1
|
Campinha-Bacote J. Promoting Health Equity Among Marginalized and Vulnerable Populations. Nurs Clin North Am 2024; 59:109-120. [PMID: 38272576 DOI: 10.1016/j.cnur.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
This article calls for a closer examination of health equity regarding the disparities and inequities in health care among marginalized and vulnerable populations. A review of strategies to improve culturally responsive care to these populations will be examined. This examination includes a discussion of the need for structural competence and the ongoing debate around the concepts of cultural competence and cultural humility. Cultural competemility, a new paradigm of thought regarding the relationship between cultural competence and cultural humility, will be proposed. This article culminates with downstream, midstream, and upstream approaches reducing the magnitude of inequity among marginalized and vulnerable populations.
Collapse
|
2
|
Burns KE, Dubé È, Godinho Nascimento H, Meyer SB. Examining vaccine hesitancy among a diverse sample of Canadian adults. Vaccine 2024; 42:129-135. [PMID: 38103960 DOI: 10.1016/j.vaccine.2023.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 06/26/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023]
Abstract
The aim of this study was to explore the sociodemographic and individual-level factors associated with vaccine hesitancy in general, including political affiliation and beliefs in vaccine conspiracy theories, in a diverse group of Canadian adults within the context of the COVID-19 pandemic. 641 responses were included in the analysis, with those self-identifying as Indigenous, Black Canadian, and low-income (household income <$40,000) being sampled to yield data from historically marginalized populations. Demographic variables and responses to questions on vaccine hesitancy, and beliefs in vaccine conspiracy theories were used to explore explanatory variables of vaccine hesitancy. General linear regression models were fit using the method of least squares via PROC GLM and used to examine sociodemographic and individual explanatory variables of vaccine hesitancy. Age, ethnicity, political affiliation, and beliefs in vaccine conspiracies were associated with vaccine hesitancy. Findings are discussed in relation to the critical role of distrust and misinformation in hesitancy. Our data provide insight into how Canadian provincial governments may promote uptake of vaccines in ways that target diverse groups that may differ from those developed in a pre-pandemic context.
Collapse
Affiliation(s)
- Kathleen E Burns
- University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada.
| | - Ève Dubé
- Laval University, 2325 Rue de l'Université, Québec, QC G1V 0A6, Canada.
| | | | - Samantha B Meyer
- University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada.
| |
Collapse
|
3
|
Gilmore MJ, Knerr S, Kraft SA, Bulkley JE, Biesecker BB, Feigelson HS, Hunter JE, Jenkins CL, Kauffman TL, Lee SSJ, Liles EG, Mittendorf KF, Muessig KR, Porter KM, Rolf BA, Rope AF, Zepp JM, Anderson KP, Devine B, Joseph G, Leo MC, Goddard K, Wilfond BS. Improving Care for Marginalized Populations at Risk for Hereditary Cancer Syndromes: Innovations that Expanded Reach in the CHARM Study. Public Health Genomics 2023; 27:16-22. [PMID: 38142673 DOI: 10.1159/000535610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/17/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
- Marian J Gilmore
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA,
| | - Sarah Knerr
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Joanna E Bulkley
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | | | | | - Jessica Ezzell Hunter
- Genomics, Ethics, and Translational Research Program, RTI International, Research Triangle Park, North Carolina, USA
| | - Charisma L Jenkins
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Tia L Kauffman
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, New York, New York, USA
| | | | - Kathleen F Mittendorf
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Kristin R Muessig
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Bradley A Rolf
- Department of Medicine (Medical Genetics), University of Washington Medical Center, Seattle, Washington, USA
| | - Alan F Rope
- Genome Medical, South San Francisco, California, USA
| | - Jamilyn M Zepp
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | | | - Beth Devine
- The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, California, USA
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Katrina Goddard
- Department of Translational and Applied Genomics, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington, USA
| |
Collapse
|
4
|
Watson RJ, Caba AE, Layland EK, Simon K, Morgan E, Edelman EJ, Chan PA, Eaton L. Co-occurring mental health and drug use experiences among Black and Hispanic/Latino sexual and gender diverse individuals. J Behav Med 2023; 46:986-995. [PMID: 37407904 DOI: 10.1007/s10865-023-00433-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 06/21/2023] [Indexed: 07/07/2023]
Abstract
Black and Hispanic/Latino sexual and gender diverse individuals disproportionately experience overlapping health disparities, such as drug use and elevated depressive symptoms, which are often driven by minority stressors. We sought to better understand the interaction between drug use and mental health, as it may be fruitful in developing effective interventions to address co-occurring health disparities. In a longitudinal, 5-wave sample of 300 Black and Hispanic/Latino sexual and gender diverse (SGD) individuals collected between March 2020 and March 2022, we found a within-person association between greater than average levels of psychological distress (depression and anxiety) and more frequent extra-medical use of cannabis, inhalants, methamphetamines, and opioids over the span of two years. These associations held after adjusting for the direct, within-person association of internalized homonegativity with drug use frequency. These results suggest that psychological distress explains at least some variance in drug use among Black and Hispanic/Latino SGD individuals. This highlights the importance of interventions that focus on mental health among Black and Hispanic/Latino SGD individuals who report drug use.
Collapse
Affiliation(s)
- Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd, Storrs, CT, 06269, USA.
| | - Antonia E Caba
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd, Storrs, CT, 06269, USA
| | - Eric K Layland
- College of Education & Human Development, University of Delaware, Newark, DE, USA
| | - Kay Simon
- College of Education and Human Development, University of Minnesota, Minneapolis, MN, USA
| | - Ethan Morgan
- College of Nursing, The Ohio State University, 1585 Neil Ave, Columbus, OH, 43210, USA
| | - E Jennifer Edelman
- Yale School of Medicine and Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Philip A Chan
- Department of Medicine, Brown University, Providence Rhode, Island
| | - Lisa Eaton
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd, Storrs, CT, 06269, USA
| |
Collapse
|
5
|
Ji N, Johnson M, Eckel SP, Gauderman WJ, Chavez TA, Berhane K, Faham D, Lurmann F, Pavlovic NR, Grubbs BH, Lerner D, Habre R, Farzan SF, Bastain TM, Breton CV. Prenatal ambient air pollution exposure and child weight trajectories from the 3rd trimester of pregnancy to 2 years of age: a cohort study. BMC Med 2023; 21:341. [PMID: 37674158 PMCID: PMC10483706 DOI: 10.1186/s12916-023-03050-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/25/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Prenatal air pollution exposure may increase risk for childhood obesity. However, few studies have evaluated in utero growth measures and infant weight trajectories. This study will evaluate the associations of prenatal exposure to ambient air pollutants with weight trajectories from the 3rd trimester through age 2 years. METHODS We studied 490 pregnant women who were recruited from the Maternal and Development Risks from Environmental and Social Stressors (MADRES) cohort, which comprises a low-income, primarily Hispanic population in Los Angeles, California. Nitrogen dioxide (NO2), particulate matter < 10 µm (PM10), particulate matter < 2.5 µm (PM2.5), and ozone (O3) concentrations during pregnancy were estimated from regulatory air monitoring stations. Fetal weight was estimated from maternal ultrasound records. Infant/child weight measurements were extracted from medical records or measured during follow-up visits. Piecewise spline models were used to assess the effect of air pollutants on weight, overall growth, and growth during each period. RESULTS The mean (SD) prenatal exposure concentrations for NO2, PM2.5, PM10, and O3 were 16.4 (2.9) ppb, 12.0 (1.1) μg/m3, 28.5 (4.7) μg/m3, and 26.2 (2.9) ppb, respectively. Comparing an increase in prenatal average air pollutants from the 10th to the 90th percentile, the growth rate from the 3rd trimester to age 3 months was significantly increased (1.55% [95%CI 1.20%, 1.99%] for PM2.5 and 1.64% [95%CI 1.27%, 2.13%] for NO2), the growth rate from age 6 months to age 2 years was significantly decreased (0.90% [95%CI 0.82%, 1.00%] for NO2), and the attained weight at age 2 years was significantly lower (- 7.50% [95% CI - 13.57%, - 1.02%] for PM10 and - 7.00% [95% CI - 11.86%, - 1.88%] for NO2). CONCLUSIONS Prenatal ambient air pollution was associated with variable changes in growth rate and attained weight from the 3rd trimester to age 2 years. These results suggest continued public health benefits of reducing ambient air pollution levels, particularly in marginalized populations.
