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Community-based participatory research (CBPR) approaches in vaccination promotion: a scoping review. 促进疫苗接种的社区参与式研究 (CBPR) 方法:范围综述。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-11-05 DOI: 10.1186/s12939-024-02278-1
Yan Zhang, Yao Jie Xie, Lin Yang, Kin Cheung, Qingpeng Zhang, Yan Li, Chun Hao, Harry Hx Wang, Qianling Zhou, Angela Yee Man Leung
<p><strong>Background: </strong>Community-based participatory research (CBPR) is a collaborative research approach that engages academic researchers and community stakeholders as equal partners in all research steps to address community concerns and achieve health equity. The CBPR approach has been widely used in vaccination promotion programmes. However, the elements and steps of CBPR-based programmes varied among studies. The purpose of this scoping review was to synthesize the elements and steps, and establish an implementation framework to guide the utilisation of CBPR approaches in vaccination promotion.</p><p><strong>Methods: </strong>This scoping review was performed in accordance with Arksey and O'Malley's five-stage framework. A systematic search was conducted on a set of electronic databases and grey literature sources. The retrieved articles were screened according to the criteria of CBPR and vaccination promotion, and data were extracted and recorded on a calibrated and predefined form in terms of study characteristics and CBPR components. Two authors worked independently to complete literature search, study selection, and data extraction. A narrative summary was used in categorising characteristics, and the contents of the included studies were summarised through qualitative analysis.</p><p><strong>Results: </strong>A total of 8557 publications were initially screened, and 23 articles were finally included. According to the CBPR conceptual model, the elements in each CBPR component specifically for vaccination promotion included (1) the establishment of community-academic partnership (CAP)s, (2) community capacity building by partner training vaccination knowledge, research literacy, and service abilities and skills, (3) development and implementation of community-based intervention and (4) Outcome evaluation. A CAP was established between academic researchers or institutes and eight types of partners, including community service organisation-related non-government organisations (NGOs), health service institution-related NGOs, religious organisations, government agencies, educational institutions, media agencies, business agencies, and community representatives. The maintenance of CAP was achieved with four key strategies, namely, strengthening communication, forming management groups, sharing resources and information, and providing incentives. Twelve studies provided comprehensive insights into the strategies employed for intervention development, utilising either quantitative surveys, qualitative methods or a combination of both approaches. The contents of interventions included health service supports, health education activities, social marketing campaigns, community mobilisation, interactive discussions, vaccination reminders and incentives. As for outcome evaluation, vaccination rate and the effectiveness of interventions were assessed. A considerable increase was observed in 95.7% of the included studies (22/23), and the high
背景:基于社区的参与式研究(CBPR)是一种合作研究方法,它让学术研究人员和社区利益相关者作为平等伙伴参与所有研究步骤,以解决社区关注的问题,实现健康公平。社区参与式研究方法已被广泛应用于疫苗接种推广计划中。然而,基于 CBPR 的计划的要素和步骤在不同的研究中各不相同。本次范围界定综述的目的是综合这些要素和步骤,并建立一个实施框架,以指导在疫苗接种推广中使用 CBPR 方法:本次范围界定综述按照 Arksey 和 O'Malley 的五阶段框架进行。我们在一系列电子数据库和灰色文献来源中进行了系统检索。根据CBPR和疫苗接种推广的标准对检索到的文章进行筛选,并根据研究特点和CBPR的组成部分,在经过校准和预定义的表格上提取和记录数据。两位作者独立完成了文献检索、研究筛选和数据提取工作。在对特征进行分类时使用了叙述性摘要,并通过定性分析对纳入研究的内容进行了总结:初步筛选了 8557 篇文献,最终纳入 23 篇文章。根据 CBPR 概念模型,专门针对疫苗接种推广的 CBPR 各组成部分的要素包括:(1)建立社区-学术合作伙伴关系(CAP);(2)通过合作伙伴培训疫苗接种知识、研究素养、服务能力和技能,进行社区能力建设;(3)制定和实施基于社区的干预措施;(4)结果评估。学术研究人员或机构与八类合作伙伴建立了 CAP,包括与社区服务组织相关的非政府组织 (NGO)、与卫生服务机构相关的非政府组织、宗教组织、政府机构、教育机构、媒体机构、商业机构和社区代表。通过加强沟通、成立管理小组、共享资源和信息以及提供激励措施这四项关键战略,实现了对社区行动计划的维护。12 项研究采用定量调查、定性方法或两种方法相结合的方式,对制定干预措施所采用的策略进行了全面深入的探讨。干预措施的内容包括医疗服务支持、健康教育活动、社会营销活动、社区动员、互动讨论、疫苗接种提醒和激励措施。在结果评估方面,对疫苗接种率和干预措施的效果进行了评估。在 95.7% 的纳入研究(22/23 项)中观察到疫苗接种率有了显著提高,干预后的疫苗接种率提高幅度最大(92.9%)。研究还提出了一个实施框架,总结了促进疫苗接种的 CBPR 方法的要素和步骤:本综述总结了当前的证据,并生成了一个实施框架,以阐明在疫苗接种推广中开发和应用 CBPR 方法的要素和步骤。建议在未来的疫苗接种推广计划中采用 CBPR 方法,让社区利益相关者和研究专业人员参与其中,以确保不同人群都能公平地接种疫苗。
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引用次数: 0
Measuring attitudes towards ethnic minority patients: the revalidated REMP-3 instrument for graduate healthcare practitioners. 测量对少数民族患者的态度:针对毕业医护人员的 REMP-3 工具的重新验证。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-11-05 DOI: 10.1186/s12939-024-02309-x
Stijn Schelfhout, Robin Vandecasteele, Sara Willems, Eva Derous, Stéphanie De Maesschalck

