McCallum RK, Marchand K, Anand SS, Moulson N, Taylor CM, Dulay D. Indigenizing Cardiac Rehabilitation: The Role for Cultural Adaptation. Can J Cardiol 2024; 40:1069-1076. [PMID: 38081512 DOI: 10.1016/j.cjca.2023.12.006] [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: 10/27/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 04/14/2024] Open
Abstract
Cardiac rehabilitation (CR) is an integral component of cardiovascular care, which reduces morbidity and mortality, and improves quality of life. Largely as a result of Canada's colonial history, Indigenous communities face higher rates of cardiovascular morbidity and mortality. Indigenous Peoples in Canada have a unique cultural, historical, and geographic context that limits access to high-quality cardiovascular care, including CR, which has traditionally been delivered in an urban, hospital-based setting. Culturally adapted, holistic exercise and diet programs and CR programs have been successful in Canada, Australia, and New Zealand, demonstrating acceptability to the community, safety, and improvements in cardiovascular risk factors. Key components of a successful culturally adapted CR program include program leadership and development by Indigenous community members and key partners, cultural sensitivity training for health care providers and financial and geographic accessibility. Encouragement of traditional practices, including healthy traditional dietary practices, and recognizing land-based activities as exercise have also proved important in the successful delivery of CR in Indigenous communities. This review summarizes the current evidence for culturally adapted CR programming for Indigenous patients, including strategies to engage communities in education on cardiovascular risk-factor optimization and to promote guideline-based exercise and diet through an Indigenous lens.
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Affiliation(s)
- Miles Marchand
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada; Member of the Syilx Okanagan First Nation, British Columbia, Canada.
| | - Rylan K McCallum
- Centre for Heart and Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Member of the Manitoba Métis Federation, Manitoba, Canada
| | - Keegan Marchand
- Member of the Syilx Okanagan First Nation, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sonia S Anand
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nathaniel Moulson
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carolyn M Taylor
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daisy Dulay
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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11
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Kwaitana D, Bates MJ, Msowoya E, van Breevoort D, Mildestvedt T, Meland E, Umar E. Primary health care challenges: insights from older people with multimorbidity in Malawi - a qualitative study. BMC Public Health 2024; 24:1434. [PMID: 38811955 PMCID: PMC11134922 DOI: 10.1186/s12889-024-18947-3] [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: 03/26/2024] [Accepted: 05/24/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND The global population is undergoing a significant surge in aging leading to increased susceptibility to various forms of progressive illnesses. This phenomenon significantly impacts both individual health and healthcare systems. Low and Middle Income Countries face particular challenges, as their Primary Health Care (PHC) settings often lack the necessary human and material resources to effectively address the escalating healthcare demands of the older people. This study set out to explore the experiences of older people living with progressive multimorbidity in accessing PHC services in Malawi. METHODS Between July 2022 and January 2023, a total of sixty in-depth interviews were conducted with dyads of individuals aged ≥ 50 years and their caregivers, and twelve healthcare workers in three public hospitals across Malawi's three administrative regions. The study employed a stratified selection of sites, ensuring representation from rural, peri-urban, and urban settings, allowing for a comprehensive comparison of diverse perspectives. Guided by the Andersen-Newman theoretical framework, the study assessed the barriers, facilitators, and need factors influencing PHC service access and utilization by the older people. RESULTS Three themes, consistent across all sites emerged, encompassing barriers, facilitators, and need factors respectively. The themes include: (1) clinic environment: inconvenient clinic setup, reliable PHC services and research on diabetic foods; (2) geographical factors: available means of transportation, bad road conditions, lack of comprehensive PHC services at local health facility and need for community approaches; and (3) social and personal factors: encompassing use of alternative medicine, perceived health care benefit and support with startup capital for small-scale businesses. CONCLUSION This research highlights the impact of various factors on older people's access to and use of PHC services. A comprehensive understanding of the barriers, facilitators, and specific needs of older people is essential for developing tailored services that effectively address their unique challenges and preferences. The study underscores the necessity of community-based approaches to improve PHC access for this demographic. Engaging multiple stakeholders is important to tackle the diverse challenges, enhance PHC services at all levels, and facilitate access for older people living with progressive multimorbidity.
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Affiliation(s)
- Duncan Kwaitana
- Department of Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi.
| | - Maya Jane Bates
- Department of Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | | | - Thomas Mildestvedt
- Department of Global Public Health and Primary Care, University of Bergen, Oslo, Norway
| | - Eivind Meland
- Department of Global Public Health and Primary Care, University of Bergen, Oslo, Norway
| | - Eric Umar
- Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi
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Hayvon JC. Action against inequalities: a synthesis of social justice & equity, diversity, inclusion frameworks. Int J Equity Health 2024; 23:106. [PMID: 38783319 PMCID: PMC11119020 DOI: 10.1186/s12939-024-02141-3] [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: 01/25/2024] [Accepted: 03/03/2024] [Indexed: 05/25/2024] Open
Abstract
Inequalities in health have long been recognized as interconnected with social, economic, and various other inequalities. The application of social justice and equity, diversity, inclusion (EDI) frameworks may help expand interdisciplinary perspectives in addressing inequalities. This review study conducted an environmental scan for existing syntheses of theories, models, and frameworks (TMFs) relevant to the social justice and EDI. Results from Web of Science, Scopus, PubMed, CINAHL, PsychINFO, and MEDLINE retrieved an existing implementation science framework intently centered upon health inequalities, and draws from a synthesis of postcolonial theory, reflexivity, intersectionality, structural violence, and governance theory. Given this high degree of relevance to the objective of this review, the framework was selected as a basis for expanded synthesis. Subsequent processes sought to identify social justice TMFs which could be integrated into the base framework selected, as well as to refine scope of the study. Based upon considerations of level of evidence and non-tokenistic integration, the following social justice and EDI TMFs were identified: John Rawls' theory of justice; Amartya Sen's Capabilities Approach; Iris Marion Young's theories of justice; Paulo Freire's critical consciousness; and critical race theory (CRT). The focus of the synthesis performed was scoped towards minimizing potential harms arising from actions intending to reduce inequalities. EDI considerations were not collated into a singular construct, but rather extended as a separate component assessing inequitable distribution of risks and benefits given population heterogeneity. Reflexive analysis amended the framework with two key decisions: first, the integration of environmental justice into a single construct, which helps to inform Rawls' and Sen's TMFs; second, a temporal element of sequential-analysis was employed over a unified output. The result of synthesis consists of a three-component framework which: (1) presents sixteen constructs drawn from selected TMFs, to consider various harms or potential reinforcement of existing inequalities; (2) aims to de-invisibilize marginalized groups who are noted to experience inequitable outcomes, and acknowledges the presence of individuals belonging to multiple groups; and (3) synthesizes seven considerations related to equitable dissemination and evaluation as drawn from TMFs, separated for sequential analysis after assessment of harms.
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Paterson C, Roberts C, Blackburn J, Jojo N, Northam HL, Wallis E, Hind A, Caulfield R, Barratt M, Toohey K, Kavanagh PS, Bacon R, Wilson RL. Understanding the needs and preferences for cancer care among First Nations people: An integrative review. J Adv Nurs 2024; 80:1776-1812. [PMID: 38018290 DOI: 10.1111/jan.15968] [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: 03/21/2023] [Revised: 10/23/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023]
Abstract
AIM This systematic review aimed to identify the needs and preferences for cancer care services among Australian First Nations people. DESIGN Integrative review. DATA SOURCES An integrative review was conducted. A wide range of search terms were used to increase the sensitivity and specificity of the searches in electronic databases. Methodological quality assessment, data extraction, was conducted independently by two reviewers, and a narrative synthesis was conducted. RESULTS Forty-two studies were included. A total of 2965 Australian First Nations adults, both men and women of various ages across the lifespan, were represented; no First Nations children affected by cancer were represented in the studies. Three themes emerged which included: (1) discrimination, racism and trauma, resulting from colonization, directly impacted First National people's cancer care experience; (2) cultural ways of knowing, being and doing are fundamental to how First Nations people engage with cancer care services; and (3) First Nations people need culturally safe person-centred cancer care services that address practical needs. CONCLUSION Most participants represented in this review experienced discrimination, racism and trauma, resulting from colonization, which directly negatively impacted Aboriginal peoples' cancer care experience. While the Optimal Cancer Pathway (OCP) was launched in Australia several years ago, people with cancer may continue to experience distressing unmet care needs. PATIENT OR PUBLIC CONTRIBUTION Our team includes both First Nations people, non-First Nations researchers and healthcare professionals with expertise in cancer care. The researchers employed decolonizing restorative approaches to ensure voice, respect, accountability and reciprocity in this review work. IMPLICATIONS FOR NURSING PRACTICE Members of the multidisciplinary team including nurses and policymakers should reflect on these findings, ensure that they have up-to-date cultural safety training and stand together with Indigenous and non-Indigenous cancer leaders to take proactive steps to stamp out and dismantle oppression in health, and safely implement the OCP.
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Affiliation(s)
- C Paterson
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
- Central Adelaide Local Health Network, Adelaide, South Australia, Australia
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
- Robert Gordon University, Aberdeen, UK
| | - C Roberts
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - J Blackburn
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - N Jojo
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - H L Northam
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - E Wallis
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - A Hind
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - R Caulfield
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - M Barratt
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - K Toohey
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
- Faculty of Health, Southern Cross University, Gold Coast, Queensland, Australia
| | - P S Kavanagh
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
- Justice and Society, University of South Australia, Magill, South Australia, Australia
| | - R Bacon
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - R L Wilson
- School of Nursing and Midwifery, University of Newcastle, Gosford, New South Wales, Australia
- School of Nursing, Massey University, Palmerston North, New Zealand
- Descendent of the Wiradjuri Nation (First Nations Person), New South Wales, Australia
- Department of Nursing, RMIT University, Melbourne, Victoria, Australia
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Clifford-Motopi A, Brown Nununccal R, White Palawa Iningai A, Harald Gangulu P, Butler D, Mathew S, Mackenzie J, Eaton M, Mills R. Aboriginal and Torres Strait Islander community members' experiences of care in an urban Aboriginal Community Controlled Health Service transforming to a Patient Centred Medical Home. Aust J Prim Health 2024; 30:PY23163. [PMID: 38739738 DOI: 10.1071/py23163] [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: 09/14/2023] [Accepted: 04/15/2024] [Indexed: 05/16/2024]
Abstract
Background Few studies have examined patient experiences of the Patient Centred Medical Home (PCMH). This qualitative study explores the experiences of patients of an urban Aboriginal Community Controlled Health Service during its transition to a model of a PCMH. Methods Twenty-eight community members who were registered as patients of an urban Aboriginal Community Controlled Health Service were purposively recruited to participate in yarning interviews. Yarns were conducted using a guide containing open-ended questions in the same domains as those used in patient satisfaction surveys at the participating clinic. Data from yarns were analysed by Aboriginal and non-Indigenous researchers using thematic analysis. The interpretations of Aboriginal and Torres Strait Islander researchers were privileged in the analysis. Results Key themes highlighted the importance of relationships, connectedness, and personal growth and empowerment to community members' health and wellbeing, which they described as a journey of healing and recovery. Delays in implementing a process to empanel patients in a care team meant that most community members were unaware a PCMH had been implemented. However, community members commonly reported a more welcoming environment, more contact with the same doctor and more involvement of Aboriginal Health Workers in their care. Conclusions Aboriginal and Torres Strait Islander community members' narratives of their experiences bear evidence of the acceptability of a PCMH model for delivery in Aboriginal Community Controlled Health Services to improve relational care between patients and health staff. A patient-directed empanelment process has been implemented to better connect patients to their care team in the clinic, and the role of the Aboriginal Health Worker reshaped to strengthen connections between patients and their care team in and outside the clinic.
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Affiliation(s)
- Anton Clifford-Motopi
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia; and The University of Queensland, Poche Centre for Indigenous Health, 74 High Street, Toowong, Qld 4066, Australia
| | - Renee Brown Nununccal
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia
| | | | - Patrice Harald Gangulu
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia
| | - Danielle Butler
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia; and National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Saira Mathew
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia; and The University of Queensland, Poche Centre for Indigenous Health, 74 High Street, Toowong, Qld 4066, Australia
| | - Julie Mackenzie
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia
| | - Martie Eaton
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia
| | - Richard Mills
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld 4030, Australia
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Shakya P, Sood M, Mathur R, Prajapati N, Patil V. Pathways to care and barriers in treatment among patients with Dissociative disorders. Asian J Psychiatr 2024; 95:104000. [PMID: 38507864 DOI: 10.1016/j.ajp.2024.104000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/02/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Dissociative disorder patients often present with sudden and embarrassing symptoms, and it is difficult for the patient and care giver to understand initially, recognize the need for help and reach for appropriate treatment timely. This can result in high risk of engaging in dangerous behaviors such as self-harm and suicidal acts, impaired global functioning, and poor quality of life. Knowledge about the types of barriers which are there in treatment seeking, can help in planning strategies for their removal and to facilitate the treatment process. METHODS Cross-sectional study among patients (n=133) with Dissociative disorders which were recruited from January 2023 to June 2023 in a tertiary care hospital. Pathways to care and barriers in treatment for Dissociative disorders were assessed by interviewing patients using semi-structured proforma. The Dissociative Experience Scale and World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0)) were used to assess disease severity and impact of illness on various domains of life respectively. Group comparison was made to assess differences in social- clinical profile of patients choosing different modalities of treatment. RESULTS 133 patients of Dissociative disorders with mean age 29.6±9.2, showed their first-choice of help seeking from general practitioner/ neurologist (40.6%), traditional faith healers (35.3%), psychiatrist (18.1%) and 5.2% preferred alternative treatments. This trend changed with 2nd and 3rd contact of help seeking with greater preference for psychiatrist in their 2nd (n=45, 33.8%) and 3rd (n=69, 51.8%) contact. The median duration of untreated illness was 56 weeks (IQR 24-182 weeks). Social-clinical profile of patients varied with their choice of treatment, having lower education level (P = 0.013), longer duration of untreated illness (p=0.003), more severity of symptoms (p=0.032) and greater disability scores(p=0.002) in patients whose first treatment choice was traditional faith healers. More than 70% patients faced availability barriers, stigma, unawareness about mental illness and influence of others in treatment of choice as barriers in initiating and continuing treatment. CONCLUSION Patients with Dissociative disorders seek treatment from a multitude of healthcare providers including traditional faith healers, general physicians, and alternative medicine practitioners before reaching psychiatrist and undergoes various barriers in treatment. There is need to implement necessary measures for sensitization and awareness about Dissociative disorders to prevent prolonged and undue delays in initiation of appropriate management.