Collapse
Affiliation(s)
- Nan Ji
- Division of Environmental Health, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1845 N Soto St, MC 9239, Los Angeles, CA, 90039, USA
| | | | - Sandrah P Eckel
- Division of Environmental Health, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1845 N Soto St, MC 9239, Los Angeles, CA, 90039, USA
| | - William J Gauderman
- Division of Environmental Health, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1845 N Soto St, MC 9239, Los Angeles, CA, 90039, USA
| | - Thomas A Chavez
- Division of Environmental Health, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1845 N Soto St, MC 9239, Los Angeles, CA, 90039, USA
| | - Kiros Berhane
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Dema Faham
- Division of Environmental Health, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1845 N Soto St, MC 9239, Los Angeles, CA, 90039, USA
| | - Fred Lurmann
- Sonoma Technology Inc., Petaluma, CA, 94954, USA
| | | | - Brendan H Grubbs
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | | | - Rima Habre
- Division of Environmental Health, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1845 N Soto St, MC 9239, Los Angeles, CA, 90039, USA
| | - Shohreh F Farzan
- Division of Environmental Health, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1845 N Soto St, MC 9239, Los Angeles, CA, 90039, USA
| | - Theresa M Bastain
- Division of Environmental Health, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1845 N Soto St, MC 9239, Los Angeles, CA, 90039, USA
| | - Carrie V Breton
- Division of Environmental Health, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1845 N Soto St, MC 9239, Los Angeles, CA, 90039, USA.
| |
Collapse
|
6
|
Lambert LK, Horrill TC, Beck SM, Bourgeois A, Browne AJ, Cheng S, Howard AF, Kaur J, McKenzie M, Stajduhar KI, Thorne S. Health and healthcare equity within the Canadian cancer care sector: a rapid scoping review. Int J Equity Health 2023; 22:20. [PMID: 36709295 PMCID: PMC9883825 DOI: 10.1186/s12939-023-01829-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/11/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Despite a publicly-funded healthcare system, alarming cancer-related health and healthcare inequities persist in Canada. However, it remains unclear how equity is being understood and taken up within the Canadian cancer context. Our objective was to identify how health and healthcare equity are being discussed as goals or aims within the cancer care sector in Canada. METHODS A rapid scoping review was conducted; five biomedical databases, 30 multidisciplinary websites, and Google were searched. We included English-language documents published between 2008 and 2021 that discussed health or healthcare equity in the Canadian cancer context. RESULTS Of 3860 identified documents, 83 were included for full-text analysis. The prevalence of published and grey equity-oriented literature has increased over time (2008-2014 [n = 20]; 2015-2021 [n = 62]). Only 25% of documents (n = 21) included a definition of health equity. Concepts such as inequity, inequality and disparity were frequently used interchangeably, resulting in conceptual muddling. Only 43% of documents (n = 36) included an explicit health equity goal. Although a suite of actions were described across the cancer control continuum to address equity goals, most were framed as recommendations rather than direct interventions. CONCLUSION Health and healthcare equity is a growing priority in the cancer care sector; however, conceptual clarity is needed to guide the development of robust equity goals, and the development of sustainable, measurable actions that redress inequities across the cancer control continuum. If we are to advance health and healthcare equity in the cancer care sector, a coordinated and integrated approach will be required to enact transformative and meaningful change.
Collapse
Affiliation(s)
- Leah K. Lambert
- Present Address: Nursing and Allied Health Research and Knowledge Translation, BC Cancer, Suite 500, 686 West Broadway, Vancouver, BC V5Z 1G1 Canada ,grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
| | - Tara C. Horrill
- grid.21613.370000 0004 1936 9609College of Nursing, University of Manitoba, Winnipeg, Canada
| | - Scott M. Beck
- Present Address: Nursing and Allied Health Research and Knowledge Translation, BC Cancer, Suite 500, 686 West Broadway, Vancouver, BC V5Z 1G1 Canada
| | - Amber Bourgeois
- Present Address: Nursing and Allied Health Research and Knowledge Translation, BC Cancer, Suite 500, 686 West Broadway, Vancouver, BC V5Z 1G1 Canada ,grid.143640.40000 0004 1936 9465School of Nursing, University of Victoria, Victoria, Canada
| | - Annette J. Browne
- grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
| | | | - A. Fuchsia Howard
- grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
| | - Jagbir Kaur
- Present Address: Nursing and Allied Health Research and Knowledge Translation, BC Cancer, Suite 500, 686 West Broadway, Vancouver, BC V5Z 1G1 Canada ,grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
| | - Michael McKenzie
- Radiation Therapy Program, BC Cancer, Vancouver, Canada ,grid.17091.3e0000 0001 2288 9830Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, Canada
| | - Kelli I. Stajduhar
- grid.143640.40000 0004 1936 9465School of Nursing, University of Victoria, Victoria, Canada
| | - Sally Thorne
- grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, Canada
| |
Collapse
|
7
|
Fisher EL, Sack DE, González Peña T, Cooper Lloyd M, Weaver EO, Hagemann TM, Miller RF. COVID-19 vaccination program at a student-run free clinic: A descriptive study. Prev Med Rep 2022; 30:101992. [PMID: 36157714 PMCID: PMC9484103 DOI: 10.1016/j.pmedr.2022.101992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/29/2022] [Accepted: 09/17/2022] [Indexed: 11/26/2022] Open
Abstract
People historically excluded from receiving medical care in the United States, in addition to being at greater risk for SARS-CoV-2 infection, have had slower vaccine uptake due to structural barriers to availability. We present one student-run free clinic’s SARS-CoV-2 vaccination program from January 15 to August 1, 2021, in Nashville, Tennessee. We tracked SARS-CoV-2 vaccine primary series completion among 273 free clinic patients with the help of medical student volunteers, who scheduled appointments and answered vaccine-related questions. We worked with our academic medical center partner to host a single-dose vaccination event at our clinic. We compared vaccine series completion in our clinic to adult vaccine completion in Davidson County, Tennessee on August 1, 2021. Of the 273 free clinic participants, 144 identified as Spanish-speaking (52.7%) and 172 (63%) had at least one qualifying comorbidity per the December 30, 2020, Tennessee COVID-19 Vaccination Plan. As such, 183 (67%) were characterized as vaccine eligible in Phase 1a2, 1b, or 1c. On August 1, 2021, 63.1% of free clinic patients had completed their primary SARS-CoV-2 vaccination series compared with 58.9% of adults in Davidson County, Tennessee (RD 4.2%, 95% CI: −1.5% to 9.9%). Spanish-speaking free clinic patients were most likely to have completed their vaccination series. We describe a framework for a patient-centered vaccination effort to reach individuals traditionally missed by large vaccination campaigns. We highlight structural hurdles experienced by vulnerable populations, including language barriers, lack of technology or reliable internet access, inflexible working schedules, lack of transportation, and vaccine misinformation.