Objective: Measuring intercultural attitudes can aid in understanding and addressing persistent inequities in healthcare. Instead of creating new instruments, several sources call for a more rigorous revalidation of existing instruments towards a more broad population. As an example of such an existing instrument, the EMP-3 (Ethnic Minority Patients) focuses on the attitudes of physicians towards ethnic minority patients. Starting from a robust theoretical underpinning and a rigorous methodological setup, the present study revalidates the EMP-3 instrument for physicians towards the REMP-3 instrument for graduate healthcare practitioners.

Methods: We assessed the reliability and validity of the old EMP-3, which we then updated to a new REMP-3 instrument. We used structural equation modeling to model the framework of intercultural effectiveness on two waves of independent data, N2021 = 368 and N2022 = 390. Within this framework, we tested the new REMP-3 instrument as an operationalization of intercultural attitudes. We conducted a confirmatory factor analysis on the first wave, after which we made adaptations to the original EMP-3 instrument to obtain a new REMP-3 instrument. The new REMP-3 instrument was then cross-validated using the data of the second wave.

Results: The new REMP-3 instrument is a psychometric upgrade compared to the EMP-3. The REMP-3 now has a cross-validated structure, with three subscale dimensions (i.e., task perception, background perception and the perceived need to communicate) and an overarching higher-order, full-scale dimension. Both the subscales as well as the full instrument show acceptable to good internal consistency reliability, with a reduced number of items from eighteen to ten. As theoretically predicted, the REMP-3 also functions as a measure of intercultural attitudes in an intercultural competence framework.

Conclusion: Ultimately, the REMP-3 instrument can contribute to more equity in healthcare by concisely and reliably assessing and monitoring attitudes in healthcare practitioners. This attitude assessment represents the potential of learning new skills and knowledge to address interactions with ethnic minority patients, which is especially useful during training situations like an internship.

目的:测量跨文化态度有助于了解和解决医疗保健领域长期存在的不公平现象。一些资料显示,与其创建新的工具,不如针对更广泛的人群对现有工具进行更严格的重新验证。作为现有工具的一个例子,EMP-3(少数民族患者)主要关注医生对少数民族患者的态度。从坚实的理论基础和严谨的方法论设置出发,本研究重新验证了针对医生的 EMP-3 工具和针对毕业医疗从业人员的 REMP-3 工具:我们评估了旧版 EMP-3 的信度和效度,然后将其更新为新版 REMP-3 工具。我们使用结构方程模型对两波独立数据(N2021 = 368 和 N2022 = 390)的跨文化有效性框架进行建模。在此框架内,我们测试了作为跨文化态度操作化的新 REMP-3 工具。我们对第一波数据进行了确认性因素分析,然后对原有的 EMP-3 工具进行了调整,得到了新的 REMP-3 工具。新的 REMP-3 工具随后使用第二波的数据进行了交叉验证:结果:与 EMP-3 相比,新的 REMP-3 测量工具在心理测量学方面有所提升。现在,REMP-3 具有经过交叉验证的结构,包括三个子量表维度(即任务感知、背景感知和感知到的沟通需求)和一个总体的高阶全量表维度。子量表和全量表都显示出可接受到良好的内部一致性可靠性,项目数量从 18 个减少到 10 个。正如理论上所预测的那样,REMP-3 也可以作为跨文化能力框架下的跨文化态度测量工具:最终,REMP-3 工具可以通过简明可靠地评估和监测医疗从业人员的态度,促进医疗保健领域的公平。这种态度评估体现了学习新技能和知识以应对与少数民族患者互动的潜力,在实习等培训期间尤其有用。
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引用次数: 0
Discrimination experiences of transgender individuals in healthcare: an interview study on the perspective of health professionals specializing in the treatment of transgender individuals. 变性人在医疗保健领域遭受歧视的经历:关于专门治疗变性人的医疗专业人员视角的访谈研究。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-11-02 DOI: 10.1186/s12939-024-02313-1
Tobias Skuban-Eiseler, Marcin Orzechowski, Florian Steger

Background: Experiences of discrimination in healthcare lead to poorer mental and physical health for transgender individuals. There is evidence that trans-specialists, i.e. health professionals specializing in transgender care, are an important source of discrimination experienced by transgender individuals in healthcare. In this qualitative interview study, we explored the reasons for this possibly surprising finding by analyzing subjective views of trans-specialists on various issues related to discrimination of transgender individuals.

