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Paimre M, Virkus S, Osula K. How Technology, Health Information Seeking, and Socioeconomic Factors Are Associated With Coronavirus Disease 2019 Vaccination Readiness in Estonians Over 50 Years? HEALTH EDUCATION & BEHAVIOR 2024; 51:502-511. [PMID: 38712912 PMCID: PMC11193318 DOI: 10.1177/10901981241249972] [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: 05/08/2024]
Abstract
Despite the proven effectiveness of COVID-19 vaccines in preventing severe illness, many individuals, including older adults who are most susceptible to the virus, have opted against vaccination. Various factors could shape vaccination decisions, including seeking health information (HI). The internet is the primary source of HI today; however, older adults are often referred to as those missing out on digital benefits. The study explores the correlations between information and communication technology (ICT) use, online HI seeking, socioeconomic factors, and COVID-19 vaccination readiness among individuals aged 50 and above in Estonia. The survey data were gathered from 501 people aged 50 and older after the first lockdown in 2020. The outcomes revealed that vaccination readiness positively correlated with factors such as higher educational attainment, greater income, male gender, access to ICT, a readiness to employ digital technologies for health-related purposes, a greater demand for HI, and a higher frequency of seeking it online. There was some discrepancy in the preference of HI sources; for example, vaccination consenters preferred online versions of professional press publications and specific health portals. Based on the findings, it is advisable to encourage older adults to utilize the internet and new technology for health-related purposes. This practice expands the range of information sources available to them, ultimately enabling better decision-making regarding their health behaviors.
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Affiliation(s)
- Marianne Paimre
- Tallinn University, Tallinn, Estonia
- Tallinn Health Care College, Tallinn, Estonia
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Coetzer JA, Loukili I, Goedhart NS, Ket JCF, Schuitmaker-Warnaar TJ, Zuiderent-Jerak T, Dedding C. The potential and paradoxes of eHealth research for digitally marginalised groups: A qualitative meta-review. Soc Sci Med 2024; 350:116895. [PMID: 38710135 DOI: 10.1016/j.socscimed.2024.116895] [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: 10/03/2023] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024]
Abstract
Whilst the transformation towards digital healthcare is accelerating, there is still a substantial risk of excluding people with a distance to the online world. Groups like people with a low socioeconomic position, people with a migrant background or the elderly, who are already most at risk of experiencing health inequalities, are simultaneously experiencing increased digital exclusion. Researchers play a role in determining how eHealth access is framed and can thus impact how the barriers to its use are addressed. This qualitative meta-review critically evaluates the way researchers (as authors) discuss eHealth use in digitally marginalised groups. Specifically, it seeks to understand how eHealth is framed to address existing health systems problems; how the barriers to eHealth use are presented and which solutions are provided in response; and who authors suggest should be responsible for making eHealth work. The results of this review found four paradoxes in how current literature views eHealth use. Firstly, that health systems problems are complex and nuanced, yet eHealth is seen as a simple answer. Secondly, that there are many political, social and health systems-based solutions suggested to address eHealth use, however most of the identified barriers are individually framed. This focus on personal deficits results in misallocating responsibility for making these systemic improvements. Thirdly, although eHealth is meant to simplify the tasks of patients and healthcare workers, these are the groups most often burdened with the responsibility of ensuring its success. Lastly, despite tailoring eHealth to the user being the most suggested solution, researchers generally speak about groups as a homogenous entity - thus rendering tailoring difficult. Ultimately, this review finds that a shift to focus research on addressing systemic issues on a systems level is necessary to prevent further exacerbating existing health inequalities.
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Affiliation(s)
- Jessica A Coetzer
- Athena Institute, Faculty of Science, VU University, De Boelelaan 1085, 1081HV, Amsterdam, the Netherlands.
| | - Ibrahim Loukili
- Department of Ethics, Law & Humanities, Amsterdam UMC, De Boelelaan 1089a, F-vleugel medische faculteit, Amsterdam, The Netherlands.
| | - Nicole S Goedhart
- Department of Ethics, Law & Humanities, Amsterdam UMC, De Boelelaan 1089a, F-vleugel medische faculteit, Amsterdam, The Netherlands.
| | - Johannes C F Ket
- VUmc, Medische Bibliotheek, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
| | | | - Teun Zuiderent-Jerak
- Athena Institute, Faculty of Science, VU University, De Boelelaan 1085, 1081HV, Amsterdam, the Netherlands.
| | - Christine Dedding
- Department of Ethics, Law & Humanities, Amsterdam UMC, De Boelelaan 1089a, F-vleugel medische faculteit, Amsterdam, The Netherlands.