Collapse
Affiliation(s)
- Emilie L Fisher
- Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Daniel E Sack
- Vanderbilt University School of Medicine, Nashville, TN, United States
| | | | - M Cooper Lloyd
- Vanderbilt University School of Medicine, Nashville, TN, United States.,Vanderbilt University Medical Center, Department of Medicine, Nashville, TN, United States
| | - Eleanor O Weaver
- Vanderbilt University School of Medicine, Nashville, TN, United States.,Vanderbilt University Medical Center, Department of Medicine, Nashville, TN, United States
| | - Tracy M Hagemann
- University of Tennessee Health Science Center, College of Pharmacy, Nashville, TN, United States
| | - Robert F Miller
- Vanderbilt University School of Medicine, Nashville, TN, United States.,Vanderbilt University Medical Center, Department of Medicine, Nashville, TN, United States
| |
Collapse
|
8
|
O'Callaghan D, Lambert S. The impact of COVID-19 on health care professionals who are exposed to drug-related deaths while supporting clients experiencing addiction. J Subst Abuse Treat 2022; 138:108720. [PMID: 35086760 DOI: 10.1016/j.jsat.2022.108720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/09/2021] [Accepted: 01/10/2022] [Indexed: 02/08/2023]
Abstract
INTRODUCTION This paper explores the impact of the COVID-19 pandemic on health care professionals who support clients experiencing addiction. During the pandemic, addiction support became more challenging, as existing health care models had changed or been completely abolished. Clients continued to engage with social, justice, and health services in limited capacities, connecting with general practitioners, key workers, homelessness support workers, and other service providers. This marginalized population was among the most high-risk groups for adverse health outcomes during the pandemic and understanding the associated implications for practitioner well-being is crucial. METHODS Fifteen health care professionals who work with active addiction in homelessness, public health, addiction, emergency medicine, and other areas participated in individual semi-structured interviews. Data analyses utilized reflexive thematic analysis. RESULTS Four core themes emerged from the analysis: (i) Shift in Priority, (ii) Being Left Behind, (iii) Managing a Death, and (iv) Anxious Environment. Within each core theme, associated subthemes provide further context. The COVID-19 pandemic had a significant impact on the well-being of clinicians who work with people who use drugs, fostering a more anxious environment and compounding what can already be a high-stress occupation. Participants exhibited high levels of concern for the well-being of clients, and uncertainty permeated throughout conversations. Furthermore, staff expressed concern for their own well-being in the long term due to the inability to process adverse events, such as a service user's death, due to the chaotic nature of the pandemic. CONCLUSIONS This paper highlights some areas of concern to address for future service delivery and presents opportunities to future-proof services as the world moves toward hybrid models of working. The inflexibility of service provision during the pandemic and the digital divide due to public health measures pushed marginalized groups further into the margins, with significant implications for practitioner occupational well-being due to feelings of anxiety, powerlessness, and concern for mortality of clients. This study collects a broad scope of experiences across disciplines in health care and demonstrates how professionals navigated unprecedented circumstances.
Collapse
|
9
|
Xavier J, Greer A, Pauly B, Loyal J, Mamdani Z, Ackermann E, Barbic S, Buxton JA. "There are solutions and I think we're still working in the problem": The limitations of decriminalization under the good Samaritan drug overdose act and lessons from an evaluation in British Columbia, Canada. Int J Drug Policy 2022; 105:103714. [PMID: 35561485 DOI: 10.1016/j.drugpo.2022.103714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/20/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Drug prohibition has been associated with increased risk of overdose. However, drug prohibition remains the dominant drug policy, including in Canada with the Controlled Drugs and Substances Act. In 2017, the Good Samaritan Drug Overdose Act (GSDOA) was enacted, to encourage people to contact emergency medical services by providing bystanders at the scene of an overdose with legal protection for simple possession and conditions related to simple possession. METHODS We conducted an evaluation of the GSDOA in British Columbia, Canada that included one-on-one interviews with people who use illicit drugs (PWUD), to determine peoples' experiences and perceptions surrounding this form of decriminalization. We present findings from a thematic analysis of 37 interviews. RESULTS We identified limitations of the GSDOA at overdose events; key themes and concerns causing PWUD to hesitate to or avoid contacting emergency medical services included drug confiscation, the thin line between simple possession and drug trafficking, and enforcement of other charges and court ordered conditions that are not legally protected by the GSDOA. Moreover, participants discussed the GSDOA as inequitable; benefiting some while excluding PWUD with intersecting marginalized identities. CONCLUSION Our findings are pertinent in light of many jurisdictions across the world considering dejure decriminalization, including BC and Vancouver. The GSDOA and associated limitations that emerged in our evaluation can serve to guide jurisdictions implementing or amending dejure decriminalization policies.