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Affiliation(s)
- Pooja Shakya
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Mamta Sood
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Rahul Mathur
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Nisha Prajapati
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Vaibhav Patil
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
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Sehgal A, Henderson R, Murry A, Crowshoe LL, Barnabe C. Advancing health equity for Indigenous peoples in Canada: development of a patient complexity assessment framework. BMC PRIMARY CARE 2024; 25:144. [PMID: 38684966 PMCID: PMC11057171 DOI: 10.1186/s12875-024-02362-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 04/03/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Indigenous patients often present with complex health needs in clinical settings due to factors rooted in a legacy of colonization. Healthcare systems and providers are not equipped to identify the underlying causes nor enact solutions for this complexity. This study aimed to develop an Indigenous-centered patient complexity assessment framework for urban Indigenous patients in Canada. METHODS A multi-phased approach was used which was initiated with a review of literature surrounding complexity, followed by interviews with Indigenous patients to embed their lived experiences of complexity, and concluded with a modified e-Delphi consensus building process with a panel of 14 healthcare experts within the field of Indigenous health to identify the domains and concepts contributing to health complexity for inclusion in an Indigenous-centered patient complexity assessment framework. This study details the final phase of the research. RESULTS A total of 27 concepts spanning 9 domains, including those from biological, social, health literacy, psychological, functioning, healthcare access, adverse life experiences, resilience and culture, and healthcare violence domains were included in the final version of the Indigenous-centered patient complexity assessment framework. CONCLUSIONS The proposed framework outlines critical components that indicate the presence of health complexity among Indigenous patients. The framework serves as a source of reference for healthcare providers to inform their delivery of care with Indigenous patients. This framework will advance scholarship in patient complexity assessment tools through the addition of domains not commonly seen, as well as extending the application of these tools to potentially mitigate racism experienced by underserved populations such as Indigenous peoples.
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Affiliation(s)
- Anika Sehgal
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
| | - Rita Henderson
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Adam Murry
- Department of Psychology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Lynden Lindsay Crowshoe
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
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Bourdon G, Lenne X, Godart F, Storme L, Theis D, Subtil D, Bruandet A, Rakza T. Epidemiology of congenital heart defects in France from 2013 to 2022 using the PMSI-MCO (French Medical Information System Program in Medicine, Surgery, and Obstetrics) database. PLoS One 2024; 19:e0298234. [PMID: 38626139 PMCID: PMC11020754 DOI: 10.1371/journal.pone.0298234] [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: 07/26/2023] [Accepted: 01/19/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Congenital heart defects are common and occur in approximately 0.9% of births. In France, the registries cover approximately 20% of the population but not the entirety of France; therefore, we aimed to update the incidence data for congenital heart defects in France from 2013 to 2022 using the medico-administrative database PMSI-MCO (French Medical Information System Program in Medicine, Surgery, and Obstetrics). We aimed to compare the frequency of risk factors in a population with congenital heart defects and a reference population. METHODS From 2013 to 2022, we included children aged < 3 years diagnosed with congenital heart defects according to the International Classification of Diseases, 10th Revision, in the PMSI-MCO database. We compared them with a population without congenital defects on several medical data items (e.g., parity, gemellarity, and mortality rate). Bivariate and multivariate analyses compared children with congenital heart defects and children without congenital malformation. RESULTS We identified 83,879 children with congenital heart defects in France from 2013 to 2022 in the PMSI-MCO database and 7,739,840 children without such defects, including 7,218,952 without any congenital defects. We observed more deaths (7.49% vs. 0.68%, d = 0.59) and more twinning (8.67% vs. 1.23%, d = 0.35) among children with congenital heart defects. Multivariate analysis revealed an increased risk of congenital heart defects in male individuals (OR [odds ratio] 1.056, 95% CI [confidence interval] [1.039-1.076]) and cases of medically assisted reproduction (OR 1.115, 95% CI [1.045-1.189]) and a reduced risk in the case of multiparity (OR 0.921, 95% CI [0.905-0.938]). CONCLUSIONS According to the PMSI-MCO database, the incidence of congenital heart defects in France from 2013 to 2022 is 1% of births. Congenital heart defects are more frequent in cases of prematurity, twinning, primiparity, male sex, and maternal age > 40 years.
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Affiliation(s)
- Gurvan Bourdon
- Maternity Unit, Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France
| | - Xavier Lenne
- Department of Medical Information, Lille University Hospital, Lille, France
| | - François Godart
- Cardiology Unit, Department of Pediatrics, Lille University Hospital, Lille, France
| | - Laurent Storme
- Department of Neonatology, Lille University Hospital, Lille, France
| | - Didier Theis
- Department of Medical Information, Lille University Hospital, Lille, France
| | - Damien Subtil
- Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France
| | - Amelie Bruandet
- Department of Medical Information, Lille University Hospital, Lille, France
| | - Thameur Rakza
- Maternity Unit, Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France
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McGannan M, Grant L, Fearon D, Dozier M, Barber-Fleming V. Palliative care needs of people and/or their families with serious and/or chronic health conditions in low- or middle-income country (LMIC) humanitarian settings-a systematic scoping review protocol. Syst Rev 2024; 13:105. [PMID: 38605398 PMCID: PMC11007922 DOI: 10.1186/s13643-024-02521-4] [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: 01/05/2023] [Accepted: 03/26/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Palliative care in low- or middle-income country (LMIC) humanitarian settings is a new area, experiencing a degree of increased momentum over recent years. The review contributes to this growing body of knowledge, in addition to identifying gaps for future research. The overall aim is to systematically explore the evidence on palliative care needs of patients and/or their families in LMIC humanitarian settings. METHODS Arksey and O'Malley's (Int J Soc Res Methodol. 8:19-32, 2005) scoping review framework forms the basis of the study design, following further guidance from Levac et al. (Implement Sci 5:1-9, 2010), the Joanna Briggs Institute (JBI) Peters et al. (JBI Reviewer's Manual JBI: 406-452, 2020), and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) from Tricco et al. (Ann Intern Med 169:467-73, 2018). This incorporates a five-step approach and the population, concept, and context (PCC) framework. Using already identified key words/terms, searches for both published research and gray literature from January 2012 to October 2022 will be undertaken using databases (likely to include Cumulative Index of Nursing and Allied Health (CINAHL), MEDLINE, Embase, Global Health, Scopus, Applied Social Science Index and Abstracts (ASSIA), Web of Science, Policy Commons, JSTOR, Library Network International Monetary Fund and World Bank, Google Advanced Search, and Google Scholar) in addition to selected pre-print sites and websites. Data selection will be undertaken based on the inclusion and exclusion criteria and will be reviewed at each stage by two reviewers, with a third to resolve any differences. Extracted data will be charted in a table. Ethical approval is not required for this review. DISCUSSION Findings will be presented in tables and diagrams/charts, followed by a narrative description. The review will run from late October 2022 to early 2023. This is the first systematic scoping review specifically exploring the palliative care needs of patients and/or their family, in LMIC humanitarian settings. The paper from the review findings will be submitted for publication in 2023.
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Affiliation(s)
- Michelle McGannan
- Deanery of Molecular, Genetic and Population Health Sciences, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
| | - Liz Grant
- Global Health and Development-Centre for Global Health, Deanery of Molecular, Genetic and Population Health Sciences, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - David Fearon
- Deanery of Molecular, Genetic and Population Health Sciences, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Marshall Dozier
- Library Academic Support, University of Edinburgh, Edinburgh, UK
| | - Victoria Barber-Fleming
- Advanced Care Research Centre (ACRC), College of Medicine and Veterinary Medicine and School of Engineering, University of Edinburgh, Edinburgh, UK
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Balkaran K, Linton J, Doupe M, Roger K, Kelly C. Research on Abuse in Home Care: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:885-897. [PMID: 37078630 PMCID: PMC10913332 DOI: 10.1177/15248380231165922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Home care is the preferred care option for most people who need support; yet abuse exists in these settings toward both home care workers and clients. There are no existing reviews that assess the scope of current research on abuse in home care, and tangentially related reviews are dated. For these reasons, a scoping review is warranted to map the current state of research on abuse in home care and examine current interventions in this field. Databases selected for searching were Medline and EMBASE on OVID, Scopus, and the following databases in EBSCOhost: Academic Search Complete, AgeLine, and Cumulative Index to Nursing and Allied Health Literature. Records were included if: (a) they were written in English; (b) the participants were home care workers or clients age 18 years or older; (c) they were published in journals; (d) they undertook empirical research; and (e) they were published within the last 10-year period. Following Graham et al. (2006), the 52 included articles are categorized as either knowledge inquiry or as intervention studies. We find three themes among knowledge inquiry studies: (1) prevalence and types of abuse in home care, (2) abuse in the context of living with dementia, and (3) working conditions and abuse. Analysis from the intervention studies suggest that not all organizations have specific policies and practices to prevent abuse, and no existing interventions to protect the well-being of clients were identified. Findings from this review can inform up-to-date practice and policymaking to improve the health and well-being of home care clients and workers.
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Yadav UN, Davis JM, Bennett-Brook K, Coombes J, Wyber R, Pearson O. A rapid review to inform the policy and practice for the implementation of chronic disease prevention and management programs for Aboriginal and Torres Strait Islander people in primary care. Health Res Policy Syst 2024; 22:34. [PMID: 38509612 PMCID: PMC10956197 DOI: 10.1186/s12961-024-01121-x] [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: 10/26/2023] [Accepted: 02/10/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND More than 35% of Aboriginal and Torres Strait Islander adults live with cardiovascular disease, diabetes, or chronic kidney disease. There is a pressing need for chronic disease prevention and management among Aboriginal and Torres Strait Islander people in Australia. Therefore, this review aimed to synthesise a decade of contemporary evidence to understand the barriers and enablers of chronic disease prevention and management for Aboriginal and Torres Strait Islander People with a view to developing policy and practice recommendations. METHODS We systematically searched for peer-reviewed published articles between January 2014 to March 2023 where the search was performed using subject headings and keywords related to "Aboriginal and Torres Strait Islander peoples," "Chronic Disease," and "Primary Health Care". Quality assessment for all included studies was conducted using the Aboriginal and Torres Strait Islander Quality Appraisal Tool. The data were extracted and summarised using a conventional content analysis approach and applying strength-based approaches. RESULTS Database searches identified 1653 articles where 26 met inclusion criteria. Studies varied in quality, primarily reporting on 14 criteria of the Aboriginal and Torres Strait Islander Quality Appraisal Tool. We identified six key domains of enablers and barriers of chronic disease prevention and management programs and implied a range of policy and practice options for improvement. These include culturally acceptable and safe services, patient-provider partnerships, chronic disease workforce, primary health care service attributes, clinical care pathways, and accessibility to primary health care services. This review also identified the need to address social and cultural determinants of health, develop the Aboriginal and Torres Strait Islander and non-Indigenous chronic disease workforce, support multidisciplinary teams through strengthening clinical care pathways, and engage Aboriginal and Torres Strait Islander communities in chronic disease prevention and management program design and delivery. CONCLUSION Enabling place-based partnerships to develop contextual evidence-guided strategies that align with community priorities and aspirations, with the provision of funding mechanisms and models of care through policy and practice reforms will strengthen the chronic disease prevention and management program for Aboriginal and Torres Strait Islander people.
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Affiliation(s)
- Uday Narayan Yadav
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, ACT, Australia.
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.
| | | | | | | | - Rosemary Wyber
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, ACT, Australia
- Telethon Kids Institute, Perth, WA, Australia
| | - Odette Pearson
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Faculty of Health and Medical Science, University of Adelaide, Adelaide, SA, Australia
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Bedi S, Strachan R, Zehbe I. Awareness of human papillomavirus infection among Indigenous males in North America and Oceania: a Scoping Review. Cancer Causes Control 2024; 35:437-449. [PMID: 37831275 DOI: 10.1007/s10552-023-01804-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 09/15/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE Human papillomavirus (HPV) is the most commonly transmitted sexually transmitted infection. HPV infections have been on the rise among males, especially in the form of oropharyngeal cancer. Despite this, there is a gap in healthcare guidelines to increase HPV vaccine administration among males. In this study, we focus on the Indigenous population of North America and Oceania to determine existing barriers resulting in low HPV vaccination rates among the population. METHOD We surveyed peer-reviewed literature on the awareness of HPV infection among Indigenous males in North America and Oceania. Using keywords HPV plus male, men or boy, and ethnical filters such as Indigenous, Aboriginal or First Nations, we retrieved 54 articles based on titles, of which 15 were included after reading the abstracts. RESULTS Reported HPV awareness was generally low in Indigenous males in North America, with no peer-reviewed data from Oceania. The lower understanding by males compared to females was largely attributable to misconceptions about HPV-related diseases, their transmission, and prevention. Lack of awareness and concern toward the risk of contracting HPV infection in Indigenous males suggests an impediment in disseminating health information about this cancer-causing virus. CONCLUSION Culturally sensitive education, with emphasis on Indigenous males, is needed to improve this group's HPV knowledge. Researchers should also engage meaningfully with Indigenous communities by building rapport to achieve a positive change in attitude.
