Twelve Tips for Inclusive Practice in Healthcare Settings

Inclusive Language to Support Health Equity and Belonging in Dentistry

Inclusive language in dentistry is essential for delivering high-quality, equitable care that respects and empathizes with patients from diverse backgrounds. It involves using language that avoids exclusion and bias, focusing on person-first terms, and understanding the preferences of individuals and communities. This approach not only promotes health equity and belonging but also strengthens trust and communication between providers and patients and among members of the dental health care team. Education, training, and consistent deliberate practice in inclusive language among health care professionals are crucial for integrating these principles into oral health care.

Models of Diversity, Equity, Inclusion, and Belonging: Part II-Exploring Models of Inclusion from Other Health Professions for Dentistry

This study describes examples of models and frameworks from other professions that could be applied toward creating environments of inclusion and belonging in dentistry. Examples are provided of activities, frameworks, and models that can serve to launch similar activities within dentistry. Selected models of inclusion from library science, medicine, nursing, dental hygiene, and social work can be used by the dental profession to help make definitive strides in the inclusion arena to combat challenges of access and inequitable oral health status.

Preparation of dental and nursing professionals within Swedish higher education: navigating to confidence in literacies and professional knowledge

BACKGROUND

The professional education of dentists and nurses includes literacy, academic and professional literacy, and professional knowledge. These have a reciprocal relationship and contribute to the development of students and professionals. However, this is an area in need of further exploration. Therefore, this study aimed to investigate dentists' and nurses' experiences of academic and professional literacy and professional knowledge at the time of their graduation, and five years into their profession.

METHODS

The material consisted of an evaluation distributed twice to dentists and nurses. The first time was immediately after graduation (degree evaluation), and the second time was five years after graduation (alum evaluation). Approximately 30% of the dentists and the nurses responded both times. We analyzed the data using non-parametrical methods.

RESULTS

Upon graduation, the dentists scored high in academic and professional literacy and knowledge. Five years into the profession, dentists reported experiencing challenges with communication in English and tasks related to equitable treatment and equal rights. Nurses followed a similar pattern as the dentists. Still, by graduation, the newly graduated nurses expressed concerns about communication in English, and promoting sustainable development within their profession. The challenges persisted five years into their profession, particularly in areas such as communication in English and sustainable development, as well as work related to equitable treatment and equal rights.

CONCLUSIONS

The level of confidence and perception of a sufficient degree of knowledge regarding academic literacy, professional literacy, and professional knowledge is higher at the time of graduation in both professions compared to five years into the profession, where there is a decrease in areas concerning work related to equitability, and equality, and for dentists also in communication in English. Furthermore, nurses had a constant low confidence rating in both evaluations concerning sustainable development and communication in English. This indicates that targeted and continuous professional development is crucial to address these challenges and to bridge the gap between the knowledge and confidence levels at graduation and the evolving demands of professional practice over time. Thus, when reconstructing the overall curriculum in professional educations it is of great importance to provide tools to enhance future professional development rather than the perception of that they can rely solely on their education at graduation time.

Addressing Stigma-Related Health Disparities for Autistic Individuals Through Cultural Competemility: Insights from Research and Lived Experience

PURPOSE OF REVIEW

Autistic individuals experience disproportionate stigma across the life course in interpersonal, healthcare, and educational contexts. These experiences contribute to negative health and healthcare outcomes for this population. This paper seeks to describe autistic individuals' experiences of stigma and marginalization; discuss frameworks such as Campinha-Bacote's innovative concept of cultural competemility and its relevance to autistic populations; offer recommendations to healthcare providers based on this framework; and apply theory to practice in a case study.

RECENT FINDINGS

Autistic individuals increasingly understand autism as an important aspect of their identity. There are, however, few culturally informed healthcare efforts that reflect this understanding. As a result, efforts to address stigma-related health disparities for this population have limited effectiveness. In this manuscript, we highlight opportunities within clinical encounters, medical training, healthcare offices and systems, and research to provide higher quality culturally informed care to autistic populations and address stigma-related health disparities.