Collapse
Affiliation(s)
- Jessica Xavier
- British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Alissa Greer
- School of Criminology, Simon Fraser University,8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Bernadette Pauly
- School of Nursing, University of Victoria, 3800 Finnerty Road, HSD Building, Victoria, BC V8P 5C2, Canada
| | - Jackson Loyal
- British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Zahra Mamdani
- British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Emma Ackermann
- British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Skye Barbic
- Occupational Science & Occupational Therapy, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z8, Canada; British Columbia Center for Disease Control,655W 12th Avenue, Vancouver, BC V5Z 4R4, Canada.
| |
Collapse
|
10
|
Stajduhar KI, Giesbrecht M, Mollison A, d'Archangelo M. "Everybody in this community is at risk of dying": An ethnographic exploration on the potential of integrating a palliative approach to care among workers in inner-city settings. Palliat Support Care 2020; 18:670-5. [PMID: 32378499 DOI: 10.1017/S1478951520000280] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE At the end of life, the need for care increases. Yet, for structurally vulnerable populations (i.e., people experiencing homelessness and poverty, racism, criminalization of illicit drug use, stigma associated with mental health), access to care remains highly inaccessible. Emerging research suggests that enhancing access to palliative care for these populations requires moving care from traditional settings, such as the hospital, into community settings, like shelters and onto the street. Thus, inner-city workers (ICWs) (e.g., housing support and community outreach) have the potential to play pivotal roles in improving access to care by integrating a "palliative approach to care" in their work. METHOD Drawing upon observational field notes and interview data collected for a larger critical ethnographic study, this secondary thematic analysis examines ICWs' (n = 31) experiences providing care for dying clients and garners their perspectives regarding the constraints and facilitators that exist in successfully integrating a palliative approach to care in their work. RESULTS Findings reveal three themes: (1) Approaches, awareness, and training; (2) Workplace policies and filling in the gaps; and (3) Grief, bereavement, and access to supports. In brief, ICWs who draw upon harm reduction strategies strongly parallel palliative approaches to care, although more knowledge/training on palliative approaches was desired. In their continuous work with structurally vulnerable clients, ICWs have the opportunity to build trusting relationships, and over time, are able to identify those in need and assist in providing palliative support. However, despite death and dying is an everyday reality of ICWs, many described a lack of formal acknowledgement by employers and workplace support as limitations. SIGNIFICANCE OF RESULTS Findings contribute promising practices for enhancing equitable access to palliative care for society's most vulnerable populations by prioritizing front-line workers' perspectives on how best to integrate a palliative approach to care where structurally vulnerable populations live and die.
Collapse
|
11
|
Sukhera J, Kulkarni C, Taylor T. Structural distress: experiences of moral distress related to structural stigma during the COVID-19 pandemic. Perspect Med Educ 2021; 10:222-229. [PMID: 33914288 PMCID: PMC8082743 DOI: 10.1007/s40037-021-00663-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/17/2021] [Accepted: 03/30/2021] [Indexed: 05/14/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has taken a significant toll on the health of structurally vulnerable patient populations as well as healthcare workers. The concepts of structural stigma and moral distress are important and interrelated, yet rarely explored or researched in medical education. Structural stigma refers to how discrimination towards certain groups is enacted through policy and practice. Moral distress describes the tension and conflict that health workers experience when they are unable to fulfil their duties due to circumstances outside of their control. In this study, the authors explored how resident physicians perceive moral distress in relation to structural stigma. An improved understanding of such experiences may provide insights into how to prepare future physicians to improve health equity. METHODS Utilizing constructivist grounded theory methodology, 22 participants from across Canada including 17 resident physicians from diverse specialties and 5 faculty members were recruited for semi-structured interviews from April-June 2020. Data were analyzed using constant comparative analysis. RESULTS Results describe a distinctive form of moral distress called structural distress, which centers upon the experience of powerlessness leading resident physicians to go above and beyond the call of duty, potentially worsening their psychological well-being. Faculty play a buffering role in mitigating the impact of structural distress by role modeling vulnerability and involving residents in policy decisions. CONCLUSION These findings provide unique insights into teaching and learning about the care of structurally vulnerable populations and faculty's role related to resident advocacy and decision-making. The concept of structural distress may provide the foundation for future research into the intersection between resident well-being and training related to health equity.
Collapse
Affiliation(s)
- Javeed Sukhera
- Departments of Psychiatry/Paediatrics and Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Chetana Kulkarni
- Hospital for Sick Children (SickKids), Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Taryn Taylor
- Department of Obstetrics and Gynecology and Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| |
Collapse
|
12
|
Krissberg JR, Sutherland SM, Chamberlain LJ, Wise PH. Policy in pediatric nephrology: successes, failures, and the impact on disparities. Pediatr Nephrol 2021; 36:2177-88. [PMID: 32968856 DOI: 10.1007/s00467-020-04755-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/10/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
Pediatric nephrology has a history rooted in pediatric advocacy and has made numerous contributions to child health policy affecting pediatric kidney diseases. Despite this progress, profound social disparities remain for marginalized and socially vulnerable children with kidney disease. Different risk factors, such as genetic predisposition, environmental factors, social risk factors, or health care access influence the emergence and progression of pediatric kidney disease, as well as access to life-saving interventions, leading to disparate outcomes. This review will summarize the breadth of literature on social determinants of health in children with kidney disease worldwide and highlight policy-based initiatives that mitigate the adverse social factors to generate greater equity in pediatric kidney disease.
Collapse
|
13
|
Kazemi M, Honarvar B, Heydari ST, Joulaei H, Haghighi MRR, Lankarani KB. Happiness in marginalized populations: a community-based study in South Central Iran. BMC Psychol 2021; 9:58. [PMID: 33892781 PMCID: PMC8063348 DOI: 10.1186/s40359-021-00545-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 02/28/2021] [Indexed: 02/08/2023] Open
Abstract
Background Happiness has multiple levels and determinants in different communities, cultures, and social groups. The current study aimed to investigate happiness and its main determinants in slums in south central Iran. Methods This community-based, cross-sectional study was conducted with the participation of adults at least 18 years of age living in the biggest slum area in Shiraz, south central Iran. To determine levels of happiness, participants were asked to complete the Persian version of the GHQ28 questionnaire and a checklist based on the 2017 World Happiness Report. Data was analyzed using SPSS software version 19. A p-value less than 0.05 was considered significant. Results The mean age of the participants was 42.06 ± 16.34 years. Overall, 542 participants (45 %) were females, 257 (21.3 %) were illiterate, 678 (56.3 %) were married, and 495 (41.1 %) were unemployed and lived with their household. The happiness score, according to the Cantril ladder score, was 6.41 ± 2 (out of a total score of 10). Happiness was not correlated with gender (p = 0.37) or immigration (p = 0.06). Lower levels of happiness were seen in older adults (r=− 0.12, p < 0.001), illiterates (p = 0.03), the unemployed (p < 0.001), and people separated from their spouses (p < 0.001). Job satisfaction (p < 0.001, r = 0.47), total general health (p < 0.001, r=-0.36) and hope (p < 0.001, r = 0.41) were significantly correlated with happiness. Social support (< 0.001) and sufficient income and satisfaction (p < 0.001) were related with a higher score of happiness. Conclusions Marital status, smoking, employment and job satisfaction, social support and trust, feelings of insecurity in the neighborhood, hope for the future, facing violence, and income satisfaction were the main determinants of happiness in the Sang Siah slum area. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00545-2.