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Affiliation(s)
- Simran Bedi
- Biology Department, Lakehead University, Thunder Bay, ON, P7B5E1, Canada.
| | - Robert Strachan
- Biology Department, Lakehead University, Thunder Bay, ON, P7B5E1, Canada
- Probe Development and Biomarker Exploration, Thunder Bay Regional Research Institute, Thunder Bay, ON, Canada
| | - Ingeborg Zehbe
- Biology Department, Lakehead University, Thunder Bay, ON, P7B5E1, Canada
- Probe Development and Biomarker Exploration, Thunder Bay Regional Research Institute, Thunder Bay, ON, Canada
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22
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Martins LOM, Dos Reis MF, Chaoubah A, Rego G. Distributive justice and equity in resource allocation: a temporal analysis of hospitalization costs in indigenous populations in Brazil. Int J Equity Health 2024; 23:21. [PMID: 38317184 PMCID: PMC10845569 DOI: 10.1186/s12939-024-02102-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION In Brazil, a country of continental dimensions, the health needs of each region have an impact. In this context and the name of the principle of equity, the SUS organizes actions especially aimed at social groups such as the elderly, children, pregnant women, and indigenous peoples. The concept of justice proposed by John Rawls is one of equity, which is essential to this country. METHODS This is an ecological, descriptive study, which analyzed hospital spending on cardiovascular diseases in the Unified Health System (SUS) among the indigenous elderly population and other ethnicities/colors in Brazil, between 2010 and 2019. RESULTS Hospitalization costs and fatality rates for indigenous populations and other colors/ethnicities, between 2010 and 2019, were evaluated. A reduction in hospitalization costs for the indigenous population and an increase in other populations was observed throughout the historical series, while there was an increase in fatality rates for both groups. A comparison was made between hospitalization costs and the fatality rates of indigenous populations and other colors/ethnicities according to sex, between 2010 and 2019. It was observed that regardless of sex, there are significant differences (p<0.05) between hospitalization costs and fatality rates, with higher costs for patients of other colors/ethnicities and higher fatality rates for the indigenous population. CONCLUSIONS Hospitalization costs due to cardiovascular diseases in elderly people from indigenous populations were lower compared to other ethnicities in most federative units, which may suggest an unequal allocation of resources or access for this indigenous population to the SUS. Although there is no strong correlation between spending on hospital admissions and fatality rates, it was found that these rates increased between 2010 and 2019, while spending was reduced.
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Ladia MAJ, Belizario VY, Cubarrubias DLPF, Agustin AMD. Accessibility of Soil-transmitted Helminthiasis Control Strategies in Selected Indigenous People Communities in the Philippines. ACTA MEDICA PHILIPPINA 2024; 58:25-33. [PMID: 38939852 PMCID: PMC11199370 DOI: 10.47895/amp.vi0.6439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
Background Indigenous peoples (IPs) remain vulnerable to soil-transmitted helminthiasis (STH) due to limited access to sanitary toilets, clean water, quality health education, and services. The World Health Organization recommends periodic mass drug administration (MDA) of anthelminthics, health education, and improvements in water, sanitation, and hygiene (WASH) as control strategies to reduce morbidities caused by STH in target populations such as school-age children (SAC).This paper complements the published results of the parasitological survey (prevalence and intensity of STH) conducted in selected Aeta and Ata-Manobo communities. Objectives This study aimed to describe the accessibility of STH control strategies to respond to the needs of SAC in IP communities in Pampanga and Davao del Norte, the Philippines. It likewise intended to describe access of these IP communities to STH control strategies. Methods Data on accessibility of and access to STH control strategies were collected using key informant interviews (KIIs) and focus group discussions (FGDs). Eleven officials and workers from the departments of health and education, local government units, and two IP leaders were interviewed on the existing STH burden in SAC, implementation of STH control strategies, particularly of MDA, health education campaigns, and improvements in WASH including good practices and challenges in program implementation.Three FGDs with parents, elementary school teachers of IP schools, and rural health midwives were conducted separately. Guide questions focused on accessibility of and access to STH prevention and control strategies for SAC in IP communities. Informed consent to conduct and record KIIs and FGDs were obtained from participants prior to participation.Analysis of a multi-disciplinary team was based on the accessibility framework for IPs accessing indigenous primary health care services by Davy et al. (2016). Results The characteristics of the STH control strategies and the target populations are interrelated factors that influence accessibility. Challenges in the availability of the MDA program, particularly, inadequate staffing, drug shortages, and delays in delivery affect accessibility of and access to the free STH control strategies. Perceived harm, adverse events, stigma, beliefs, and practices likewise affect access. Lack of information on the similarity of treatment through community- and school-based MDA programs also affected engagement of SAC.IP communities are special settings where geographic isolation, peace and order situation as well as water supply need to be considered to help ensure access to STH control strategies, high MDA coverage, and improvements in WASH leading to desired outcomes. Conclusions Considering the context of IP communities and addressing the challenges in the accessibility of and access to STH control strategies are necessary to ensure successful implementation of an integrated approach in STH prevention and control strategies. Challenges in the accessibility of STH control strategies are inadequate staffing, poor inventory, and delays in the delivery of drugs, as well as poor sanitation and hygiene. Access of SAC is likewise affected by misconceptions on safety and efficacy of anthelminthics, including stigma and cultural practices. The similarity of the MDA programs based in school or community need to be disseminated.
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Affiliation(s)
- Mary Ann J. Ladia
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila
| | - Vicente Y. Belizario
- Department of Parasitology, College of Public Health, University of the Philippines Manila
- Neglected Tropical Diseases Study Group, National Institutes of Health, University of the Philippines Manila
| | | | - Audrey Marie D.L. Agustin
- Neglected Tropical Diseases Study Group, National Institutes of Health, University of the Philippines Manila
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Shiraz M, Capaldi CA, Ooi LL, Roberts KC. Health care barriers and perceived mental health among adults in Canada during the COVID-19 pandemic: a population-based cross-sectional study. Health Promot Chronic Dis Prev Can 2024; 44:21-33. [PMID: 38231090 PMCID: PMC10849610 DOI: 10.24095/hpcdp.44.1.03] [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: 01/18/2024]
Abstract
INTRODUCTION The perceived mental health of individuals in Canada who faced health care barriers during the COVID-19 pandemic is underexplored. METHODS We analyzed data collected March to June 2021 from adults who reported needing health care services within the past 12 months in the Survey on Access to Health Care and Pharmaceuticals during the Pandemic. Unadjusted and adjusted logistic regression analyses examined the associations between health care barriers (appointment scheduling problems, delaying contacting health care) and high self-rated mental health and perceived worsening mental health compared to before the pandemic, overall and stratified by gender, age group, number of chronic health conditions and household income tertile. RESULTS Individuals who experienced pandemic-related appointment changes or had appointments not yet scheduled were less likely to have high self-rated mental health (aOR = 0.81 and 0.64, respectively) and more likely to have perceived worsening mental health (aOR = 1.50 and 1.94, respectively) than those with no scheduling problems. Adults who delayed contacting health care for pandemic-related reasons (e.g. fear of infection) or other reasons were less likely to have high self-rated mental health (aOR = 0.52 and 0.45, respectively) and more likely to have perceived worsening mental health (aOR = 2.31 and 2.43, respectively) than those who did not delay. Delaying contacting health care for pandemic-related reasons was associated with less favourable perceived mental health in all subgroups, while the association between perceived mental health and pandemic-related appointment changes was significant in some groups. CONCLUSION Health care barriers during the pandemic were associated with less favourable perceived mental health. These findings could inform health care resource allocation and public health messaging.
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Affiliation(s)
- Mehrunnisa Shiraz
- McGill University, Montréal, Quebec, Canada
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | | | - Laura L Ooi
- Public Health Agency of Canada, Ottawa, Ontario, Canada
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25
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Keramat SA, Perales F, Alam K, Rashid R, Haque R, Monasi N, Hashmi R, Siddika F, Siddiqui ZH, Ali MA, Gebremariam ND, Kondalsamy-Chennakesavan S. Multimorbidity and health-related quality of life amongst Indigenous Australians: A longitudinal analysis. Qual Life Res 2024; 33:195-206. [PMID: 37587324 PMCID: PMC10784343 DOI: 10.1007/s11136-023-03500-3] [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] [Accepted: 07/27/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND The burden of multimorbidity has been observed worldwide and it has significant consequences on health outcomes. In Australia, health-related quality of life (HRQoL) is comparatively low amongst Aboriginal and/or Torres Strait Islanders, yet no studies have examined the effect of multimorbidity on HRQoL within this at-risk population. This study seeks to fill that gap by employing a longitudinal research design. METHODS Longitudinal data were derived from three waves (9, 13, and 17) of the household, income and labour dynamics in Australia (HILDA) Survey. A total of 1007 person-year observations from 592 Aboriginal and/or Torres Strait Islander individuals aged 15 years and above were included. HRQoL was captured using the 36-item Short-Form Health Survey (SF-36), and multimorbidity was defined using self-reports of having been diagnosed with two or more chronic health conditions. Symmetric fixed-effects linear regression models were used to assess how intraindividual changes in multimorbidity were associated with intraindividual changes in HRQoL. RESULTS Approximately 21% of Indigenous Australians were classified as experiencing multimorbidity. Respondents had statistically significantly lower HRQoL on the SF-36 sub-scales, summary measures, and health-utility index in those observations in which they experienced multimorbidity. Among others, multimorbidity was associated with lower scores on the SF-36 physical-component scale (β = - 6.527; Standard Error [SE] = 1.579), mental-component scale (β = - 3.765; SE = 1.590) and short-form six-dimension utility index (β = - 0.075; SE = 0.017). CONCLUSION This study demonstrates that having multiple chronic conditions is statistically significantly associated with lower HRQoL amongst Indigenous Australians. These findings suggest that comprehensive and culturally sensitive health strategies addressing the complex needs of individuals with multimorbidity should be implemented to improve the HRQoL of Indigenous Australians.
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Affiliation(s)
- Syed Afroz Keramat
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia.
- Economics Discipline, Khulna University, Khulna, 9208, Bangladesh.
| | - Francisco Perales
- School of Social Science, The University of Queensland, Michie Building (#9), St Lucia, Brisbane, QLD, 4067, Australia
| | - Khorshed Alam
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Rumana Rashid
- Economics Discipline, Khulna University, Khulna, 9208, Bangladesh
| | - Rezwanul Haque
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Nahid Monasi
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Rubayyat Hashmi
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Farzana Siddika
- Department of Mathematics and Natural Sciences, BRAC University, Dhaka, Bangladesh
| | - Zubayer Hassan Siddiqui
- Department of Business Administration, Bangladesh University of Professionals, Dhaka, Bangladesh
| | - Mohammad Afshar Ali
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
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Charchar FJ, Prestes PR, Mills C, Ching SM, Neupane D, Marques FZ, Sharman JE, Vogt L, Burrell LM, Korostovtseva L, Zec M, Patil M, Schultz MG, Wallen MP, Renna NF, Islam SMS, Hiremath S, Gyeltshen T, Chia YC, Gupta A, Schutte AE, Klein B, Borghi C, Browning CJ, Czesnikiewicz-Guzik M, Lee HY, Itoh H, Miura K, Brunström M, Campbell NR, Akinnibossun OA, Veerabhadrappa P, Wainford RD, Kruger R, Thomas SA, Komori T, Ralapanawa U, Cornelissen VA, Kapil V, Li Y, Zhang Y, Jafar TH, Khan N, Williams B, Stergiou G, Tomaszewski M. Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension. J Hypertens 2024; 42:23-49. [PMID: 37712135 PMCID: PMC10713007 DOI: 10.1097/hjh.0000000000003563] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/12/2023] [Accepted: 08/22/2023] [Indexed: 09/16/2023]
Abstract
Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools.