Methods: We conducted 20 semi-structured, qualitative, exploratory interviews with healthcare professionals specializing in transgender care. Interview questions were developed based on an extensive literature analysis and results of previous research on the topic. The interviews were conducted online, were digitally recorded and transcribed. Data analysis was conducted using the methods of content analysis and thematic analysis.

Results: The interviewees had great difficulty giving a consistent definition of the concept of gender identity. Most of them saw it as a self-determination of a transgender individual. Although herewith emphasizing the autonomy of transgender individuals, most trans-specialists felt that they had to be convinced of their patient's transsexuality to carry out treatment. Most trans-specialists reported having had doubts about whether some transgender individuals were suffering from gender incongruence or not. There was also ambiguity among interviewees about whether transsexuality is a mental illness.

Conclusions: We were able to identify specific topics that can cause discrimination experiences on the part of transgender individuals in their contact with trans-specialists. These include the vagueness of the construct of gender identity and the ambivalence between respect for the autonomy of transgender individuals and the validation of the diagnosis "transsexuality". Also, uncertainties regarding the classification of transsexuality as a mental illness can lead to experiences of discrimination. Furthermore, our results imply that trans-specialists might remember own discriminatory behavior less than it actually took place. Our results can contribute to the development of specific measures to avoid discrimination experiences of transgender individuals in contact with trans-specialists. These should include a reflection on one's own gender identity and training on mechanisms of discrimination.

背景:医疗保健中的歧视经历导致变性人的身心健康较差。有证据表明,变性专家(即专门从事变性护理的卫生专业人员)是变性人在医疗保健中遭受歧视的一个重要来源。在这项定性访谈研究中,我们通过分析跨性别专家对与歧视跨性别者有关的各种问题的主观看法,探讨了这一可能令人吃惊的发现的原因:方法:我们对专门从事跨性别护理的医护人员进行了 20 次半结构化、定性、探索性访谈。访谈问题是在广泛的文献分析和以往相关研究成果的基础上拟定的。访谈在网上进行,并进行了数字录音和转录。数据分析采用了内容分析和主题分析的方法:受访者很难对性别认同的概念给出一致的定义。大多数受访者认为性别认同是变性人的自我决定。尽管在此强调变性人的自主性,但大多数变性专科医生认为,他们必须确信病人是变性人,才能进行治疗。大多数变性专科医生都表示,他们对一些变性人是否患有性别不协调症存有疑虑。受访者对变性是否属于精神疾病也存在模糊认识:我们能够找出变性人在与变性专科医生接触时可能遭受歧视的具体问题。这些问题包括性别认同概念的模糊性,以及在尊重变性人的自主性和 "变性 "诊断的有效性之间的矛盾性。此外,变性被归类为精神疾病的不确定性也会导致歧视经历。此外,我们的研究结果表明,变性专家对自己的歧视行为的记忆可能比实际发生的要少。我们的研究结果有助于制定具体措施,避免变性人在与变性专家接触时遭受歧视。这些措施应包括对自身性别认同的反思和关于歧视机制的培训。
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引用次数: 0
The community food environment as an effect modifier of the relationship between racial discrimination and food insecurity among adults in Southern Brazil. 社区食品环境是巴西南部成年人中种族歧视与食品不安全之间关系的影响调节因素。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-31 DOI: 10.1186/s12939-024-02311-3
Emanuele Bottega de Vargas, Mariane da Silva Dias, Ilaine Schuch, Priscila Bárbara Zanini Rosa, Marcos Fanton, Raquel Canuto

Background: Racial discrimination is linked to unhealthy food environments and a higher prevalence of food insecurity. However, no study has explored their interrelated effects. We analyzed the relationship between racial discrimination, community food environment, and food insecurity in adults of different socioeconomic status. We also investigated the potential modifying effect of the food environment on the relationship between racism and food insecurity.

Methods: This was a cross-sectional study of 400 adults aged 20-70 years residing in the central area of ​​Porto Alegre, the capital of Rio Grande do Sul state. Race and racial discrimination were assessed by self-reported race/skin color using the Experiences of Discrimination scale (EOD), respectively. The food environment was assessed using the Nutrition Environment Measures Survey in Stores (NEMS-S) tool. Food insecurity was assessed using the short version of the Brazilian Food Insecurity Scale (EBIA for short, in Portuguese). Poisson regression with robust variance was employed for the multivariate analysis.