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Wilderink L, Bakker I, Schuit AJ, Seidell JC, Pop IA, Renders CM. Correction: Wilderink et al. A Theoretical Perspective on Why Socioeconomic Health Inequalities Are Persistent: Building the Case for an Effective Approach. Int. J. Environ. Res. Public Health 2022, 19, 8384. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:573. [PMID: 38791866 PMCID: PMC11107422 DOI: 10.3390/ijerph21050573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/20/2023] [Indexed: 05/26/2024]
Abstract
In the original publication [...].
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Affiliation(s)
- Lisa Wilderink
- Department of Health Sciences, Faculty of Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (J.C.S.); (C.M.R.)
- Department of Healthy Society, Windesheim University of Applied Sciences, 8017 CA Zwolle, The Netherlands;
| | - Ingrid Bakker
- Department of Healthy Society, Windesheim University of Applied Sciences, 8017 CA Zwolle, The Netherlands;
| | - Albertine J. Schuit
- School of Social and Behavioral Sciences, Tilburg University, 5037 AB Tilburg, The Netherlands; (A.J.S.); (I.A.P.)
| | - Jacob C. Seidell
- Department of Health Sciences, Faculty of Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (J.C.S.); (C.M.R.)
| | - Ioana A. Pop
- School of Social and Behavioral Sciences, Tilburg University, 5037 AB Tilburg, The Netherlands; (A.J.S.); (I.A.P.)
| | - Carry M. Renders
- Department of Health Sciences, Faculty of Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (J.C.S.); (C.M.R.)
- Department of Healthy Society, Windesheim University of Applied Sciences, 8017 CA Zwolle, The Netherlands;
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Mudd AL, Bal M, Verra SE, Poelman MP, de Wit J, Kamphuis CBM. The current state of complex systems research on socioeconomic inequalities in health and health behavior-a systematic scoping review. Int J Behav Nutr Phys Act 2024; 21:13. [PMID: 38317165 PMCID: PMC10845451 DOI: 10.1186/s12966-024-01562-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/14/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Interest in applying a complex systems approach to understanding socioeconomic inequalities in health is growing, but an overview of existing research on this topic is lacking. In this systematic scoping review, we summarize the current state of the literature, identify shared drivers of multiple health and health behavior outcomes, and highlight areas ripe for future research. METHODS SCOPUS, Web of Science, and PubMed databases were searched in April 2023 for peer-reviewed, English-language studies in high-income OECD countries containing a conceptual systems model or simulation model of socioeconomic inequalities in health or health behavior in the adult general population. Two independent reviewers screened abstracts and full texts. Data on study aim, type of model, all model elements, and all relationships were extracted. Model elements were categorized based on the Commission on Social Determinants of Health framework, and relationships between grouped elements were visualized in a summary conceptual systems map. RESULTS A total of 42 publications were included; 18 only contained a simulation model, 20 only contained a conceptual model, and 4 contained both types of models. General health outcomes (e.g., health status, well-being) were modeled more often than specific outcomes like obesity. Dietary behavior and physical activity were by far the most commonly modeled health behaviors. Intermediary determinants of health (e.g., material circumstances, social cohesion) were included in nearly all models, whereas structural determinants (e.g., policies, societal values) were included in about a third of models. Using the summary conceptual systems map, we identified 15 shared drivers of socioeconomic inequalities in multiple health and health behavior outcomes. CONCLUSIONS The interconnectedness of socioeconomic position, multiple health and health behavior outcomes, and determinants of socioeconomic inequalities in health is clear from this review. Factors central to the complex system as it is currently understood in the literature (e.g., financial strain) may be both efficient and effective policy levers, and factors less well represented in the literature (e.g., sleep, structural determinants) may warrant more research. Our systematic, comprehensive synthesis of the literature may serve as a basis for, among other things, a complex systems framework for socioeconomic inequalities in health.