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Affiliation(s)
- Fadi J. Charchar
- Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Australia
- Department of Physiology, University of Melbourne, Melbourne, Australia
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Priscilla R. Prestes
- Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Australia
| | - Charlotte Mills
- Department of Food and Nutritional Sciences, University of Reading, Reading, UK
| | - Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang
- Department of Medical Sciences, School of Medical and Live Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Francine Z. Marques
- Hypertension Research Laboratory, School of Biological Sciences, Monash University
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne
| | - James E. Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Liffert Vogt
- Department of Internal Medicine, Section Nephrology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands
| | - Louise M. Burrell
- Department of Medicine, University of Melbourne, Austin Health, Melbourne, Australia
| | - Lyudmila Korostovtseva
- Department of Hypertension, Almazov National Medical Research Centre, St Petersburg, Russia
| | - Manja Zec
- School of Nutritional Sciences and Wellness, University of Arizona, Tucson, USA
- Colorado Program for Musculoskeletal Research, Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Mansi Patil
- Department of Nutrition and Dietetics, Asha Kiran JHC Hospital, Chinchwad
- Hypertension and Nutrition, Core Group of IAPEN India, India
| | - Martin G. Schultz
- Department of Internal Medicine, Section Nephrology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands
| | | | - Nicolás F. Renna
- Unit of Hypertension, Hospital Español de Mendoza, School of Medicine, National University of Cuyo, IMBECU-CONICET, Mendoza, Argentina
| | | | - Swapnil Hiremath
- Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, Canada
| | - Tshewang Gyeltshen
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Yook-Chin Chia
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, Selangor
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Abhinav Gupta
- Department of Medicine, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, India
| | - Aletta E. Schutte
- School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, New South Wales, Australia
- Hypertension in Africa Research Team, SAMRC Unit for Hypertension and Cardiovascular Disease, North-West University
- SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Britt Klein
- Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Australia
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, Faculty of Medicine, University of Bologna, Bologna, Italy
| | - Colette J. Browning
- Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Australia
| | - Marta Czesnikiewicz-Guzik
- School of Medicine, Dentistry and Nursing-Dental School, University of Glasgow, UK
- Department of Periodontology, Prophylaxis and Oral Medicine; Jagiellonian University, Krakow, Poland
| | - Hae-Young Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hiroshi Itoh
- Department of Internal Medicine (Nephrology, Endocrinology and Metabolism), Keio University, Tokyo
| | - Katsuyuki Miura
- NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Norm R.C. Campbell
- Libin Cardiovascular Institute, Department of Medicine, University of Calgary, Calgary, Canada
| | | | - Praveen Veerabhadrappa
- Kinesiology, Division of Science, The Pennsylvania State University, Reading, Pennsylvania
| | - Richard D. Wainford
- Department of Pharmacology and Experimental Therapeutics, The Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston
- Division of Cardiology, Emory University, Atlanta, USA
| | - Ruan Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Shane A. Thomas
- Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Australia
| | - Takahiro Komori
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Udaya Ralapanawa
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Vikas Kapil
- William Harvey Research Institute, Centre for Cardiovascular Medicine and Devices, NIHR Barts Biomedical Research Centre, BRC, Faculty of Medicine and Dentistry, Queen Mary University London
- Barts BP Centre of Excellence, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Yan Li
- Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai
| | - Yuqing Zhang
- Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences, Chinese Hypertension League, Beijing, China
| | - Tazeen H. Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Nadia Khan
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Bryan Williams
- University College London (UCL), Institute of Cardiovascular Science, National Institute for Health Research (NIHR), UCL Hospitals Biomedical Research Centre, London, UK
| | - George Stergiou
- Hypertension Centre STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester
- Manchester Academic Health Science Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
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de Oliveira LA, dos Santos Barbosa M, Leite Torres AJ, Croda MG, Oliveira da Silva B, dos Santos PCP, Rossoni R, Machado LOCL, Croda J, Maymone Gonçalves CC, Marques MF, da Silva Ferreira T, Sardi SI, Campos GS, de Almeida GB, Alves Gomes MM, Marchioro SB, Simionatto S. Seroprevalence Of SARS-COV-2 infection in asymptomatic indigenous from the largest Brazilian periurban area. PLoS One 2023; 18:e0295211. [PMID: 38134187 PMCID: PMC10745159 DOI: 10.1371/journal.pone.0295211] [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: 08/24/2023] [Accepted: 11/15/2023] [Indexed: 12/24/2023] Open
Abstract
This study assessed the seroprevalence of SARS-CoV-2 in 496 asymptomatic individuals from Mato Grosso do Sul, located in Dourados, the largest periurban indigenous area in Brazil, from January 25 to February 4, 2021. The volunteers participated before receiving their first dose of the CoronaVac inactivated vaccine. For screening, blood samples were collected and analyzed using SARS-CoV-2 rapid tests and the enzyme-linked immunosorbent assay (ELISA). We observed varying trends in total anti-SARS-CoV-2 antibodies across different variables. Seropositivity among the participants tested was 63.70% (316/496) using the rapid test and 52.82% (262/496) were positive using the ELISA method. The majority of participants identified with the Guarani-Kaiowá ethnic group, with 66.15% (217/328), and other ethnic groups with 58.84% (193/328). The median age of the subjects was 30.5 years, with 79.57% (261/328) being femaleThis research showed the elevated seroprevalence of SARS-CoV-2 antibodies in asymptomatic Brazilians. The findings indicate a high seropositivity rate among the asymptomatic indigenous population of Midwest Brazil. This underscores the overlooked status of these communities and underscores the need for targeted national initiatives that emphasize the protection of vulnerable ethnic groups in the fight against COVID-19.
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Affiliation(s)
| | - Marcelo dos Santos Barbosa
- Health Science Research Laboratory, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
| | - Alex José Leite Torres
- Laboratory of Immunology and Molecular Biology, Institute of Health Sciences, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Mariana Garcia Croda
- School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Bruna Oliveira da Silva
- Health Science Research Laboratory, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
| | | | - Regina Rossoni
- Health Science Research Laboratory, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
| | | | - Julio Croda
- School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
- Oswaldo Cruz Foundation, Campo Grande, Mato Grosso do Sul, Brazil
| | - Crhistinne Cavalheiro Maymone Gonçalves
- School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
- State Secretariat of Health of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Michele Ferreira Marques
- Health Science Research Laboratory, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
| | - Tiago da Silva Ferreira
- Health Science Research Laboratory, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
| | - Silvia Inês Sardi
- Laboratory of Immunology and Molecular Biology, Institute of Health Sciences, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Gubio Soares Campos
- Laboratory of Immunology and Molecular Biology, Institute of Health Sciences, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Gabriel Barroso de Almeida
- Laboratory of Immunology and Molecular Biology, Institute of Health Sciences, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Marilia Maria Alves Gomes
- Health Science Research Laboratory, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
| | - Silvana Beutinger Marchioro
- Laboratory of Immunology and Molecular Biology, Institute of Health Sciences, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Simone Simionatto
- Health Science Research Laboratory, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
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Knisley L, Driedger SM, Hartling L, Chartrand F, Sanguins J, Scott SD. We're here too: child health information-seeking experiences and preferences of Red River Métis families - a qualitative study. Int J Equity Health 2023; 22:252. [PMID: 38057802 DOI: 10.1186/s12939-023-02069-0] [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: 09/03/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Red River Métis families need access to meaningful and appropriate resources when their children are sick. At the invitation of the Manitoba Métis Federation (MMF) to partner in this research, our aim was to understand Red River Métis parents' experiences and preferences for seeking child health information when their child is acutely ill, to inform the adaptation of existing parent resources. METHODS A qualitative descriptive approach underpinned by a participatory paradigm guided this study. Semi-structured interviews were conducted with 19 Red River Métis parents and Elders via Zoom or telephone. An inductive thematic analysis approach was used to explore patterns and themes across the data. RESULTS Analysis generated four themes: (1) We're here too; (2) We are not all the same; (3) Finding trustworthy information; and (4) Information needs to be widely available. Red River Métis pride was prominent in the results. Parents provided tangible ways to modify existing parent resources, including adding information on how to access Elders, healers and/or traditional medicines and showing different family structures, transport, living situations, Métis names, and incorporating Métis languages. While most parents reported looking for child health information online, they also stressed the need to provide multiple options, including information sheets, recognizing that parents seek information in different contexts. Parents also emphasized the importance of accessible, safe spaces to find child health information, including local schools, community centres, healthcare organizations and the MMF. CONCLUSION There is a lack of child health information created specifically for Red River Métis families. The development of this information can support their information needs and preferences and the ongoing efforts to revitalize Red River Métis culture and language. Study findings will inform the adaptation and dissemination of existing child health resources to ensure they reflect Red River Métis parents' information needs and preferences. This research is a critical step in addressing an identified need for Red River Métis families to have culturally relevant and meaningful child health resources, and in the pursuit of equitable care for all children in Canada. TRIAL REGISTRATION N/A.
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Affiliation(s)
- Lisa Knisley
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Level 3, 11405 87 Avenue, Edmonton, Canada
| | - S Michelle Driedger
- Rady Faculty of Health Sciences, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | - Julianne Sanguins
- Rady Faculty of Health Sciences, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Shannon D Scott
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Level 3, 11405 87 Avenue, Edmonton, Canada.
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Keenan A, Sadri P, Marzanek F, Pirrie M, Angeles R, Agarwal G. Adapting the Community Paramedicine at Clinic (CP@clinic) program to a remote northern first nation community: a qualitative study of community members' and local health care providers' views. Int J Circumpolar Health 2023; 82:2258025. [PMID: 37722676 PMCID: PMC10512856 DOI: 10.1080/22423982.2023.2258025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/06/2023] [Indexed: 09/20/2023] Open
Abstract
The views of community Elders and health care providers in a rural remote First Nation community in Ontario, Canada on their health care landscape and adapting the Community Paramedicine at Clinic (CP@clinic) Program to their community are presented. Key informant interviews took place between September 2020 and March 2021, and were thematically analysed using the Framework Hierarchical Analysis. There were seven themes that emerged with many subthemes: available services in the community, health care access, health challenges in community, causes of frailty, health care and community appreciations, community-specific benefits of CP@clinic, and CP@clinic program considerations for adaptation. CP@clinic program considerations for adaptation included defining the role of CP, refining referral processes to capture the target population, advertising and promoting, ensuring community awareness, determining clinic setting and composition, focusing on advocacy and timely continuity, adding to the program through time, managing resistance, engaging community and partners, deploying cultural training and language accommodations, leveraging community assets, and ensuring sustainability. Focusing on continuity, engagement, and leveraging available resources may support the success of the CP@clinic program implementation. Findings from this study may be useful to other underserved communities in Canada seeking health programming.
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Affiliation(s)
- Amelia Keenan
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Pauneez Sadri
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Francine Marzanek
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Pirrie
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ricardo Angeles
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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McCormack H, Wand H, Newman CE, Bourne C, Kennedy C, Guy R. Exploring Whether the Electronic Optimization of Routine Health Assessments Can Increase Testing for Sexually Transmitted Infections and Provider Acceptability at an Aboriginal Community Controlled Health Service: Mixed Methods Evaluation. JMIR Med Inform 2023; 11:e51387. [PMID: 38032729 PMCID: PMC10722379 DOI: 10.2196/51387] [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: 07/30/2023] [Revised: 10/22/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND In the context of a syphilis outbreak in neighboring states, a multifaceted systems change to increase testing for sexually transmitted infections (STIs) among young Aboriginal people aged 15 to 29 years was implemented at an Aboriginal Community Controlled Health Service (ACCHS) in New South Wales, Australia. The components included electronic medical record prompts and automated pathology test sets to increase STI testing in annual routine health assessments, the credentialing of nurses and Aboriginal health practitioners to conduct STI tests independently, pathology request forms presigned by a physician, and improved data reporting. OBJECTIVE We aimed to determine whether the systems change increased the integration of STI testing into routine health assessments by clinicians between April 2019 and March 2020, the inclusion of syphilis tests in STI testing, and STI testing uptake overall. We also explored the understandings of factors contributing to the acceptability and normalization of the systems change among staff. METHODS We used a mixed methods design to evaluate the effectiveness and acceptability of the systems change implemented in 2019. We calculated the annual proportion of health assessments that included tests for chlamydia, gonorrhea, and syphilis, as well as an internal control (blood glucose level). We conducted an interrupted time series analysis of quarterly proportions 24 months before and 12 months after the systems change and in-depth semistructured interviews with ACCHS staff using normalization process theory. RESULTS Among 2461 patients, the annual proportion of health assessments that included any STI test increased from 16% (38/237) in the first year of the study period to 42.9% (94/219) after the implementation of the systems change. There was an immediate and large increase when the systems change occurred (coefficient=0.22; P=.003) with no decline for 12 months thereafter. The increase was greater for male individuals, with no change for the internal control. Qualitative data indicated that nurse- and Aboriginal health practitioner-led testing and presigned pathology forms proved more difficult to normalize than electronic prompts and shortcuts. The interviews identified that staff understood the modifications to have encouraged cultural change around the role of sexual health care in routine practice. CONCLUSIONS This study provides evidence for the first time that optimizing health assessments electronically is an effective and acceptable strategy to increase and sustain clinician integration and the completeness of STI testing among young Aboriginal people attending an ACCHS. Future strategies should focus on increasing the uptake of health assessments and promote whole-of-service engagement and accountability.
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Affiliation(s)
- Heather McCormack
- Kirby Institute, University of New South Wales, Kensington, Australia
- Centre for Population Health, New South Wales Ministry of Health, Sydney, Australia
| | - Handan Wand
- Kirby Institute, University of New South Wales, Kensington, Australia
| | - Christy E Newman
- Centre for Social Research in Health, University of New South Wales, Kensington, Australia
| | - Christopher Bourne
- Kirby Institute, University of New South Wales, Kensington, Australia
- Centre for Population Health, New South Wales Ministry of Health, Sydney, Australia
- Sydney Sexual Health Centre, Sydney, Australia
| | | | - Rebecca Guy
- Kirby Institute, University of New South Wales, Kensington, Australia
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Gomez Cardona L, Yang M, Seon Q, Karia M, Velupillai G, Noel V, Linnaranta O. The methods of improving cultural sensitivity of depression scales for use among global indigenous populations: a systematic scoping review. Glob Ment Health (Camb) 2023; 10:e83. [PMID: 38161748 PMCID: PMC10755398 DOI: 10.1017/gmh.2023.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 11/01/2023] [Accepted: 11/14/2023] [Indexed: 01/03/2024] Open
Abstract
Cultural adaptation of psychometric measures has become a process aimed at increasing acceptance, reliability, and validity among specific Indigenous populations. We present a systematic scoping review to: (1) identify the depression scales that have been culturally adapted for use among Indigenous populations worldwide, (2) globally report on the methods used in the cultural adaptation of those scales, and (3) describe the main features of those cultural adaptation methods. We included articles published from inception to April 2021, including 3 levels of search terms: Psychometrics, Indigenous, and Depression. The search was carried out in the Ovid Medline, PubMed, Embase, Global Health, PsycINFO, and CINAHL databases, following PRISMA guidelines. We identified 34 reports on processes of cultural adaptation that met the criteria. The scales were adapted for use among Indigenous populations from Africa, Australia, Asia, North America, and Latin America. The most common scales that underwent adaptation were the Patient Health Questionnaire (PHQ-9), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Edinburgh Postnatal Depression Scale (EPDS). Methods of adaptation involved a revision of the measures' cultural appropriateness, standard/transcultural translation, revision of the administration process, and inclusion of visual supports. Culturally safe administration of scales was reported in some studies. To come to a consensus on most appropriate methods of improving cultural safety of psychometric measurement, most studies utilized qualitative methods or mixed methods to understand the specific community's needs. Revision of linguistic equivalence and cultural relevance of content, culturally safe administration procedures, qualitative methods, and participatory research were key features of developing safe culturally adapted measures for depressive symptoms among Indigenous populations. While for comparability, uniform scales would be ideal as mental health evaluations, an understanding of the cultural impact of measurements and local depression expressions would benefit the process of developing culturally sensitive psychometric scales. PROSPERO registration ID: CRD42023391439.