Collapse
Affiliation(s)
- Maryam Kazemi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, 7134845794, Islamic Republic of Iran
| | - Behnam Honarvar
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, 7134845794, Islamic Republic of Iran
| | - S Taghi Heydari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, 7134845794, Islamic Republic of Iran
| | - Hassan Joulaei
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, 7134845794, Islamic Republic of Iran
| | - Mohammad Reza Rahmanian Haghighi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, 7134845794, Islamic Republic of Iran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, 7134845794, Islamic Republic of Iran.
| |
Collapse
|
14
|
Schmidt J, Trappenburg M, Tonkens E. Social dignity for marginalized people in public healthcare: an interpretive review and building blocks for a non-ideal theory. Med Health Care Philos 2021; 24:85-97. [PMID: 33111158 PMCID: PMC7910373 DOI: 10.1007/s11019-020-09987-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
Jacobson (Social Science & Medicine 64:292-302, 2007) finds two distinct meanings of "dignity" in the literature on dignity and health: (1) intrinsic human dignity and (2) social dignity constituted through interactions with caregivers. Especially the latter has been central in empirical health research and warrants further exploration. This article focuses on the social dignity of people marginalized by mental illness, substance abuse and comparable conditions in extramural settings. 35 studies published between 2007 and 2017 have addressed this issue, most of them identifying norms for social dignity: civilized interactions, non-stigmatizing treatment, treatment as unique individuals, being taken seriously, maintaining a positive identity, experiencing independence, relating to others, and participating in daily life. We argue that these norms belong to ideal theory, whereas we agree with Robeyns (Social Theory and Practice 34:341-362, 2008) and others that improving practice is better served by non-ideal theory. Towards this end, we derive from the literature four building blocks for a non-ideal theory of dignity: (1) avoid violations of dignity rather than seeking to promote it; (2) dignity is not a goal to be reached; it requires ongoing effort; (3) promoting dignity is a balancing act; contradictory norms can make it impossible to realize; and (4) dignity can be undermined by organizational and discursive constraints.
Collapse
Affiliation(s)
- Jante Schmidt
- Department Citizenship and Humanisation of the Public Sector, University of Humanistic Studies, P.O. Box 797, 3500 AT, Utrecht, The Netherlands.
| | - Margo Trappenburg
- Department Citizenship and Humanisation of the Public Sector, University of Humanistic Studies, P.O. Box 797, 3500 AT, Utrecht, The Netherlands
| | - Evelien Tonkens
- Department Citizenship and Humanisation of the Public Sector, University of Humanistic Studies, P.O. Box 797, 3500 AT, Utrecht, The Netherlands
| |
Collapse
|
15
|
Lavalley J, Kastor S, Tourangeau M, Goodman A, Kerr T. You just have to have other models, our DNA is different: the experiences of indigenous people who use illicit drugs and/or alcohol accessing substance use treatment. Harm Reduct J 2020; 17:19. [PMID: 32209101 PMCID: PMC7092530 DOI: 10.1186/s12954-020-00366-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 03/13/2020] [Indexed: 11/10/2022] Open
Abstract
Objectives In Canada, and elsewhere, indigenous peoples who use illicit drugs and/or alcohol (IPWUID/A) commonly experience vulnerability and a disproportionate burden of harm related to substance use. In Vancouver, Canada, there are concerns that inequitable access, retention, and post treatment care within substance use treatment programs may exacerbate these harms. This study sought to understand the policies and practices with the potential to produce inequities and vulnerabilities for IPWUID/A in substance use treatment, situate the vulnerabilities of IPWUID/A in substance use treatment within the context of wider structural vulnerability of IPWUID/A, and generate recommendations for culturally safe treatment options. Methods This research employed a qualitative indigenous-led community-based approach using the indigenous methodology of talking circles to explore experiences with substance use treatment. Under the participatory research framework, community researchers led the study design, data collection, and analysis. Talking circles elicited peers’ experiences of substance use treatment and were audio-recorded and transcribed. Results The talking circles identified three key themes that illustrated the experiences of IPWUID/A when accessing substance use treatment: (a) barriers to accessing detox and substance use treatment; (b) incompatible and culturally inappropriate structure, policies, and procedures within treatment programs, such as forced Christianity within treatment settings; and (c) the importance of culturally relevant, peer-led substance use treatment programming. Discussion Our work demonstrates that some IPWUID/A have limited access to or retention in mainstream treatment due to excessive waiting times, strict rules, and lack of cultural appropriate care while in treatment. However, IPWUID/A narratives revealed strategies that can improve IPWUID/A access and experiences, including those informed by the diverse perspectives of IPWUID/A and those that include trauma-informed and culturally safe practices.
Collapse
Affiliation(s)
- Jennifer Lavalley
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9, Canada
| | - Shelda Kastor
- Western Aboriginal Harm Reduction Society, Vancouver, British Columbia, Canada
| | - Malcolm Tourangeau
- Western Aboriginal Harm Reduction Society, Vancouver, British Columbia, Canada
| | | | - Ashley Goodman
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, V6Z 2A9, Canada. .,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.
| |
Collapse
|
16
|
Abstract
"Street Medicine" programs provide medical care to homeless populations outside of traditional healthcare institutions, literally on the street and in transitional settings where unsheltered homeless people live. Such programs are emerging around the world often based at medical schools and primary care residency programs, and can provide ideal frameworks for twenty-first century "Classrooms Without Walls" aimed at improving Population Health. We provide a 12-step blueprint for creating a Street Medicine program in the context of a medical teaching institution.
Collapse
Affiliation(s)
- Noemi C. Doohan
- Scripps Mercy Family Medicine Residency Program, - Chula Vista, Chula Vista, CA USA
| | - Ranit Mishori
- Global Health Initiatives, Georgetown University School of Medicine, 3900 Reservoir Rd. NW, GB-01D, Washington, DC 20007 USA
| |
Collapse
|
17
|
Abstract
PURPOSE OF REVIEW This review summarizes emerging evidence for the relationship between food insecurity and eating disorder (ED) pathology, outlines priorities for future research in this area, and comments on considerations for clinical and public health practice. RECENT FINDINGS Among adults, food insecurity is cross-sectionally associated with higher levels of overall ED pathology, binge eating, compensatory behaviors, binge-eating disorder, and bulimia nervosa. Evidence for similar relationships among adolescents has been less robust; however, compared to studies of adults, there have been substantially fewer studies conducted in adolescents to date. Emerging evidence consistently indicates that food insecurity is cross-sectionally associated with bulimic-spectrum ED pathology among adults. Findings emphasize the need for ED research to include marginalized populations who have historically been overlooked in the ED field. Much more research is needed to better understand the relationship between food insecurity and ED pathology and to determine effective ways to intervene.