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Affiliation(s)
- Andrea L Mudd
- Department of Interdisciplinary Social Science- Public Health, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands.
| | - Michèlle Bal
- Department of Interdisciplinary Social Science- Public Health, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
| | - Sanne E Verra
- Department of Interdisciplinary Social Science- Public Health, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
| | - Maartje P Poelman
- Chair Group Consumption and Healthy Lifestyles, Wageningen University & Research, Hollandseweg 1, 6706 KN, Wageningen, the Netherlands
| | - John de Wit
- Department of Interdisciplinary Social Science- Public Health, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science- Public Health, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
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Sponselee HCS, ter Beek L, Renders CM, Kroeze W, Fransen MP, van Asselt KM, Steenhuis IHM. Letting people flourish: defining and suggesting skills for maintaining and improving positive health. Front Public Health 2023; 11:1224470. [PMID: 37900021 PMCID: PMC10602807 DOI: 10.3389/fpubh.2023.1224470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Background The concept of "positive health" emerged from the need for a holistic and more dynamic perspective on health, emphasising the ability of individuals to adapt and self-manage. The positive health conversation tool helps understand how people score on six positive health dimensions. However, skills within these dimensions to maintain or improve health have not yet been described. This is important for enabling individuals to put health advice into practise. Therefore, this paper aims to define and suggest skills for maintaining and improving positive health. Subsections Suggestions for definitions of skills within the positive health dimensions are described using the functional, interactive, and critical health literacy framework. Additionally, executive functions and life skills were incorporated. Moreover, the environment's role in these individual skills was noted, mentioning organisational health literacy that emphasises organisations' responsibility to provide comprehensible health information to all individuals. We propose that health promotion interventions can incorporate the proposed skills in practical exercises while aligning intervention materials and implementation tools with end-users and implementers. Discussion and conclusion The suggested skills for maintaining and improving positive health are a first step towards a more comprehensive understanding and open to discussion. These skills may also be applied to other practical conversation tools for maintaining or improving health. Increasing positive health through the defined skills may be especially relevant to those with a lower socioeconomic position who also have limited health literacy and thereby may contribute to reducing health inequalities. Taken together, strengthening the defined skills may hopefully contribute to allowing people to flourish in life.
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Affiliation(s)
- Hanne C. S. Sponselee
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Lies ter Beek
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Carry M. Renders
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Willemieke Kroeze
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Care for Nutrition and Health Group, School of Nursing, Christian University of Applied Sciences, Ede, Netherlands
| | - Mirjam P. Fransen
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, Netherlands
| | - Kristel M. van Asselt
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ingrid H. M. Steenhuis
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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Ávila-Burgos L, Guzmán-Saldaña R, Márquez-Corona MDL, Pontigo-Loyola AP, Márquez-Rodríguez S, Mora-Acosta M, Acuña-González GR, Hernández-Morales A, Medina-Solís CE. Socioeconomic Inequalities in Alcohol and Tobacco Consumption: A National Ecological Study in Mexican Adolescents. ScientificWorldJournal 2023; 2023:3604004. [PMID: 37434965 PMCID: PMC10332929 DOI: 10.1155/2023/3604004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 04/26/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023] Open
Abstract
Alcohol and cigarettes are the psychoactive substances that adolescents use most frequently. When both addictions are combined, they carry the worst burden of disease globally. The objective of this study was to identify whether socioeconomic factors correlate with alcohol and tobacco consumption in Mexican adolescents aged 10 years or more and to establish the relationship in the consumption between the two substances. This ecological study utilized data describing alcohol and tobacco consumption among adolescents aged 10-16 years (n = 48,837 ≈ N = 11,621,100). Having ever consumed any alcohol-containing beverage constituted alcohol consumption. Smoking a cigarette within 30 days constituted cigarette consumption. For both variables, the state-level percentages reported in the survey were used. Diverse socioeconomic variables were collected from official sources. Data on the prevalence of tobacco use and alcohol consumption were entered into an Excel database estimated for each of the states of the Mexican Republic, as well as the socioeconomic variables. We performed the analysis using Stata 14. Consumption prevalence was 15.0% for alcohol and 4.2% for tobacco. Alcohol consumption was not correlated with any studied socioeconomic variable (p > 0.05). The prevalence of tobacco consumption among elementary school students correlated (p < 0.05) with the portion of the population living in private dwellings without sewage, drainage, or sanitation (r = 0.3853). The prevalence of tobacco consumption among middle-school adolescents correlated with the portion of the employed population that earned up to two minimum wages (r = 0.3960), the percentage in poverty by income 2008 (r = 0.4754) and 2010 (r = 0.4531), and the percentage in extreme poverty by income 2008 (r = 0.4612) and 2010 (r = 0.4291). Positive correlations were found between tobacco consumption and alcohol consumption among both elementary (r = 0.5762, p=0.0006) and middle-school children (r = 0.7016, p=0.0000). These results suggest that certain socioeconomic factors correlate with tobacco consumption but not alcohol consumption. A correlation between alcohol consumption and tobacco consumption was observed. The results can be used for developing interventions in adolescents.