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Affiliation(s)
- Liliana Gomez Cardona
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Michelle Yang
- École interdisciplinaire des sciences de la santé/Interdisciplinary School of Health Sciences, Université d’Ottawa/University of Ottawa, Ottawa, ON, Canada
| | - Quinta Seon
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Maharshee Karia
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | | | - Valérie Noel
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- ACCESS Open Minds, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Outi Linnaranta
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
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Govender K, Müller A. Secondary Prophylaxis Among First Nations People With Acute Rheumatic Fever in Australia: An Integrative Review. J Transcult Nurs 2023; 34:443-452. [PMID: 37572036 PMCID: PMC10637076 DOI: 10.1177/10436596231191248] [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: 08/14/2023] Open
Abstract
INTRODUCTION The prevalence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) among Australia's First Nations populations are some of the highest in the world, accounting for 95% of the 2,244 ARF notifications between 2015 and 2019 in Australia. A key issue in treating ARF is long-term secondary prophylaxis, yet only one in five patients received treatment in 2019. This review identifies barriers to secondary prophylaxis of ARF in Australia's First Nations people. METHODS An integrative review was undertaken utilizing PubMed, CINAHL, ProQuest, and Wiley Online. Joanna Briggs Institute critical appraisal tools were used, followed by thematic analysis. RESULTS The key themes uncovered included: issues with database and recall systems, patient/family characteristics, service delivery location and site, pain of injection, education (including language barriers), and patient-clinician relationship. CONCLUSIONS A national RHD register, change in operation model, improved pain management, improved education, and need for consistent personnel is suggested.
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Affiliation(s)
| | - Amanda Müller
- Flinders University, Adelaide, South Australia, Australia
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Nsengimana A, Biracyaza E, Isimbi J, Uwambajimana C, Hategekimana JC, Kagisha V, Asingizwe D, Nyandwi JB. Request for Antimalarial Medicines and Their Dispensing Without a Prescription in Community Pharmacies in Rwanda. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2023; 12:195-212. [PMID: 37928945 PMCID: PMC10625414 DOI: 10.2147/iprp.s428105] [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] [Received: 06/29/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose This study aimed to explore the request and dispensing of antimalarial medicines without a prescription in community pharmacies in Rwanda, as well as factors associated. Methods We employed an embedded mixed-methods design that involved a convenience sample of 235 licensed community pharmacists between February and April 2022. To simultaneously collect qualitative and quantitative data, we used a self-administered questionnaire containing a combination of close and open-ended questions. Bivariate and multivariate regression analyses were performed to examine the relationship between dispensing antimalarial medicines without a prescription and the selected independent variables. Statistical significance was set at p<0.05, and a 95% confidence interval was applied. The factors influencing the dispensing of antimalarial medicines without a prescription were analyzed using thematic content analysis as a qualitative analysis approach. Results Most respondents (88.5%) were asked to dispense antimalarial medicines by clients without a prescription. More than half of them (54%) agreed, but 34.5% refused; instead, they referred clients to malaria diagnostic testing facilities. Those who had rapid diagnostic tests for malaria in stock (OR=2.08, 95% CI:1.1-3.94), and thought that antimalarials were over-the-counter medicines (OR=7.03, 95% CI:2.01-24.5) were more likely to dispense antimalarial medicines without prescriptions. The primary reasons reported by community pharmacists for dispensing antimalarial medicines without prescriptions included their prior knowledge of malaria diagnosis, client pressure, and fear of losing clients. However, non-adherence to negative results obtained from formal health facilities and long queues at these institutions have also been cited as additional factors driving clients to seek antimalarial medicines without prescriptions. Conclusion Dispensing antimalarial medicines without prescriptions is a common practice in community pharmacies in Rwanda. The main factors contributing to this practice include lack of awareness regarding the classification of antimalarials as prescription medicines, the availability of malaria diagnostic tests, client pressure, and fear of losing clients.
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Affiliation(s)
- Amon Nsengimana
- US Agency for International Development Global Health Supply Chain Program, Procurement and Supply Chain Management, Kigali, Rwanda
| | - Emmanuel Biracyaza
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
| | - Joyce Isimbi
- Department of Pharmacy, University of Rwanda, Kigali, Rwanda
| | | | | | - Vedaste Kagisha
- Department of Pharmacy, University of Rwanda, Kigali, Rwanda
| | - Domina Asingizwe
- Department of Physiotherapy; University of Rwanda, Kigali, Rwanda
- East African Community Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, University of Rwanda, Kigali, Rwanda
| | - Jean Baptiste Nyandwi
- Department of Pharmacy, University of Rwanda, Kigali, Rwanda
- East African Community Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, University of Rwanda, Kigali, Rwanda
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Sehgal A, Scott S, Murry A, Henderson R, Barnabe C, Crowshoe LL. Critically examining health complexity experienced by urban Indigenous peoples in Canada by exploring the factors that allow health complexity to persist: a qualitative study of Indigenous patients in Calgary, Alberta. BMJ Open 2023; 13:e073184. [PMID: 37903604 PMCID: PMC10619072 DOI: 10.1136/bmjopen-2023-073184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/05/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVES This study aims to identify and critically examine the components of health complexity, and explore the factors that allow it to exist, among urban Indigenous peoples in Canada. DESIGN Qualitative exploration with relational conversations. SETTING Calgary, Alberta, Canada. PARTICIPANTS A total of nine urban Indigenous patients were recruited from a multidisciplinary primary healthcare clinic that serves First Nations, Métis and Inuit peoples. Recruitment and data collection took place between September and November 2021. RESULTS Thematic analysis revealed three main themes, namely: sources of health complexity, psychological responses to adversity, and resilience, strengths, and protective factors. Key sources of health complexity arose from material resource disparities and adverse interpersonal interactions within the healthcare environment, which manifest into psychological distress while strengths and resilience emerged as protective factors. CONCLUSION The healthcare system remains inapt to address complexity among urban Indigenous peoples in Canada. Healthcare violence experienced by Indigenous peoples only further perpetuates health complexity. Future clinical tools to collect information about health complexity among urban Indigenous patients should include questions about the factors defined in this study.
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Affiliation(s)
- Anika Sehgal
- Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sara Scott
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adam Murry
- Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Rita Henderson
- Family Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lynden Lindsay Crowshoe
- Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Cama E, Beadman K, Beadman M, Walker M, Treloar C. Insights from the scale-up and implementation of the Deadly Liver Mob program across nine sites in New South Wales, Australia, according to the RE-AIM framework. Harm Reduct J 2023; 20:154. [PMID: 37864220 PMCID: PMC10588043 DOI: 10.1186/s12954-023-00889-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The Deadly Liver Mob (DLM) program is a peer-led health promotion program that aims to improve access to screening and treatment for blood borne viruses and sexually transmissible infections for Aboriginal and Torres Strait Islander Australians. In this paper, we used client and staff insights to explore the successes and challenges of implementing the DLM program according to the RE-AIM framework, which explores real-world implementation of interventions according to reach, effectiveness, adoption, implementation, and maintenance. METHODS Clients and staff were recruited through the DLM program. Semi-structured interviews were conducted with four Aboriginal and Torres Strait Islander and 11 non-Aboriginal or Torres Strait Islander health workers, as well as 33 Aboriginal and Torres Strait Islander clients of the program. RESULTS Findings show the positive effects of the DLM program, in creating a culturally safe and sensitive environment for Aboriginal and Torres Strait Islander clients to access care. In particular, the employment of frontline Aboriginal and Torres Strait Islander workers to deliver the education was touted as one of the primary successes of the program, in enabling workers to build trust between clients and mainstream health systems, which has the flow on effect of encouraging clients to go through to screening. The use of the RE-AIM framework illustrates the challenges of implementing real-world interventions across various locations, such as the difficulties in delivering DLM in regional and remote areas due to covering large geographic areas with minimal public transport available. CONCLUSIONS The data emphasise the need for interventions to be adaptable and flexible, altering elements of the program to suit local and community needs, such as by offering mobile and outreach services to enable access across regional and rural areas. The findings of this evaluation have been used to develop tools so that the learnings from DLM can be shared with others who may be hoping to implement DLM or other similar programs.
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Affiliation(s)
- Elena Cama
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Kim Beadman
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Mitch Beadman
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Melinda Walker
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Carla Treloar
- Centre for Social Research in Health, John Goodsell Building, UNSW Sydney, Sydney, NSW, 2052, Australia
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Khatri RB, Assefa Y. Drivers of the Australian Health System towards Health Care for All: A Scoping Review and Qualitative Synthesis. BIOMED RESEARCH INTERNATIONAL 2023; 2023:6648138. [PMID: 37901893 PMCID: PMC10611547 DOI: 10.1155/2023/6648138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 08/03/2023] [Accepted: 10/07/2023] [Indexed: 10/31/2023]
Abstract
Background Australia has made significant progress towards universal access to primary health care (PHC) services. However, disparities in the utilisation of health services and health status remain challenges in achieving the global target of universal health coverage (UHC). This scoping review aimed at synthesizing the drivers of PHC services towards UHC in Australia. Methods We conducted a scoping review of the literature published from 1 January 2010 to 30 July 2021 in three databases: PubMed, Scopus, and Embase. Search terms were identified under four themes: health services, Australia, UHC, and successes or challenges. Data were analysed using an inductive thematic analysis approach. Drivers (facilitators and barriers) of PHC services were explained by employing a multilevel framework that included the proximal level (at the level of users and providers), intermediate level (organisational and community level), and distal level (macrosystem or distal/structural level). Results A total of 114 studies were included in the review. Australia has recorded several successes in increased utilisation of PHC services, resulting in an overall improvement in health status. However, challenges remain in poor access and high unmet needs of health services among disadvantaged/priority populations (e.g., immigrants and Indigenous groups), those with chronic illnesses (multiple chronic conditions), and those living in rural and remote areas. Several drivers have contributed in access to and utilisation of health services (especially among priority populations)operating at multilevel health systems, such as proximal level drivers (health literacy, users' language, access to health facilities, providers' behaviours, quantity and competency of health workforce, and service provision at health facilities), intermediate drivers (community engagement, health programs, planning and monitoring, and funding), and distal (structural) drivers (socioeconomic disparities and discriminations). Conclusion Australia has had several successes towards UHC. However, access to health services poses significant challenges among specific priority populations and rural residents. To achieve universality and equity of health services, health system efforts (supply- and demand-side policies, programs and service interventions) are required to be implemented in multilevel health systems. Implementation of targeted health policy and program approaches are needed to provide comprehensive PHC and address the effects of structural disparities.
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Affiliation(s)
- Resham B. Khatri
- Health Social Science and Development Research Institute, Kathmandu, Nepal
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
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MacPherson M. Immigrant, Refugee, and Indigenous Canadians' Experiences With Virtual Health Care Services: Rapid Review. JMIR Hum Factors 2023; 10:e47288. [PMID: 37812489 PMCID: PMC10594134 DOI: 10.2196/47288] [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: 03/14/2023] [Revised: 06/28/2023] [Accepted: 08/04/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND The remote, dispersed, and multicultural population of Canada presents unique challenges for health care services. Currently, virtual care solutions are being offered as an innovative solution to improve access to care. OBJECTIVE Given the inequities in health care access faced by immigrant, refugee, and Indigenous Canadians, this review aimed to summarize information obtained from original research regarding these people's experiences with virtual care services in Canada. METHODS We conducted a rapid review following published recommendations. MEDLINE and CINAHL were searched for studies relating to virtual care and Canadian immigrants, refugees, or Indigenous peoples. Peer-reviewed articles of any type were included so long as they included information on the experiences of virtual care service delivery in Canada among the abovementioned groups. RESULTS This review demonstrates an extreme paucity of evidence examining the experiences of immigrant, refugee, and Indigenous groups with virtual care in Canada. Of the 694 publications screened, 8 were included in this review. A total of 2 studies focused on immigrants and refugees in Canada, with the remaining studies focusing on Indigenous communities. Results demonstrate that virtual care is generally accepted within these communities; however, cultural appropriateness or safety and inequitable access to wireless services in certain communities were among the most cited barriers. CONCLUSIONS Little evidence exists outlining immigrants', refugees', and Indigenous peoples' perspectives on the landscape of virtual care in Canada. The development of virtual care programming should take into consideration the barriers, facilitators, and recommendations outlined in this review to improve equitable access. Further, developers should consult with local community members to ensure the appropriateness of services for immigrant, refugee, and Indigenous communities in Canada.
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Cueva GAH, Ramírez RGN, Visconti-Lopez FJ, Bendezu-Quispe G, Vargas-Fernández R. Association Between the Autonomy of Peruvian Women and the Choice of the Place of Delivery: Analysis of a National Survey, 2019. Matern Child Health J 2023; 27:1823-1833. [PMID: 37329422 DOI: 10.1007/s10995-023-03740-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES To determine the association between Peruvian women's autonomy and place of delivery. METHODS An analytical cross-sectional study of secondary data from the Demographic and Family Health Survey 2019 was carried out. The dependent variable was institutionalized childbirth, and the independent variable was women's autonomy. Likewise, the association between women's autonomy and institutionalized childbirth was evaluated using Poisson family generalized linear models with logarithmic link function, and crude (PR) and adjusted prevalence ratios (aPR) with their respective 95% confidence interval (CI) were estimated. RESULTS The analysis included 15,334 women aged 15-49 years. It was found that a high proportion of women had a low level of autonomy (42.6%; 95% CI: 41.5-43.7), while 92.1% (95% CI: 91.3-92.9) had institutionalized childbirth. Moderate (PR: 1.10; 95% CI: 1.08-1.12) and high (PR: 1.13; 95% CI: 1.12-1.15) levels of women's autonomy were found to be associated with institutionalized childbirth, and the same association was found in the adjusted analysis. CONCLUSION Being a woman with a higher level of autonomy was related to a higher prevalence of institutionalized childbirth. Therefore, as decision-making is a multifactorial characteristic, it is necessary to study in depth the determinants of non-institutionalized childbirth in women with less autonomy.