Collapse
Affiliation(s)
- Vivienne M Hazzard
- Sanford Center for Biobehavioral Research, 120 Eighth Street South, Fargo, ND, 58103, USA.
| | - Katie A Loth
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Laura Hooper
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | | |
Collapse
|
18
|
Lavoie JG, Varcoe C, Wathen CN, Ford-Gilboe M, Browne AJ. Sentinels of inequity: examining policy requirements for equity-oriented primary healthcare. BMC Health Serv Res 2018; 18:705. [PMID: 30200952 PMCID: PMC6131743 DOI: 10.1186/s12913-018-3501-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/28/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Non-government, not-for-profit community health centres (CHCs) play a crucial role within healthcare systems in fostering equity, acting both as direct providers of services and as sentinels of health and social inequity. In a study of an intervention to promote equity-oriented health care, we enlisted four diverse primary healthcare clinics with mandates to serve highly marginalized populations. All of these CHCs operate as not-for-profit, non-government organizations (NGOs), and have a marginal relationship financially and socially to other parts of the system. The purpose of this paper is to provide an analysis of the factors that shape how CHCs are able to carry out an equity mandate and, from this, to identify what is required at the level of policy to enhance capacity to provide equity-oriented health care. METHODS We systematically examined the clinics' policy and funding contexts, and identified influences on the clinics' capacities to promote equity-oriented health care. RESULTS We identified three key mechanisms of influence, each playing out against the backdrop of a contested and marginal position of CHCs within the health care system: a) accountability and performance frameworks; b) patterns of funding and allocation of resources, and c) pathways for emergent priorities. We examine these mechanisms, considering how each influenced the pursuit of equity, and propose policy directions to optimize the primary health care sectors' capacity to support equity-oriented health care. CONCLUSIONS Although this analysis is based on a study within a high-income country, we argue that because the dynamics between community health centres and broader healthcare systems are similar across national boundaries, the implications have applicability to low and middle-income countries.
Collapse
Affiliation(s)
- Josée G. Lavoie
- Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Ongomiizwin Research, 715 John Buhler Research Centre, 727 McDermot Ave, Winnipeg, MB R3E 3P5 Canada
| | - Colleen Varcoe
- School of Nursing, The University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
| | - C. Nadine Wathen
- Centre for Research and Education on Violence against Women and Children, Faculty of Information & Media Studies, Western University, FIMS & Nursing Building, Room 2050, London, ON N6A 5B9 Canada
| | - Marilyn Ford-Gilboe
- Arthur Labatt Family School of Nursing, Western University, FIMS & Nursing Building, Room 3306, London, ON N6A 5B9 Canada
| | - Annette J. Browne
- School of Nursing, The University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
| | - On behalf of the EQUIP Research Team
- Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Ongomiizwin Research, 715 John Buhler Research Centre, 727 McDermot Ave, Winnipeg, MB R3E 3P5 Canada
- School of Nursing, The University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
- Centre for Research and Education on Violence against Women and Children, Faculty of Information & Media Studies, Western University, FIMS & Nursing Building, Room 2050, London, ON N6A 5B9 Canada
- Arthur Labatt Family School of Nursing, Western University, FIMS & Nursing Building, Room 3306, London, ON N6A 5B9 Canada
| |
Collapse
|
19
|
Becker CB, Middlemass K, Johnson C, Taylor B, Gomez F, Sutherland A. Traumatic event exposure associated with increased food insecurity and eating disorder pathology. Public Health Nutr 2018; 21:3058-66. [PMID: 30107865 DOI: 10.1017/S1368980018001738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The primary aim was to investigate the association between food insecurity (FI) and eating disorders, which are nutrition-based public health problems, with traumatic event exposure in a low-income marginalized population. The study also investigated the association between traumatic event exposure, anxiety and weight stigma. DESIGN The study used self-report surveys in a cross-sectional design. SETTING Food pantries affiliated with the local food bank in a major US city. SUBJECTS Participants (n 503) consisted of clients presenting to food pantries. Participants were predominantly female (76·5 %), Latino/Hispanic (64·6 %) and low-income (59 % reported earning under $US 10 000 per year). RESULTS Results indicated that 55·7 % of participants had directly experienced a traumatic event; this increased to 61·6 % when witnessing was included. Higher levels of FI were associated with greater traumatic event exposure. Increased exposure to traumatic events correlated with worsened overall eating disorder pathology (r=-0·239), weight stigma (r=-0·151) and anxiety (r=-0·210). CONCLUSIONS The present study is the first to investigate the association of FI, eating disorders and trauma in a low-income marginalized population. Results indicate that exposure to traumatic events is common in this civilian population and that traumatic event exposure is associated with higher levels of FI and eating disorder pathology. Results indicate that further research is warranted given that traumatic event exposure, eating disorder pathology, weight stigma and anxiety may complicate effective delivery of public health interventions in those living with FI.
Collapse
|
20
|
Snow ME, Tweedie K, Pederson A. Heard and valued: the development of a model to meaningfully engage marginalized populations in health services planning. BMC Health Serv Res 2018; 18:181. [PMID: 29544486 PMCID: PMC5856315 DOI: 10.1186/s12913-018-2969-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 02/27/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Recently, patient engagement has been identified as a promising strategy for supporting healthcare planning. However, the context and structure of universalistic, "one-size-fits-all" approaches often used for patient engagement may not enable diverse patients to participate in decision-making about programs intended to meet their needs. Specifically, standard patient engagement approaches are gender-blind and might not facilitate the engagement of those marginalized by, for example, substance use, low income, experiences of violence, homelessness, and/or mental health challenges-highly gendered health and social experiences. The project's purpose was to develop a heuristic model to assist planners to engage patients who are not traditionally included in healthcare planning. METHODS Using a qualitative research approach, we reviewed literature and conducted interviews with patients and healthcare planners regarding engaging marginalized populations in health services planning. From these inputs, we created a model and planning manual to assist healthcare planners to engage marginalized patients in health services planning, which we piloted in two clinical programs undergoing health services design. The findings from the pilots were used to refine the model. RESULTS The analysis of the interviews and literature identified power and gender as barriers to participation, and generated suggestions to support diverse populations both to attend patient engagement events and to participate meaningfully. Engaging marginalized populations cannot be reduced to a single defined process, but instead needs to be understood as an iterative process of fitting engagement methods to a particular situation. Underlying this process are principles for meaningfully engaging marginalized people in healthcare planning. CONCLUSION A one-size-fits-all approach to patient engagement is not appropriate given patients' diverse barriers to meaningful participation in healthcare planning. Instead, planners need a repertoire of skills and strategies to align the purpose of engagement with the capacities and needs of patient participants. Just as services need to meet diverse patients' needs, so too must patient engagement experiences.
Collapse
Affiliation(s)
- M. Elizabeth Snow
- Centre for Health Evaluation & Outcome Sciences (CHÉOS), University of British Columbia, St. Paul’s Hospital, 588 - 1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Katherine Tweedie
- University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4 Canada
| | - Ann Pederson
- BC Women’s Hospital + Health Centre, E305 - 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| |
Collapse
|
21
|
Spadola CE, Rottapel R, Khandpur N, Kontos E, Bertisch SM, Johnson DA, Quante M, Khalsa SBS, Saper RB, Redline S. Enhancing yoga participation: A qualitative investigation of barriers and facilitators to yoga among predominantly racial/ethnic minority, low-income adults. Complement Ther Clin Pract 2017; 29:97-104. [PMID: 29122272 DOI: 10.1016/j.ctcp.2017.09.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 09/01/2017] [Accepted: 09/02/2017] [Indexed: 11/26/2022]
Abstract
Yoga is underutilized among racial/ethnic minorities and low-income populations. To enhance participation among these demographic groups and to inform a future clinical trial, we conducted a qualitative formative investigation, informed by the Social Contextual Model of health behavior change, to identify barriers and facilitators to yoga that could impact study participation. We recruited twenty-four racially/ethnically diverse adults, with and without prior yoga experience, from a low-income, urban housing community to participate in either an individual interview or focus group. A thematic data analysis approach was employed. Barriers to yoga engagement included the perception that yoga lacks physicality and weight loss benefits, fear of injury, lack of ability/self-efficacy to perform the practices, preference for other physical activities, and scheduling difficulties. Facilitators of yoga engagement included a quality yoga instructor who provides individualized instruction, beginner level classes, and promotional messaging that highlights the potential benefits of yoga, such as stress reduction.