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Affiliation(s)
- Leticia Ávila-Burgos
- Health Systems Research Center, The National Institute of Public Health, Cuernavaca, Mexico
| | - Rebeca Guzmán-Saldaña
- Academic Area of Psychology, Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca, Mexico
| | | | | | - Sonia Márquez-Rodríguez
- Academic Area of Dentistry, Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca, Mexico
| | - Mariana Mora-Acosta
- Academic Area of Dentistry, Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca, Mexico
| | | | | | - Carlo Eduardo Medina-Solís
- Academic Area of Dentistry, Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca, Mexico
- Advanced Studies and Research Center in Dentistry “Keisaburo Miyata”, School of Dentistry, Autonomous University of State of Mexico, Toluca, Mexico
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Bogt MJJT, Bevelander KE, Tholen L, Molleman GRM, van den Muijsenbergh M, Fransen GAJ. Leverage point themes within Dutch municipalities' healthy weight approaches: A qualitative study from a systems perspective. PLoS One 2023; 18:e0287050. [PMID: 37310977 DOI: 10.1371/journal.pone.0287050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Despite all efforts of national and local approaches, obesity rates continue to rise worldwide. It is increasingly recognized that the complexity of obesity should be further addressed by incorporating a systems perspective when implementing approaches. Such an approach has four interconnected system levels: events, structures, goals, and beliefs, in which small changes ('leverage points') can lead to substantial changes in the functioning of the entire system. The current research examined the functioning of five Dutch municipalities' healthy weight approaches (HWAs) and the leverage point themes that can be identified in their system. METHODS Thirty-four semi-structured interviews were conducted with various stakeholders about the HWA, including policy advisors, care professionals, practice professionals, and citizens. An inductive thematic analysis was performed. RESULTS Three main themes were identified: 1) HWA organization structure, 2) collaboration between professionals, and 3) citizen participation. Across all system levels, we identified leverage point themes. The upper-levels events and structures occurred the most and were explained by underlying goals and beliefs. Leverage point themes regarding "HWA organization structure" were municipal processes, such as perceived impact; diversity of themes, activities, and tasks; network; and communication strategies, such as messages about the HWA. Leverage point themes regarding "collaboration between professionals" were linking pins, indicating central players within the network; motivation and commitment including support base; and stimulating one another to work on the HWA by spurring other professionals into action. Lastly, leverage point themes under "citizen participation" included reaching the target group, e.g., look for entry points; and citizens' motivation, including customization. DISCUSSION This paper provides unique insights into HWAs' leverage point themes that can lead to substantial changes in how the entire system functions and makes suggestions about underlying leverage points to help stakeholders improve their HWA. Future research could focus on studying leverage points within leverage point themes.
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Affiliation(s)
- Maud J J Ter Bogt
- Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
- AMPHI Academic Collaborative Centre, Nijmegen, The Netherlands
| | - Kirsten E Bevelander
- Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
- AMPHI Academic Collaborative Centre, Nijmegen, The Netherlands
| | - Lisa Tholen
- Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Gerard R M Molleman
- Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
- AMPHI Academic Collaborative Centre, Nijmegen, The Netherlands
| | - Maria van den Muijsenbergh
- Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
- Pharos, The Dutch Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Gerdine A J Fransen
- Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
- AMPHI Academic Collaborative Centre, Nijmegen, The Netherlands
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Perafita X, Saez M. Housing Supply and How It Is Related to Social Inequalities-Air Pollution, Green Spaces, Crime Levels, and Poor Areas-In Catalonia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085578. [PMID: 37107859 PMCID: PMC10138561 DOI: 10.3390/ijerph20085578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023]
Abstract
We carried out a search of over 12,000 houses offered on the rental market in Catalonia and assessed the possibility of families below the poverty threshold being able to rent these homes. In this regard, we wanted to evaluate whether the economic situation of families is able to influence their social environment, surroundings, and safety. We observed how their economic situation can allow families the possibility of developing a life without exposure to health risks, and how economic constraints result in disadvantages in several areas of life. The results show how families at risk of poverty live in less favourable conditions and experience a widening of different gaps, with current prices leading to a possible poverty trap for the most disadvantaged groups. The higher the percentage of the population below the threshold, the lower the possibility of not being able to rent a house compared to areas with a lower prevalence of population below the threshold. This association was observed both when considering the risk linearly and non-linearly. Linearly, the probability of not renting a house was reduced by 8.36% for each 1% increase in the prevalence of population at risk of extreme poverty. In the second, third and fourth percentage quartiles, the probability of not being able to rent a house decreased by 21.13%, 48.61%, and 57.79%, respectively. In addition, the effect was different inside and outside of metropolitan areas, with the former showing a decrease of 19.05% in the probability of renting a house, whereas outside metropolitan areas the probability increased by 5.70%.