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Affiliation(s)
| | | | | | - Guido Bendezu-Quispe
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
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Dawson AP, Warrior E, Pearson O, Boyd MA, Dwyer J, Morey K, Brodie T, Towers K, Waters S, Avila C, Hammond C, Lake KJ, Lampard ‘UF, Wanganeen ‘UF, Bennell O, Bromley D, Shearing T, Rigney N, Czygan S, Clinch N, Pitson A, Brown A, Howard NJ. Exploring self-determined solutions to service and system challenges to promote social and emotional wellbeing in Aboriginal and Torres Strait Islander people: a qualitative study. Front Public Health 2023; 11:1206371. [PMID: 37809004 PMCID: PMC10556859 DOI: 10.3389/fpubh.2023.1206371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/28/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Many Aboriginal and Torres Strait Islander people living on Kaurna Country in northern Adelaide experience adverse health and social circumstances. The Taingiwilta Pirku Kawantila study sought to understand challenges facing Aboriginal and Torres Strait Islander communities and identify solutions for the health and social service system to promote social and emotional wellbeing. Methods This qualitative study applied Indigenous methodologies undertaken with Aboriginal and Torres Strait Islander governance and leadership. A respected local Aboriginal person engaged with Aboriginal and Torres Strait Islander community members and service providers through semi-structured interviews and yarning circles that explored community needs and challenges, service gaps, access barriers, success stories, proposed strategies to address service and system challenges, and principles and values for service design. A content analysis identified the breadth of challenges in addition to describing key targets to empower and connect communities and optimize health and social services to strengthen individual and collective social and emotional wellbeing. Results Eighty-three participants contributed to interviews and yarning circles including 17 Aboriginal community members, 38 Aboriginal and Torres Strait Islander service providers, and 28 non-Indigenous service providers. They expressed the need for codesigned, strengths-based, accessible and flexible services delivered by Aboriginal and Torres Strait Islander workers with lived experience employed in organisations with Aboriginal and Torres Strait Islander leadership and governance. Community hubs and cultural events in addition to one-stop-shop service centres and pre-crisis mental health, drug and alcohol and homelessness services were among many strategies identified. Conclusion Holistic approaches to the promotion of social and emotional wellbeing are critical. Aboriginal and Torres Strait Islander people are calling for places in the community to connect and practice culture. They seek culturally safe systems that enable equitable access to and navigation of health and social services. Aboriginal and Torres Strait Islander workforce leading engagement with clients is seen to safeguard against judgement and discrimination, rebuild community trust in the service system and promote streamlined access to crucial services.
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Affiliation(s)
- Anna P. Dawson
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Eugene Warrior
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
| | - Odette Pearson
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Mark A. Boyd
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
- Division of Medicine, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Judith Dwyer
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Kim Morey
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
| | - Tina Brodie
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
| | - Kurt Towers
- Division of Medicine, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Sonia Waters
- Aboriginal Services, AnglicareSA, Adelaide, SA, Australia
| | | | - Courtney Hammond
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
| | - Katherine J. Lake
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
- Indigenous Health Equity, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - ‘Uncle’ Frank Lampard
- Division of Medicine, Northern Adelaide Local Health Network, Adelaide, SA, Australia
- Executive Office, Kaurna Elder and Aboriginal Community Representative, Adelaide, SA, Australia
| | - ‘Uncle’ Frank Wanganeen
- Executive Office, Kaurna Elder and Aboriginal Community Representative, Adelaide, SA, Australia
| | - Olive Bennell
- Executive Office, Nunga Mi:Minars Inc., Adelaide, SA, Australia
| | | | - Toni Shearing
- Division of Medicine, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Nathan Rigney
- Aboriginal Health Promotion, Wellbeing SA, Adelaide, SA, Australia
| | | | - Nikki Clinch
- Statewide Operations, South Australian Department for Corrections, Adelaide, SA, Australia
| | - Andrea Pitson
- Aboriginal Education Directorate, South Australian Department for Education, Adelaide, SA, Australia
| | - Alex Brown
- Indigenous Genomics, Telethon Kids Institute, Adelaide, South Australia, Australia
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT, Australia
| | - Natasha J. Howard
- Wardliparingga Aboriginal Health Equity, South Australian Health and Research Institute, Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Jaleel A, Arlappa N, Ramakrishna KS, Sunu PV, Jayalakshmi G, Neeraja G, Narasimhulu D, Kumar TS, Kumar SB. Examining the Triple Burden of Malnutrition: Insights from a Community-Based Comprehensive Nutrition Survey among Indigenous Tribal Children (0-19 Years) in the Western Ghats Hills of India. Nutrients 2023; 15:3995. [PMID: 37764778 PMCID: PMC10537611 DOI: 10.3390/nu15183995] [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: 08/02/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
This article presents findings from a community-based cross-sectional study conducted in Attappadi, Kerala, India, aimed at assessing the prevalence of the triple burden of malnutrition among indigenous children aged 0-19 years. Historically, the indigenous population in Attappadi has faced significant developmental challenges, including high rates of malnutrition, infant mortality, and neonatal mortality. This study revealed alarming rates of undernutrition among children aged 0-59 months, with 40.9% experiencing stunting, 27.4% wasting, and 48.3% being underweight. Adolescent girls also suffered from undernutrition, with 21% classified as underweight and 43.3% experiencing stunting. Surprisingly, overweight or obesity was identified as a nutritional problem, affecting 1.4% of children aged 0-59 months, 4.2% of children aged 5-9 years, and 10.5% of adolescent girls. Additionally, a distressing proportion of young children aged 12-59 months (91.2%) were anaemic, with 50% diagnosed specifically with iron deficiency anaemia (IDA). Nearly all adolescent girls (96.6%) were reportedly suffering from anaemia. Deficiencies in vitamin B12, vitamin D, folate, and vitamin-A were prevalent among 35%, 20%, 16%, and 12% of children aged 12-59 months, respectively. The study underscores the urgent need for comprehensive interventions to address this triple burden of malnutrition. Recommendations include promoting culturally appropriate local food-based solutions, establishing participatory and community-led systems for health and nutrition information dissemination, and strengthening the nutrition surveillance system through village-level health and nutrition workers. By adopting a holistic approach, these interventions can help improve the nutritional status and well-being of the indigenous tribal children in Attappadi.
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Affiliation(s)
- Abdul Jaleel
- Division of Public Health Nutrition, ICMR-National Institute of Nutrition (NIN), Hyderabad 500007, India; (A.J.); (K.S.R.); (P.V.S.); (G.J.); (G.N.); (D.N.); (T.S.K.)
| | - N. Arlappa
- Division of Public Health Nutrition, ICMR-National Institute of Nutrition (NIN), Hyderabad 500007, India; (A.J.); (K.S.R.); (P.V.S.); (G.J.); (G.N.); (D.N.); (T.S.K.)
| | - K. Sree Ramakrishna
- Division of Public Health Nutrition, ICMR-National Institute of Nutrition (NIN), Hyderabad 500007, India; (A.J.); (K.S.R.); (P.V.S.); (G.J.); (G.N.); (D.N.); (T.S.K.)
| | - P. V. Sunu
- Division of Public Health Nutrition, ICMR-National Institute of Nutrition (NIN), Hyderabad 500007, India; (A.J.); (K.S.R.); (P.V.S.); (G.J.); (G.N.); (D.N.); (T.S.K.)
| | - G. Jayalakshmi
- Division of Public Health Nutrition, ICMR-National Institute of Nutrition (NIN), Hyderabad 500007, India; (A.J.); (K.S.R.); (P.V.S.); (G.J.); (G.N.); (D.N.); (T.S.K.)
| | - G. Neeraja
- Division of Public Health Nutrition, ICMR-National Institute of Nutrition (NIN), Hyderabad 500007, India; (A.J.); (K.S.R.); (P.V.S.); (G.J.); (G.N.); (D.N.); (T.S.K.)
| | - D. Narasimhulu
- Division of Public Health Nutrition, ICMR-National Institute of Nutrition (NIN), Hyderabad 500007, India; (A.J.); (K.S.R.); (P.V.S.); (G.J.); (G.N.); (D.N.); (T.S.K.)
| | - T. Santhosh Kumar
- Division of Public Health Nutrition, ICMR-National Institute of Nutrition (NIN), Hyderabad 500007, India; (A.J.); (K.S.R.); (P.V.S.); (G.J.); (G.N.); (D.N.); (T.S.K.)
| | - Senthil B. Kumar
- Department of Epidemiology Statistics, ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai 600031, India;
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Mathew S, Barzi F, Clifford-Motopi A, Brown Nunuccal R, Ward Pitjantjatjara And Nukunu J, Mills R, Turner L, White Palawa And Iningai A, Eaton M, Butler D. Transformation to a patient-centred medical home led and delivered by an urban Aboriginal and Torres Strait Islander community, and association with engagement and quality-of-care: quantitative findings from a pilot study. BMC Health Serv Res 2023; 23:959. [PMID: 37674143 PMCID: PMC10483750 DOI: 10.1186/s12913-023-09955-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The patient-centred medical home (PCMH) is a model of team-based primary care that is patient-centred, coordinated, accessible, and focused on quality and safety. In response to substantial population growth and increasing demand on existing primary care services, the Institute for Urban Indigenous Health (IUIH) developed the IUIH System of Care-2 (ISoC2), based on an international Indigenous-led PCMH. ISoC2 was piloted at an urban Aboriginal and Torres Strait Islander Community-Controlled Health Service in South-East Queensland between 2019-2020, with further adaptations made to ensure its cultural and clinical relevance to local Aboriginal and Torres Strait Islander people. Little is known on the implementation and impact of PCMH in the Australian Indigenous primary care setting. Changes in implementation process measures and outcomes relating to engagement and quality-of-care are described here. METHODS De-identified routinely collected data extracted from electronic health records for clients regularly attending the service were examined to assess pre-post implementation changes relevant to the study. Process measures included enrolment in PCMH team-based care, and outcome measures included engagement with the health service, continuity-of-care and clinical outcomes. RESULTS The number of regular clients within the health service increased from 1,186 pre implementation to 1,606 post implementation; representing a small decrease as a proportion of the services' catchment population (38.5 to 37.6%). In clients assigned to a care team (60% by end 2020), care was more evenly distributed between providers, with an increased proportion of services provided by the Aboriginal and Torres Strait Islander Health Worker (16-17% versus 10-11%). Post-implementation, 41% of clients had continuity-of-care with their assigned care team, while total, preventive and chronic disease services were comparable pre- and post-implementation. Screening for absolute cardiovascular disease risk improved, although there were no changes in clinical outcomes. CONCLUSIONS The increase in the number of regular clients assigned to a team and their even distribution of care among care team members provides empirical evidence that the service is transforming to a PCMH. Despite a complex transformation process compounded by the COVID-19 pandemic, levels of service delivery and quality remained relatively stable, with some improvements in risk factor screening.
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Affiliation(s)
- Saira Mathew
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld, 4030, Australia
- The University of Queensland, Poche Centre for Indigenous Health, 74 High Street, Toowong, Qld, 4066, Australia
| | - Federica Barzi
- The University of Queensland, Poche Centre for Indigenous Health, 74 High Street, Toowong, Qld, 4066, Australia
| | - Anton Clifford-Motopi
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld, 4030, Australia
| | - Renee Brown Nunuccal
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld, 4030, Australia
| | | | - Richard Mills
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld, 4030, Australia
| | - Lyle Turner
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld, 4030, Australia
| | | | - Martie Eaton
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld, 4030, Australia
| | - Danielle Butler
- The Institute for Urban Indigenous Health Ltd, 22 Cox Road, Windsor, Qld, 4030, Australia.
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, 2601, Australia.
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Cunningham J, Bailie J, Warner S, Condon A, Cheung D, Minc A, Herbert S, Edmiston N. Determinants of access to general practice in a shared care model for people living with HIV: a qualitive study of patients' perspectives in an Australian rural community. BMC PRIMARY CARE 2023; 24:179. [PMID: 37674116 PMCID: PMC10483738 DOI: 10.1186/s12875-023-02142-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 08/29/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Improved management of human immunodeficiency virus (HIV) has resulted in improved life expectancy for people living with HIV and an ageing population with a significant comorbidity burden. Shared care models, involving the co-ordinated liaison between general practitioners and specialist physicians, have been advocated for in Australia to provide comprehensive care. People living with HIV in rural areas have reduced access to general practice and therefore shared care. This study explores the perspectives of people living with HIV on the barriers and enablers to accessing shared care in an Australian rural setting. METHODS In this qualitative study, semi-structured interviews were conducted with adults living with HIV who either resided in or accessed care in a rural area of Australia. Interviews were conducted via video conferencing, phone or face-to-face. Transcripts were imported into NVivo, coded and analysed in alignment with a conceptual framework of healthcare access defined by Levesque and colleagues. RESULTS Thirteen interviews were conducted in total. Participants' narratives demonstrated the substantial influence of accessibility to general practice on their ability to engage in effective shared care. Challenges included the perception that general practitioners would not provide additive value to participants' care, which restricted the ability to both seek and engage in the shared care model. Healthcare beliefs, expectations and experiences with stigma led participants to prioritise the perceived interpersonal qualities of specialist care above a shared care system. Access to shared care was facilitated by continuity of care in general practice but logistical factors such as affordability, transport and availability impacted the ability to access regular high-quality healthcare. CONCLUSIONS Navigating patient priorities and anticipated stigma in general practice within the resource limitations of rural healthcare were barriers to effective shared care. General practitioners' ability to build rapport and long-term relationships with participants was instrumental in the perception of valuable care. Strategies are required to secure continuity of care with interpersonally skilled general practitioners to ensure provision of quality primary care for people living with HIV, which can be supported by specialist physicians in a shared care model.
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Affiliation(s)
- Juliet Cunningham
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jodie Bailie
- University Centre for Rural Health, The University of Sydney, Lismore, Australia
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Sherridan Warner
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ashleigh Condon
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Daniel Cheung
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ariane Minc
- Northern New South Wales Sexual Health Service, North Coast Public Health, Mid North Coast Local Health District, Lismore, Australia
| | - Simone Herbert
- Northern New South Wales Sexual Health Service, North Coast Public Health, Mid North Coast Local Health District, Lismore, Australia
| | - Natalie Edmiston
- University Centre for Rural Health, The University of Sydney, Lismore, Australia.