Interrogating the effectiveness of service engagement for underserved populations in complex health and social care systems: towards an equitable engagement strategy

There are increased sector-wide efforts within health and social care systems to engage those with lived experience in service design, delivery, and monitoring - aiming to secure more equitable health outcomes. However, critical knowledge gaps persist around how national whole-system engagement strategies can account for the challenges experienced by populations that encounter exclusion within complex multi-layered systems. This includes a failure to delineate shared challenges across groups, and to develop transferable cross-group frameworks to assist sector-wide change. There is, therefore, a danger that those groups already least heard will be collectively left behind. With a view to informing a more inclusive engagement strategy in Ireland, this national study aims to investigate multi-level (policy and strategic, operational, on-the-ground services, individual) shared challenges impacting engagement for five populations who have been identified as underserved groups in a complex health and social care system, including: (1) those who misuse drugs and alcohol, (2) those who are experiencing homelessness, (3) those experiencing mental health, (4) migrants and those of minority ethnicies, and (5) Irish Travellers. Adopting a mixed-methods approach which draws on an evidence-informed multistakeholder perspective, this study employs data from: focus groups and life-course interviews with lived-experience populations (n=136), five focus groups (n=39) and a national on-line survey (n=320) with population-specific services providers; and national-level stakeholder interviews (n=9). Two cross-group participatory consultative forums with lived-experience and provider participants (n=28) were used to co-produce priority action areas based on study findings. This article presents findings on shared challenges in engaging these groups around leadership and commitment, implementation and action, population capacities, trust, and representation, stigma, and discrimination. Derived from these challenges, six development areas are presented to advance an inclusive equitable engagement approach in Ireland. These comprise: 1) balancing top-down prioritisation, and bottom-up direction; 2) sustaining multi-level, multi-form implementation; 3) measuring effectiveness and action; 4) embedding inclusive equitable engagement; 5) trust as a prerequisite, and outcome; and 6) an equalising, agency empowering agenda.

Diversity Audit of Medical School Examination Questions

Phenomenon: This article reports the under-researched presentation of demographic, social, and economic diversity in medical school examination questions. Approach: The present study audited 3,566 pre-clinical and clinical multiple-choice and short answer examination questions in the same year (2018) from three medical schools in two continents to review the diversity of patients portrayed. The audit was based on an extension of Critical Race Theory beyond race and ethnicity to include pertinent social determinants of health. Findings: Patients were presented in 1,537 (43.1%) of the audited examination questions. Apart from age (89.4%) and binary genders (93.9%), other diversity characteristics were rarely portrayed (ethnicity 7.2%, relationship status 1.9%, sexual identity 1.1%, socio-economic status 0.5%, geographic residence 0.1%, disability 0.1%), or not at all (non-binary genders; residency status; religion/spirituality). Insights: While presenting excessive and unnecessary patient characteristics in examination questions should be avoided, the absence of many diversity aspects may reduce examination authenticity and defeat the teaching of diversity in medicine. Medical schools should consider a routine audit and reasonable improvement of the diversity features of patients in examination questions to support teaching and learning activities addressing patients' diversity.

Understanding the Health Literacy Experiences and Practices of Australian-Resettled Myanmar Refugees: Relevance for Nutrition and Dietetics Practice

Background/Objectives: Refugees typically experience poorer health compared with people from non-refugee backgrounds, and health literacy may play a part in this discrepancy. Using the WHO's revised health literacy definitions as a framework, this qualitative study sought to examine the health literacy experiences and practices of Australian resettled refugees from Myanmar from refugee and service provider perspectives. Methods: Four refugee participant focus groups (n = 27) along with one focus group and four interviews with service providers (n = 7) were conducted in Melbourne, Australia, and analysed using deductive content analysis. Results: Our study found that in addition to individual health literacy, community literacy was practiced by Myanmar refugees, thus highlighting the relevance of social support to health literacy. Furthermore, our study found gaps in healthcare service provision and resourcing related to health literacy development and responsiveness by the healthcare system. Conclusions: Our study confirms the relevance of WHO's revised health literacy definitions to Myanmar refugees while also discussing, in the context of nutrition and dietetics practice, the importance of understanding the different aspects of health literacy and how this relates to working with those who are most marginalised to improve their health and wellbeing.

Genetic counseling workforce diversity, inclusion, and capacity in Australia and New Zealand

Purpose

To understand diversity, inclusion, and capacity of genetic counselors (GCs) in Australasia (Australia and New Zealand).