Collapse
Affiliation(s)
- Christine E Spadola
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, United States; Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States.
| | - Rebecca Rottapel
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, United States
| | - Neha Khandpur
- Department of Nutrition, Faculty of Public Health, University of Sao Paulo, Brazil
| | - Emily Kontos
- DynaMed, EBSCO Health, Ipswich, MA, United States
| | - Suzanne M Bertisch
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, United States
| | - Dayna A Johnson
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, United States; Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Mirja Quante
- Department of Neonatology, University of Tuebingen, Germany
| | - Sat Bir S Khalsa
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, United States; Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Robert B Saper
- Department of Family Medicine, Boston Medical Center, Boston, MA, United States
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, United States; Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
22
|
Goodman A, Fleming K, Markwick N, Morrison T, Lagimodiere L, Kerr T. "They treated me like crap and I know it was because I was Native": The healthcare experiences of Aboriginal peoples living in Vancouver's inner city. Soc Sci Med 2017; 178:87-94. [PMID: 28214449 DOI: 10.1016/j.socscimed.2017.01.053] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 01/03/2017] [Accepted: 01/23/2017] [Indexed: 11/26/2022]
Abstract
There is growing evidence that Aboriginal peoples often experience healthcare inequalities due to racism. However, research exploring the healthcare experiences of Aboriginal peoples who use illicit substances is limited, and research rarely accounts for how multiple accounts of stigma intersect and contribute to the experiences of marginalized populations. Our research aimed to explore the healthcare experiences of Aboriginal peoples who use illicit drugs and or illicit alcohol (APWUID/A) living in Vancouver's inner city. Using Indigenous methodologies, a community research team comprised of APWUID/A led the study design, data collection and analysis. Peer-facilitated talking circles explored community members' experiences accessing healthcare services and patient-provider encounters. Using an intersectionality framework, our research demonstrated how healthcare inequalities among Aboriginal peoples are perpetuated by systemic racism and discrimination. Stigmatizing racial stereotypes were perceived to negatively influence individual attitudes and clinical practice. Participants' experiences of medical dismissal often resulted in disengagement from care or delay in care. The findings suggest healthcare providers must understand the structural and historical forces that influence racial disparities in healthcare and personal attitudes in clinical practice. Adequate clinical protocols for pain management within the context of illicit substance use are urgently needed. The valuation of Aboriginal peoples and cultures within healthcare is paramount to addressing the health gap between Aboriginal and non-Aboriginal Canadians.
Collapse
Affiliation(s)
- Ashley Goodman
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Kim Fleming
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Nicole Markwick
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Tracey Morrison
- Western Aboriginal Harm Reduction Society, Vancouver, British Columbia, Canada
| | - Louise Lagimodiere
- Western Aboriginal Harm Reduction Society, Vancouver, British Columbia, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | | |
Collapse
|
23
|
Dugas M, Trottier MÈ, Chipenda Dansokho S, Vaisson G, Provencher T, Colquhoun H, Dogba MJ, Dupéré S, Fagerlin A, Giguere AMC, Haslett L, Hoffman AS, Ivers NM, Légaré F, Légaré J, Levin CA, Menear M, Renaud JS, Stacey D, Volk RJ, Witteman HO. Involving members of vulnerable populations in the development of patient decision aids: a mixed methods sequential explanatory study. BMC Med Inform Decis Mak 2017; 17:12. [PMID: 28103862 PMCID: PMC5244537 DOI: 10.1186/s12911-016-0399-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 12/15/2016] [Indexed: 04/26/2024] Open
Abstract
Background Patient decision aids aim to present evidence relevant to a health decision in understandable ways to support patients through the process of making evidence-informed, values-congruent health decisions. It is recommended that, when developing these tools, teams involve people who may ultimately use them. However, there is little empirical evidence about how best to undertake this involvement, particularly for specific populations of users such as vulnerable populations. Methods To describe and compare the development practices of research teams that did and did not specifically involve members of vulnerable populations in the development of patient decision aids, we conducted a secondary analysis of data from a systematic review about the development processes of patient decision aids. Then, to further explain our quantitative results, we conducted semi-structured telephone interviews with 10 teams: 6 that had specifically involved members of vulnerable populations and 4 that had not. Two independent analysts thematically coded transcribed interviews. Results Out of a total of 187 decision aid development projects, 30 (16%) specifically involved members of vulnerable populations. The specific involvement of members of vulnerable populations in the development process was associated with conducting informal needs assessment activities (73% vs. 40%, OR 2.96, 95% CI 1.18–7.99, P = .02) and recruiting participants through community-based organizations (40% vs. 11%, OR 3.48, 95% CI 1.23–9.83, P = .02). In interviews, all developers highlighted the importance, value and challenges of involving potential users. Interviews with developers whose projects had involved members of vulnerable populations suggested that informal needs assessment activities served to center the decision aid around users’ needs, to better avoid stigma, and to ensure that the topic truly matters to the community. Partnering with community-based organizations may facilitate relationships of trust and may also provide a non-threatening and accessible location for research activities. Conclusions There are a small number of key differences in the development processes for patient decision aids in which members of vulnerable populations were or were not specifically involved. Some of these practices may require additional time or resources. To address health inequities, researchers, communities and funders may need to increase awareness of these approaches and plan accordingly. Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0399-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Michèle Dugas
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Research Centre of the CHU de Québec, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Marie-Ève Trottier
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Research Centre of the CHU de Québec, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Selma Chipenda Dansokho
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Gratianne Vaisson
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Research Centre of the CHU de Québec, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Thierry Provencher
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Maman Joyce Dogba
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Sophie Dupéré
- Faculty of Nursing, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Williams Building, Room 1C448, Salt Lake City, UT, 84132, USA
| | - Anik M C Giguere
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Quebec Centre for Excellence on Aging, Research Centre of the CHU de Quebec, St-Sacrement Hospital, 1050, chemin Ste-Foy, Quebec City, QC, G1S 4L8, Canada
| | - Lynne Haslett
- East End Community Health Centre, 1619 Queen Street East, Toronto, ON, M4L 1G4, Canada
| | - Aubri S Hoffman
- Department of Health Services Research, The MD Anderson Cancer Center, FCT9.5028, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Noah M Ivers
- Family Practice Health Centre, Institute for Health Systems Solutions and Virtual Care and Women's College Research Institute, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S1B2, Canada.,Department of Family and Community Medicine, Institute of Health Policy, Management and Evaluation, University of Toronto, 500 University Ave, Toronto, ON, M5G1V7, Canada
| | - France Légaré
- Research Centre of the CHU de Québec, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Jean Légaré
- Patient Partner, 403 rue des Érables, Neuville, Québec, G0A 2R0, Canada
| | - Carrie A Levin
- Healthwise, Incorporated, 40 Court St, Suite 300, Boston, MA, 02108, USA
| | - Matthew Menear
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec, QC, G1V 0A6, Canada.,Research Centre of the CHU de Québec, CHU de Québec, 10 de l'Espinay, Quebec, QC, G1V 0A6, Canada
| | - Jean-Sébastien Renaud
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Dawn Stacey
- School of Nursing and Ottawa Hospital Research Institute, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H8M5, Canada
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77230, USA
| | - Holly O Witteman
- Office of Education and Professional Development, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. .,Research Centre of the CHU de Québec, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. .,Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.