- Northern New South Wales Sexual Health Service, North Coast Public Health, Mid North Coast Local Health District, Lismore, Australia.
- School of Medicine, Western Sydney University, Campbelltown, Australia.
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Cama E, Beadman K, Beadman M, Smith KA, Christian J, Jackson AC, Tyson B, Anderson C, Smyth L, Heslop J, Gahan G, Tawil V, Sheaves F, Maher L, Page J, Tilley D, Ryan A, Grant K, Donovan B, Stevens A, Slattery T, Pearce K, John-Leader F, Walden A, Lenton J, Crowley M, Treloar C. Increasing access to screening for blood-borne viruses and sexually transmissible infections for Aboriginal and Torres Strait Islander Australians: evaluation of the Deadly Liver Mob program's 'cascade of care' across nine sites in New South Wales, Australia. Harm Reduct J 2023; 20:125. [PMID: 37670361 PMCID: PMC10478220 DOI: 10.1186/s12954-023-00850-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/10/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander Australians are disproportionately impacted by blood-borne viruses (BBVs) and sexually transmissible infections (STIs). Stigma remains one of the key barriers to testing and treatment for BBVs and STIs, particularly among Aboriginal and Torres Strait Islander people. The Deadly Liver Mob (DLM) is a peer-delivered incentivised health promotion program by and for Aboriginal and Torres Strait Islander Australians. The program aims to increase access to BBV and STI education, screening, treatment, and vaccination for Aboriginal and Torres Strait Islander Australians in recognition of the systemic barriers for First Nations people to primary care, including BBV- and STI-related stigma, and institutional racism. This paper presents routinely collected data across nine sites on the 'cascade of care' progression of Aboriginal and Torres Strait Islander clients through the DLM program: hepatitis C education, screening, returning for results, and recruitment of peers. METHODS Routinely collected data were collated from each of the DLM sites, including date of attendance, basic demographic characteristics, eligibility for the program, recruitment of others, and engagement in the cascade of care. RESULTS Between 2013 and 2020, a total of 1787 Aboriginal and Torres Strait Islander clients were educated as part of DLM, of which 74% went on to be screened and 42% (or 57% of those screened) returned to receive their results. The total monetary investment of the cascade of care progression was approximately $56,220. Data highlight the positive impacts of the DLM program for engagement in screening, highlighting the need for culturally sensitive, and safe programs led by and for Aboriginal and Torres Strait Islander people. However, the data also indicate the points at which clients 'fall off' the cascade, underscoring the need to address any remaining barriers to care. CONCLUSIONS The DLM program shows promise in acting as a 'one stop shop' in addressing the needs of Aboriginal and Torres Strait Islander people in relation to BBVs and STIs. Future implementation could focus on addressing any potential barriers to participation in the program, such as co-location of services and transportation.
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Affiliation(s)
- Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Kim Beadman
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Mitch Beadman
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Kerri-Anne Smith
- Needle and Syringe Program, Mount Druitt Community Health Centre, Western Sydney Local Health District, Mount Druitt, NSW, 2770, Australia
| | - Jade Christian
- Needle and Syringe Program, Nepean Blue Mountains Local Health District, Penrith, NSW, 2747, Australia
| | - Aunty Clair Jackson
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Beverley Tyson
- Dubbo Sexual Health, Western NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Clayton Anderson
- Dubbo Sexual Health, Western NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Larissa Smyth
- Byron Central Hospital, Mid North Coast and Northern NSW Local Health District, Byron Bay, NSW, 2481, Australia
| | - Jennifer Heslop
- HIV & Related Programs, Mid North Coast and Northern NSW Local Health District, Coffs Harbour, NSW, 2450, Australia
| | - Gary Gahan
- Kirketon Road Centre, South Eastern Sydney Local Health District, Sydney, NSW, 1340, Australia
| | - Victor Tawil
- Centre for Population Health, Ministry of Health, Sydney, NSW, 2065, Australia
| | - Felicity Sheaves
- Needle and Syringe Program, Nepean Blue Mountains Local Health District, Penrith, NSW, 2747, Australia
| | - Louise Maher
- Needle and Syringe Program, Nepean Blue Mountains Local Health District, Penrith, NSW, 2747, Australia
| | - Julie Page
- Needle and Syringe Program, Nepean Blue Mountains Local Health District, Penrith, NSW, 2747, Australia
| | - Donna Tilley
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Sydney, NSW, 2150, Australia
| | - Ann Ryan
- HIV & Related Programs Unit, Western and Far West NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Kim Grant
- HIV & Related Programs Unit, Western and Far West NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Basil Donovan
- Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Annabelle Stevens
- Centre for Population Health, Ministry of Health, Sydney, NSW, 2065, Australia
| | - Trevor Slattery
- HIV & Related Programs Unit, Western and Far West NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Kate Pearce
- Needle and Syringe Program, Mount Druitt Community Health Centre, Western Sydney Local Health District, Mount Druitt, NSW, 2770, Australia
| | - Franklin John-Leader
- HIV & Related Programs, Mid North Coast and Northern NSW Local Health District, Coffs Harbour, NSW, 2450, Australia
| | - Andrew Walden
- Needle and Syringe Program, Western NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Jo Lenton
- Broken Hill Community Centre, Far West Local Health District, Broken Hill, NSW, 2880, Australia
| | - Margaret Crowley
- Dubbo Sexual Health, Western NSW Local Health District, Dubbo, NSW, 2830, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
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Wees T, Pandey M, Nicolay S, Windigo J, Bitternose A, Kopriva D. Identifying barriers to preventive care among First Nations people at risk of lower extremity amputation: a qualitative study. CMAJ Open 2023; 11:E906-E914. [PMID: 37816546 PMCID: PMC10569813 DOI: 10.9778/cmajo.20220150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND First Nations people in Canada are overrepresented among those who have undergone nontraumatic lower extremity amputation, and are more likely to be younger, have diabetic foot infections and have no previous revascularization procedures than non-First Nations populations who have undergone lower extremity amputations. We sought to identify access barriers for high-risk First Nations patients, explore patients' experiences with health care systems and identify solutions. METHODS Employing a community participatory research design, we engaged representatives from 2 communities. They assisted with research design and data analysis, and approved the final manuscript. Using a hermeneutic phenomenological approach and purposeful sampling, we conducted 5 semistructured focus groups between August and December 2021 with community health care teams and patients at risk for, or who had previously undergone, a nontraumatic lower extremity amputation. RESULTS Patients' (n = 10) and community health care providers' (n = 18) perspectives indicated that barriers to health care access led to delayed care and increased complications and risk for lower extremity amputations, leading to aggressive procedures upon receiving care. Barriers to care led to negative experiences at urban centres and aggressive procedures created further distrust, leading to care disengagement and poor outcomes. Patients and providers both suggested building stronger partnerships between urban and rural health care providers, improving education for patients and health care providers and identifying innovative strategies to improve patients' overall health. INTERPRETATION Systemic changes, health promotional program and reliable on-reserve primary care are needed to create equitable access for First Nation patients at risk for lower extremity amputations. The study results imply that health care delivery for First Nations patients at risk for lower extremity amputations can be improved through stronger partnership and communication between urban and community providers, and continued education and cultural competency training for urban health care providers.
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Affiliation(s)
- Tyrell Wees
- College of Medicine (Wees, Kopriva), University of Saskatchewan; Research (Pandey), Saskatchewan Health Authority; Wellness Wheel Medical Clinic (Nicolay), Regina, Sask.; Muskowekwan First Nation (Windigo), Lestock, Sask.; George Gordon First Nation (Bitternose), Regina, Sask
| | - Mamata Pandey
- College of Medicine (Wees, Kopriva), University of Saskatchewan; Research (Pandey), Saskatchewan Health Authority; Wellness Wheel Medical Clinic (Nicolay), Regina, Sask.; Muskowekwan First Nation (Windigo), Lestock, Sask.; George Gordon First Nation (Bitternose), Regina, Sask
| | - Susanne Nicolay
- College of Medicine (Wees, Kopriva), University of Saskatchewan; Research (Pandey), Saskatchewan Health Authority; Wellness Wheel Medical Clinic (Nicolay), Regina, Sask.; Muskowekwan First Nation (Windigo), Lestock, Sask.; George Gordon First Nation (Bitternose), Regina, Sask
| | - Juandell Windigo
- College of Medicine (Wees, Kopriva), University of Saskatchewan; Research (Pandey), Saskatchewan Health Authority; Wellness Wheel Medical Clinic (Nicolay), Regina, Sask.; Muskowekwan First Nation (Windigo), Lestock, Sask.; George Gordon First Nation (Bitternose), Regina, Sask
| | - Agnes Bitternose
- College of Medicine (Wees, Kopriva), University of Saskatchewan; Research (Pandey), Saskatchewan Health Authority; Wellness Wheel Medical Clinic (Nicolay), Regina, Sask.; Muskowekwan First Nation (Windigo), Lestock, Sask.; George Gordon First Nation (Bitternose), Regina, Sask
| | - David Kopriva
- College of Medicine (Wees, Kopriva), University of Saskatchewan; Research (Pandey), Saskatchewan Health Authority; Wellness Wheel Medical Clinic (Nicolay), Regina, Sask.; Muskowekwan First Nation (Windigo), Lestock, Sask.; George Gordon First Nation (Bitternose), Regina, Sask.
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Schnaufer EC, Barbosa MS, Marques MF, Brito GT, Ferreira TS, Ribeiro AD, Valiente AC, Machado IR, Gonçalves CC, Tanaka TS, Guimarães ML, Ribeiro SM, Croda J, Simionatto S. Prevalence of HIV-1 infection and associated characteristics in a Brazilian indigenous population: a cross-sectional study. LANCET REGIONAL HEALTH. AMERICAS 2023; 25:100562. [PMID: 37559945 PMCID: PMC10407292 DOI: 10.1016/j.lana.2023.100562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 06/29/2023] [Accepted: 07/10/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Despite significant progress in the areas of prevention, diagnosis, and treatment, HIV continues to result in a substantial number of fatalities on a global scale each year. Gaining insights from epidemiological data can prove instrumental in the development of health promotion strategies, particularly within vulnerable populations, such as indigenous groups. Consequently, our study aimed to investigate the prevalence of HIV infection within the indigenous population residing in the second-largest region of Brazil. Additionally, we sought to explore the subtypes of HIV-1 and detect any drug-resistance mutations present within this population. METHODS In this cross-sectional study, we aimed to evaluate the prevalence of HIV-1 infection and explore its associated characteristics within the indigenous population residing in the villages of Jaguapiru and Bororó, located in the Dourados area of Mato Grosso do Sul (MS), Brazil. Blood samples were collected for rapid HIV screening, serological tests, nucleic acid amplification, and HIV subtyping. Additionally, the HIV-1 viral load and CD4+ T lymphocyte count of the people living with HIV (PLHIV) were assessed at the time of recruitment and 24 weeks later. FINDINGS Out of the 2190 invited individuals, 1927 (88%) were included in this study. The average age of the participants was 34.2 (±13.8) years, with a majority of 74% being female. Moreover, 68.44% of the participants identified themselves as belonging to the Guarani-Kaiowa ethnic group. HIV seroprevalence was 0.93% (18/1927), and 73.22% (1411/1927) were unaware of their serological status. The prevalence of HIV-1 was higher in single indigenous people [10/617 (1.62%)], who received government benefits [14/1021 (1.37%)], had less than five years of formal education [11/685 (1.61%)], had sexual intercourse with users of injectable drugs [2/21 (9.52%)], with history of sexually transmitted infections (STIs) [10/62 (16.2%)] and incarceration [3/62 (4.84%)]. Of 18 positive samples, 44.4% (8/18) were successfully amplified, and HIV-1 subtype C was prevalent. Furthermore, we identified HIV-1 drug resistance mutations in four patients, specifically from the classes of Protease Inhibitor, Nucleoside Reverse Transcriptase Inhibitor, and Non-Nucleoside Reverse Transcriptase Inhibitor. Notably, three of these patients exhibited a high viral load even after 24 weeks of undergoing antiretroviral therapy. Out of the 18 PLHIV, 66.66% (12/18) had a viral load below 1000 copies/mL, while 50% (9/18) had a CD4+ T lymphocytes count greater than 350 cells/mL after 24 weeks of treatment. INTERPRETATION Despite the concerted efforts to control HIV infection, the prevalence observed in the indigenous population under study surpassed that reported in other Brazilian indigenous groups. This disparity highlights the disproportionate impact of the disease on this particular group. The detection of drug-resistance mutations further emphasizes the critical need to expand diagnostic coverage, closely monitor treatment strategies, and maintain ongoing molecular surveillance. These measures are imperative for enhancing HIV management within this vulnerable population. FUNDING This study was partially funded by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Fundação de Apoio ao Desenvolvimento do Ensino, Ciência e Tecnologia do Estado de Mato Grosso do Sul (FUNDECT), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Secretaria do Estado de Saúde (SES) of Governo do Estado de Mato Grosso do Sul, and Universidade Federal da Grande Dourados (UFGD).