Methods

Individuals with or working toward a GC qualification in Australasia were invited to complete an online survey, between November 2022 and March 2023. Quantitative data were analyzed using descriptive statistics, 1-sample proportion z-tests, 2-sample z-tests, and χ2 tests. Qualitative data were analyzed using inductive content analysis.

Results

A total of 252 participants responded to the survey. A subset analysis of respondents residing in Australia demonstrated a lack of representation across various characteristics including sex, relationship status, caregiver status, location, country of birth, Aboriginal/Torres Strait Islander identity, language, and religion. Analysis of the full data set demonstrated that most respondents also perceived that the workforce was not representative across gender, sexual orientation, ethnicity, or disability. Respondents provided examples of existing inclusive practice. They also suggested workforce needs, such as promoting education and employment for minority communities, more visible diversity, accessible services for clients, and professional development for GCs. Using survey and reference data, we estimated approximately 346 full-time equivalent GCs working in clinical practice in Australasia.

Conclusion

Our study provides a first step in illuminating GC workforce changes needed in Australasia regarding diversity, inclusion, and capacity. The survey may be of use internationally, enabling other countries to understand these issues within their jurisdiction, and supporting the international community in addressing these challenges.

Unveiling the power of neutral and inclusive language in tuberculosis prevention and care

Language plays a crucial role in shaping discourses and responses related to disease, particularly tuberculosis (TB). Stigmatising language and attitudes surrounding TB can lead to discrimination and marginalisation of affected individuals, creating barriers to seeking proper diagnosis and treatment. The terminology used to describe TB-affected individuals can be disempowering and criminalising, reinforcing an "othering" of those affected. To combat this, engaging with TB-affected communities is essential to co-construct a neutral and inclusive vocabulary that respects the dignity of individuals and fosters empathy and support. Thus, an inclusive language approach empowers affected individuals as active participants in their health management, encouraging open communication and the development of support networks. By adopting a neutral and inclusive language system, healthcare providers and communities can work together to remove unnoticed hurdles and align with the World Health Organization's TB care and prevention goals.

Does a Community Care programme reach a high health need population and high users of acute care hospital services in Melbourne, Australia? An observational cohort study

OBJECTIVE

The Community Care programme is an initiative aimed at reducing hospitalisations and emergency department (ED) presentations among patients with complex needs. We aimed to describe the characteristics of the programme participants and identify factors associated with enrolment into the programme.

DESIGN

This observational cohort study was conducted using routinely collected data from the National Centre for Healthy Ageing data platform.

SETTING

The study was carried out at Peninsula Health, a health service provider serving a population in Melbourne, Victoria, Australia.

PARTICIPANTS

We included all adults with unplanned ED presentation or hospital admission to Peninsula Health between 1 November 2016 and 31 October 2017, the programme's first operational year.

OUTCOME MEASURES

Community Care programme enrolment was the primary outcome. Participants' demographics, health factors and enrolment influences were analysed using a staged multivariable logistic regression.

RESULTS

We included 47 148 adults, of these, 914 were enrolled in the Community Care programme. Participants were older (median 66 vs 51 years), less likely to have a partner (34% vs 57%) and had more frequent hospitalisations and ED visits. In the multivariable analysis, factors most strongly associated with enrolment included not having a partner (adjusted OR (aOR) 1.83, 95% CI 1.57 to 2.12), increasing age (aOR 1.01, 95% CI 1.01 to 1.02), frequent hospitalisations (aOR 7.32, 95% CI 5.78 to 9.24), frequent ED visits (aOR 2.0, 95% CI 1.37 to 2.85) and having chronic diseases, such as chronic pulmonary disease (aOR 2.48, 95% CI 2.06 to 2.98), obesity (aOR 2.06, 95% CI 1.39 to 2.99) and diabetes mellitus (complicated) (aOR 1.75, 95% CI 1.44 to 2.13). Residing in aged care home and having high socioeconomic status) independently associated with reduced odds of enrolment.

CONCLUSIONS

The Community Care programme targets patients with high-readmission risks under-representation of individuals residing in residential aged care homes warrants further investigation. This study aids service planning and offers valuable feedback to clinicians about programme beneficiaries.