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Affiliation(s)
- Xavier Perafita
- Observatori—Organisme Autònom de Salut Pública de la Diputació de Girona (Dipsalut), 17003 Girona, Spain
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, 17003 Girona, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, 17003 Girona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Correspondence:
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Darwin Z, Blower SL, Nekitsing C, Masefield S, Razaq R, Padgett L, Endacott C, Willan K, Dickerson J. Addressing inequalities in the identification and management of perinatal mental health difficulties: The perspectives of minoritised women, healthcare practitioners and the voluntary sector. Front Glob Womens Health 2022; 3:1028192. [PMID: 36619590 PMCID: PMC9813385 DOI: 10.3389/fgwh.2022.1028192] [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: 08/25/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Background Perinatal mental health (PMH) difficulties affect approximately one in five birthing women. If not identified and managed appropriately, these PMH difficulties can carry impacts across generations, affecting mental health and relationship outcomes. There are known inequalities in identification and management across the healthcare pathway. Whilst barriers and facilitators have been identified there is a lack of clarity about how these relate to the avoidable and unfair inequalities experienced by various groups of women. Further research is required to understand how to address inequalities in PMH. Aim To understand the key factors that enable and hinder access to PMH care for women from minoritised groups across the PMH care pathway, and how these have been affected by the COVID-19 pandemic. Methods A sequential mixed-methods approach gathered views and experiences from stakeholders in one region in northern England. This included an online survey with 145 NHS healthcare practitioners and semi-structured interviews with 19 women from ethnic minority and/or socio-economically deprived backgrounds who had experienced PMH difficulties, and 12 key informants from the voluntary and community sector workforce. Quantitative data were analysed using descriptive statistics and framework analysis was applied to qualitative data. Findings Barriers and facilitators were mapped using a socio-technical framework to understand the role of (i) processes, (ii) people (organised as women, practitioners and others), (iii) technology, and (iv) the system as a whole in deepening or alleviating inequalities. Influences that were identified as pertinent to inequalities in identification and management included provision of interpreters, digital exclusion, stigma, disempowerment, distrust of services, practitioner attitudes, data capture, representation in the workforce, narrow rules of engagement and partnership working. Stakeholder groups expressed that several barriers were further compounded by the COVID-19 pandemic. Discussion The findings highlight the need for change at the system level to tackle inequalities across the PMH care pathway. Four inter-connected recommendations were developed to enable this systems change: building emotional safety between professionals and women; making PMH a part of core healthcare business; increasing cultural competency specific to PMH; and enhanced partnership working.
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Affiliation(s)
- Zoe Darwin
- School of Human and Health Sciences, Department of Allied Health Professions, Sport and Exercise, University of Huddersfield, Huddersfield, United Kingdom,Correspondence: Zoe Darwin Sarah Blower
| | - Sarah L. Blower
- Department of Health Sciences, Faculty of Sciences, University of York, York, United Kingdom,Correspondence: Zoe Darwin Sarah Blower
| | - Chandani Nekitsing
- Department of Health Sciences, Faculty of Sciences, University of York, York, United Kingdom
| | - Sarah Masefield
- Department of Health Sciences, Faculty of Sciences, University of York, York, United Kingdom
| | - Rifat Razaq
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Louise Padgett
- Department of Health Sciences, Faculty of Sciences, University of York, York, United Kingdom
| | - Charlotte Endacott
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Kathryn Willan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Josie Dickerson
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
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