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Affiliation(s)
- Erica C.S. Schnaufer
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados (UFGD), Dourados, Mato Grosso do Sul, Brazil
| | - Marcelo S. Barbosa
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados (UFGD), Dourados, Mato Grosso do Sul, Brazil
| | - Michele F.R. Marques
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados (UFGD), Dourados, Mato Grosso do Sul, Brazil
| | - Gabriel T. Brito
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados (UFGD), Dourados, Mato Grosso do Sul, Brazil
| | - Tiago S. Ferreira
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados (UFGD), Dourados, Mato Grosso do Sul, Brazil
| | - Anny D.C. Ribeiro
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados (UFGD), Dourados, Mato Grosso do Sul, Brazil
| | - Anna C. Valiente
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados (UFGD), Dourados, Mato Grosso do Sul, Brazil
| | - Indianara R. Machado
- Distrito Sanitário Especial Indígena (DSEI), Dourados, Mato Grosso do Sul, Brazil
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Crhistinne C.M. Gonçalves
- Universidade Federal do Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
- Secretaria Estadual de Saúde (SES), Campo Grande, Mato Grosso do Sul, Brazil
| | - Tayana S.O. Tanaka
- Universidade Federal do Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil
| | - Monick L. Guimarães
- Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Suzana M. Ribeiro
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados (UFGD), Dourados, Mato Grosso do Sul, Brazil
| | - Julio Croda
- Fundação Oswaldo Cruz (FIOCRUZ), Campo Grande, Mato Grosso do Sul, Brazil
- Faculdade de Medicina (FAMED), Universidade Federal do Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Simone Simionatto
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados (UFGD), Dourados, Mato Grosso do Sul, Brazil
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Butler DC, Larkins S, Korda RJ. Association of individual-socioeconomic variation in quality-of-primary care with area-level service organisation: A multilevel analysis using linked data. J Eval Clin Pract 2023; 29:984-997. [PMID: 36894510 PMCID: PMC10946916 DOI: 10.1111/jep.13834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/11/2023] [Accepted: 02/17/2023] [Indexed: 03/11/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES Ensuring equitable access to primary care (PC) contributes to reducing differences in health related to people's socioeconomic circumstances. However, there is limited data on system-level factors associated with equitable access to high-quality PC. We examine whether individual-level socioeconomic variation in general practitioner (GP) quality-of-care varies by area-level organisation of PC services. METHODS Baseline data (2006-2009) from the Sax Institute's 45 and Up Study, involving 267,153 adults in New South Wales, Australia, were linked to Medicare Benefits Schedule claims and death data (to December 2012). Small area-level measures of PC service organisation were GPs per capita, bulk-billing (i.e., no copayment) rates, out-of-pocket costs (OPCs), rates of after-hours and chronic disease care planning/coordination services. Using multilevel logistic regression with cross-level interaction terms we quantified the relationship between area-level PC service characteristics and individual-level socioeconomic variation in need-adjusted quality-of-care (continuity-of-care, long-consultations, and care planning), separately by remoteness. RESULTS In major cities, more bulk-billing and chronic disease services and fewer OPCs within areas were associated with an increased odds of continuity-of-care-more so among people of high- than low education (e.g., bulk-billing interaction with university vs. no school certificate 1.006 [1.000, 1.011]). While more bulk-billing, after-hours services and fewer OPCs were associated with long consultations and care planning across all education levels, in regional locations alone, more after-hours services were associated with larger increases in the odds of long consultations among people with low- than high education (0.970 [0.951, 0.989]). Area GP availability was not associated with outcomes. CONCLUSIONS In major cities, PC initiatives at the local level, such as bulk-billing and after-hours access, were not associated with a relative benefit for low- compared with high-education individuals. In regional locations, policies supporting after-hours access may improve access to long consultations, more so for people with low- compared with high-education.
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Affiliation(s)
- Danielle C. Butler
- National Centre for Epidemiology and Population HealthThe Australian National UniversityCanberraAustralia
| | - Sarah Larkins
- College of Medicine and DentistryJames Cook UniversityTownsvilleAustralia
| | - Rosemary J Korda
- National Centre for Epidemiology and Population HealthThe Australian National UniversityCanberraAustralia
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Cama E, Beadman M, Beadman K, Hopwood M, Treloar C. Health workers' perspectives of hepatitis B-related stigma among Aboriginal and Torres Strait Islander people in New South Wales, Australia. Harm Reduct J 2023; 20:116. [PMID: 37633903 PMCID: PMC10463284 DOI: 10.1186/s12954-023-00844-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/28/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND Experiences of stigma and discrimination can act as a significant barrier to testing, monitoring, and treatment for hepatitis B virus (HBV). Aboriginal and Torres Strait Islander Australians are a population disproportionately impacted by HBV and yet limited research has explored HBV-related stigma in these communities. To begin preliminary explorations of HBV-related stigma among Aboriginal and Torres Strait Islander people, we interviewed health workers about their perceptions regarding HBV infection and HBV-related stigma. METHODS Participants were recruited from staff involved in the Deadly Liver Mob (DLM) program which is a health promotion program that offers incentives for Aboriginal and Torres Strait Islander clients to be educated on viral hepatitis, recruit and educate peers, and receive screening and treatment for blood-borne viruses (BBVs) and sexually transmissible infections (STIs), and vaccination. Semi-structured interviews were conducted with 11 Aboriginal and Torres Strait Islander and non-Aboriginal or Torres Strait Islander health workers who have been involved in the development, implementation, and/or management of the DLM program within participating services in New South Wales, Australia. RESULTS Findings suggest that stigma is a barrier to accessing mainstream health care among Aboriginal and Torres Strait Islander clients, with stigma being complex and multi-layered. Aboriginal and Torres Strait Islander people contend with multiple and intersecting layers of stigma and discrimination in their lives, and thus HBV is just one dimension of those experiences. Health workers perceived that stigma is fuelled by multiple factors, including poor HBV health literacy within the health workforce broadly and among Aboriginal and Torres Strait Islander clients, shame about social practices associated with viral hepatitis, and fear of unknown transmission risks and health outcomes. The DLM program was viewed as helping to resist and reject stigma, improve health literacy among both health workers and clients, and build trust and confidence in mainstream health services. CONCLUSIONS Health promotion programs have the potential to reduce stigma by acting as a 'one stop shop' for BBVs and STIs through one-on-one support, yarning, and promotion of the HBV vaccine, monitoring for chronic HBV, and treatment (where required).
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Affiliation(s)
- Elena Cama
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Mitch Beadman
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Kim Beadman
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Max Hopwood
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
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Gill S, Zeki R, Kaye S, Zingirlis P, Archer V, Lewandowski A, Creighton G, Shaw C, Bowman J. Health literacy strengths and challenges of people in New South Wales prisons: a cross-sectional survey using the Health Literacy Questionnaire (HLQ). BMC Public Health 2023; 23:1520. [PMID: 37563584 PMCID: PMC10413686 DOI: 10.1186/s12889-023-16464-3] [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: 02/20/2023] [Accepted: 08/06/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Health literacy is an important factor for enabling people to manage their health and live long fulfilling lives. People in prison are frequently from marginalised communities, often out of reach of conventional community based health organisations, and have poorer health outcomes. It is essential to understanding the health literacy profiles of people in prison, and its contribution to the well-established health inequities and outcomes of this population. This study aimed to use a multi-dimensional health literacy measurement tool to describe the strengths and challenges of adults incarcerated in NSW prisons. METHODS A cross-sectional survey was conducted for people in prison across 14 publicly operated metropolitan prisons. Data were collected from 471 participants using the Health Literacy Questionnaire (HLQ). Participant characteristics and health conditions were also collected. Data were analysed using descriptive statistics. Effect sizes (ES) for standardised differences in means were used to describe the magnitude of difference between participant characteristic groups. RESULTS Participants' median age was 38.0 (range 19 - 91) years. Males comprised 81% of the sample, 21% identified as Aboriginal and/or Torres Strait Islander, and 53% reported a health problem. People in prison had lower scores for all nine HLQ scales when compared to the general Australian population. Small to medium ES were seen for mean differences between most demographic groups. Compared to males, females had lower scores for several of the HLQ scales including 'having sufficient information to manage health' (ES 0.30 [95% Confidence Interval (CI) 0.07, 0.53]), 'ability to actively engage with health care professionals' (ES 0.30 [95% CI 0.06, 0.53]), 'navigating the healthcare system' (ES 0.30 [95% CI 0.06, 0.53]), and, 'ability to find good health information' (ES 0.33 [95% CI 0.10, 0.57]). Differing health literacy scale scores with small to medium ES were found when comparing participants by legal status. Mainly small ES were seen when comparing other participant characteristic groups. CONCLUSIONS This study provides insights into the health literacy strengths and challenges for people in NSW prisons. These findings highlight the important role health literacy could have in addressing health disparities in this vulnerable population and can inform prison health services.
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Affiliation(s)
- Scott Gill
- Research Unit, Justice Health and Forensic Mental Health Network, Sydney, Australia
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Australia
| | - Reem Zeki
- Research Unit, Justice Health and Forensic Mental Health Network, Sydney, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Sharlene Kaye
- Research Unit, Justice Health and Forensic Mental Health Network, Sydney, Australia
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Panayiota Zingirlis
- Research Unit, Justice Health and Forensic Mental Health Network, Sydney, Australia
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia
| | - Vicki Archer
- Research Unit, Justice Health and Forensic Mental Health Network, Sydney, Australia
| | - Amy Lewandowski
- Research Unit, Justice Health and Forensic Mental Health Network, Sydney, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Grantley Creighton
- Aboriginal Health, Justice Health and Forensic Mental Health Network, Sydney, Australia
| | - Caron Shaw
- Adolescent Health, Justice Health and Forensic Mental Health Network, Sydney, Australia
| | - Julia Bowman
- Research Unit, Justice Health and Forensic Mental Health Network, Sydney, Australia
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Hossen MS, Sohel MS, Horaira GA, Laskor MAH, Sumi ABA, Chowdhury S, Aktar S, Sifullah MK, Sarker MFH. Exploring barriers to accessing healthcare services for older indigenous people in the Chittagong Hill Tract, Bangladesh. AIMS Public Health 2023; 10:678-697. [PMID: 37842279 PMCID: PMC10567977 DOI: 10.3934/publichealth.2023047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/08/2023] [Accepted: 07/19/2023] [Indexed: 10/17/2023] Open
Abstract
We aim to investigate the obstacles faced by elderly indigenous individuals in the Chittagong Hill Tracts, Bangladesh when accessing healthcare services. A qualitative research approach was utilized, and data collection was carried out in three distinct regions of the aforementioned area. A total of 30 in-depth, semi-structured interviews and participant observations were conducted to achieve the research objectives. Thematic analysis utilizing both a deductive and inductive approach was employed to analyze the data. The Granheim method and Nvivo-12 software were utilized to process, analyze and code the data. The study's findings indicate that a lack of knowledge about healthcare needs, geographical barriers, poor financial conditions, higher cost of medical services, scarcity of hospitals nearby and communication barriers all contribute to inadequate access to healthcare services. By recognizing the factors that impede access to healthcare services in this region, this study offers valuable insight for policymakers and healthcare providers on how to enhance healthcare services for the indigenous population, especially the elderly. Furthermore, the government can adopt a more efficient approach to include these elderly individuals in various social safety net programs.
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Affiliation(s)
- Md. Sohrab Hossen
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md. Salman Sohel
- Department of Development Studies, Daffodil International University, Dhaka–1216, Bangladesh
| | - Gazi Abu Horaira
- Ghazali Shafie Graduate School of Government, University Utara Malaysia, Malaysia
| | - Md Aminul Haque Laskor
- Department of Geography and Environment, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | | | - Srima Chowdhury
- Faculty of Business Administration, University of Chittagong, Chittagong, Bangladesh
| | - Sima Aktar
- Eden Mahila College, University of Dhaka, Dhaka, Bangladesh
| | - Md. Khaled Sifullah
- Department of Development Studies, Daffodil International University, Dhaka–1216, Bangladesh
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Corcorran MA, Thornton K, Struminger B, Easterbrook P, Scott JD. Training the healthcare workforce: the global experience with telementorship for hepatitis B and hepatitis C. BMC Health Serv Res 2023; 23:824. [PMID: 37533025 PMCID: PMC10394928 DOI: 10.1186/s12913-023-09849-y] [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: 01/19/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Telementorship has emerged as an innovative strategy to decentralise medical knowledge and increase healthcare capacity across a wide range of disease processes. We report the global experience with telementorship to support healthcare workers delivering hepatitis B virus (HBV) and hepatitis C virus (HCV) care and treatment. METHODS In early 2020, we conducted a survey of HBV and HCV telementorship programmes, followed by an in-depth interview with programme leads. Programmes were eligible to participate if they were located outside of the United States (U.S.), focused on support to healthcare workers in management of HBV and/or HCV, and were affiliated with or maintained adherence to the Project ECHO model, a telementorship programme pioneered at the University of New Mexico. One programme in the U.S., focused on HCV treatment in the Native American community, was purposively sampled and invited to participate. Surveys were administered online, and all qualitative interviews were performed remotely. Descriptive statistics were calculated for survey responses, and qualitative interviews were assessed for major themes. RESULTS Eleven of 18 eligible programmes completed the survey and follow up interview. Sixty-four percent of programmes were located at regional academic medical centers. The majority of programmes (64%) were led by hepatologists. Most programmes (82%) addressed both HBV and HCV, and the remainder focused on HCV only. The median number of participating clinical spoke sites per programme was 22, and most spoke site participants were primary care providers. Most ECHO sessions were held monthly (36%) or bimonthly (27%), with sessions ranging from 45 min to 2 h in length. Programme leaders identified collective learning, empowerment and collaboration to be key strengths of their telementorship programme, while insufficient funding and a lack of protected time for telementorship leaders and participants were identified as major barriers to success. CONCLUSION The Project ECHO model for telementorship can be successfully implemented across high and low-and-middle-income countries to improve provider knowledge and experience in management of viral hepatitis. There is a tremendous opportunity to further expand upon the existing experience with telementorship to support non-specialist healthcare workers and promote elimination of viral hepatitis.
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Affiliation(s)
- Maria A Corcorran
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA.
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Harborview Medical Center, 325 9th Ave, Box 359782, Seattle, WA, 98104, USA.
| | - Karla Thornton
- Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- Project ECHO, University of New Mexico, Albuquerque, NM, USA
| | - Bruce Struminger
- Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- Project ECHO, University of New Mexico, Albuquerque, NM, USA
| | - Philippa Easterbrook
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - John D Scott
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
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