| |
Collapse
|
24
|
Passaro RC, Haley CA, Sanchez H, Vermund SH, Kipp AM. High HIV prevalence and the internet as a source of HIV-related service information at a community-based organization in Peru: a cross-sectional study of men who have sex with men. BMC Public Health 2016; 16:871. [PMID: 27557857 PMCID: PMC4997688 DOI: 10.1186/s12889-016-3561-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 08/19/2016] [Indexed: 11/23/2022] Open
Abstract
Background The HIV prevalence among men who have sex with men (MSM) in Peru (12.4 %) is 30 times higher than in the general adult population (0.4 %). It is critical for community-based organizations to understand how to provide HIV services to MSM while maximizing limited resources. This study describes the HIV prevalence and risk profiles of MSM seeking HIV services at a community-based organization in Lima, Peru. It then compares HIV prevalence between those who found out about the HIV services through different sources. Methods A cross-sectional study of MSM seeking HIV services at Epicentro Salud in Lima, Peru for the first time between April 2012 and October 2013. We compared HIV prevalence among MSM who found out about Epicentro via online sources of information (N = 419), those using in-person sources (friends, partners) (N = 907), and sex workers (N = 140) using multivariable logistic regression models. Results HIV prevalence was 18.3 % overall: 23.2 % among MSM using online sources, 19.3 % among sex workers, and 15.9 % among MSM using in-person sources. However, when compared to the in-person group, sexual risk behaviors were not statistically higher among MSM using online sources. For the sex worker group, some behaviors were more common, while others were less. After adjusting for confounders, the odds of having HIV was higher for the online group (Odds Ratio = 1.61; 95 % Confidence Interval: 1.19–2.18), but not for the sex worker group (OR = 1.12; 95 % CI: 0.68–1.86), compared to the in-person group. Conclusion Internet-based promotion appears to successfully reach MSM at high risk of HIV in Peru. Outreach via this medium can facilitate HIV diagnosis, which is the critical first step in getting infected individuals into HIV care. For community-based organizations working in resource-limited settings, this may be an effective strategy for engaging a subset of high-risk persons in HIV care.
Collapse
Affiliation(s)
- R Colby Passaro
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA
| | - Connie A Haley
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Sten H Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aaron M Kipp
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA. .,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. .,Institute for Medicine and Public Health, 2525 West End Ave., Suite 614, Nashville, TN, USA.
| |
Collapse
|
25
|
Wallace B, Browne AJ, Varcoe C, Ford-Gilboe M, Wathen N, Long PM, Parker J. Self-reported oral health among a community sample of people experiencing social and health inequities: cross-sectional findings from a study to enhance equity in primary healthcare settings. BMJ Open 2015; 5:e009519. [PMID: 26700285 PMCID: PMC4691735 DOI: 10.1136/bmjopen-2015-009519] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/30/2015] [Accepted: 10/16/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To describe the self-reported oral health issues among a community sample of primary care clients experiencing socioeconomic disadvantages. METHODS As part of a larger mixed-methods, multiple case study evaluating an equity-oriented primary healthcare intervention, we examined the oral health of a sample of 567 people receiving care at four clinics that serve marginalised populations in two Canadian provinces. Data collected included self-rated oral health and experiences accessing and receiving healthcare, standard self-report measures of health and quality of life, and sociodemographic information. RESULTS The prevalence of self-rated poor oral health was high, with almost half (46.3%) of the participants reporting poor or fair oral health. Significant relationships were observed between poor oral health and vulnerabilities related to mental health, trauma and housing instability. Our findings suggest that the oral health of some Canadian populations may be dramatically worse than what is reported in existing population health surveys. CONCLUSIONS Our findings reinforce the importance of addressing oral health as part of health equity strategies. The health and oral health issues experienced by this client cohort highlight the need for interdisciplinary, team-based care that can address the intersections among people's health status, oral health and social issues.
Collapse
Affiliation(s)
- Bruce Wallace
- School of Social Work, University of Victoria, Victoria, British Columbia, Canada
| | - Annette J Browne
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colleen Varcoe
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marilyn Ford-Gilboe
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Nadine Wathen
- Faculty of Information & Media Studies, Western University, London, Ontario, Canada
| | - Phoebe M Long
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joanne Parker
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
26
|
Montesanti SR, Abelson J, Lavis JN, Dunn JR. The value of frameworks as knowledge translation mechanisms to guide community participation practice in Ontario CHCs. Soc Sci Med 2015; 142:223-31. [PMID: 26318211 DOI: 10.1016/j.socscimed.2015.08.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 06/27/2015] [Accepted: 08/14/2015] [Indexed: 11/20/2022]
Abstract
The community participation literature has produced numerous frameworks to guide practice and evaluation of community participation strategies in the health sector. These frameworks are useful starting points for differentiating the approaches for involving people in planning and decision-making for health services, but have been critiqued for being too generic and ignoring that community participation is highly contextual and situational. Health service organizations across Canada and internationally have begun to respond to address this limitation by developing more context-specific community participation frameworks; however, such frameworks do not exist for Ontario Community Health Centres (CHCs)-local primary health care organizations with a mandate to engage marginalized groups in planning and decision-making for health services. We conducted a series of focus groups with staff members from four Ontario CHCs to: (1) examine the factors that would influence their use of a generic framework for community participation with marginalized populations; and (2) improve the "context-specificity" of this framework, to enhance its relevance to CHCs. Participants described the difficulty of organizing the contextual, multi-faceted and situational process of community participation that they experienced with marginalized populations into a single framework, which led them to question the value of using frameworks as a resource for guiding the design, implementation and evaluation of their community participation initiatives. Instead, participants revealed that tacit knowledge, in the form of professional and personal experience and local knowledge of a marginalized population, had a greater influence on guiding participation activities in Ontario CHCs. Our findings suggest that tacit knowledge is an essential feature of community participation practice and requires further exploration regarding its role in the community participation field.
Collapse
|