Results: The prevalence of food insecurity was higher in areas with a poorer food environment (areas 1 and 3; 56.6% and 58.8%, respectively). Racial discrimination was associated with food insecurity, where every 1-point increase in the racial discrimination score increased the likelihood of food insecurity by 7% (prevalence ratio [PR] 1.07; 95% CI, 1.03-1.20). When stratifying the analyses by food environment, racial discrimination was associated with food insecurity only in areas with a poorer food environment (PR 1.06; 95% CI, 1.01-1.10).

Conclusions: Experiences of racial discrimination were associated with a higher prevalence of food insecurity in the study population. The community food environment was an effect modifier of this relationship, highlighting the relevance of interventions in the food environment focused on areas with a greater presence of Black people as a way of combating racism and food insecurity.

背景:种族歧视与不健康的食品环境和较高的食品不安全流行率有关。然而,还没有研究探讨过它们之间的相互影响。我们分析了不同社会经济地位的成年人中种族歧视、社区食品环境和食品不安全之间的关系。我们还调查了食品环境对种族主义与食品不安全之间关系的潜在调节作用:这是一项横断面研究,研究对象是居住在南里奥格兰德州首府阿雷格里港中心地区的 400 名 20-70 岁的成年人。种族和种族歧视分别通过使用歧视经历量表(EOD)对自我报告的种族/肤色进行评估。食品环境采用 "商店营养环境测量调查"(NEMS-S)工具进行评估。食品不安全状况采用巴西食品不安全量表(葡萄牙语简称 EBIA)简版进行评估。多变量分析采用了稳健方差泊松回归法:结果:在食品环境较差的地区(地区 1 和地区 3,分别为 56.6%和 58.8%),食品不安全的发生率较高。种族歧视与粮食不安全相关,种族歧视得分每增加 1 分,粮食不安全的可能性就会增加 7%(患病率比 [PR] 1.07;95% CI,1.03-1.20)。如果按食品环境进行分层分析,只有在食品环境较差的地区,种族歧视才与食品不安全有关(PR 1.06;95% CI,1.01-1.10):结论:在研究人群中,种族歧视经历与较高的粮食不安全发生率相关。社区食品环境是这一关系的效应调节器,突出了在黑人较多的地区采取食品环境干预措施作为打击种族主义和食品不安全的一种方式的相关性。
{"title":"The community food environment as an effect modifier of the relationship between racial discrimination and food insecurity among adults in Southern Brazil.","authors":"Emanuele Bottega de Vargas, Mariane da Silva Dias, Ilaine Schuch, Priscila Bárbara Zanini Rosa, Marcos Fanton, Raquel Canuto","doi":"10.1186/s12939-024-02311-3","DOIUrl":"10.1186/s12939-024-02311-3","url":null,"abstract":"<p><strong>Background: </strong>Racial discrimination is linked to unhealthy food environments and a higher prevalence of food insecurity. However, no study has explored their interrelated effects. We analyzed the relationship between racial discrimination, community food environment, and food insecurity in adults of different socioeconomic status. We also investigated the potential modifying effect of the food environment on the relationship between racism and food insecurity.</p><p><strong>Methods: </strong>This was a cross-sectional study of 400 adults aged 20-70 years residing in the central area of ​​Porto Alegre, the capital of Rio Grande do Sul state. Race and racial discrimination were assessed by self-reported race/skin color using the Experiences of Discrimination scale (EOD), respectively. The food environment was assessed using the Nutrition Environment Measures Survey in Stores (NEMS-S) tool. Food insecurity was assessed using the short version of the Brazilian Food Insecurity Scale (EBIA for short, in Portuguese). Poisson regression with robust variance was employed for the multivariate analysis.</p><p><strong>Results: </strong>The prevalence of food insecurity was higher in areas with a poorer food environment (areas 1 and 3; 56.6% and 58.8%, respectively). Racial discrimination was associated with food insecurity, where every 1-point increase in the racial discrimination score increased the likelihood of food insecurity by 7% (prevalence ratio [PR] 1.07; 95% CI, 1.03-1.20). When stratifying the analyses by food environment, racial discrimination was associated with food insecurity only in areas with a poorer food environment (PR 1.06; 95% CI, 1.01-1.10).</p><p><strong>Conclusions: </strong>Experiences of racial discrimination were associated with a higher prevalence of food insecurity in the study population. The community food environment was an effect modifier of this relationship, highlighting the relevance of interventions in the food environment focused on areas with a greater presence of Black people as a way of combating racism and food insecurity.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Determinants of COVID-19 vaccination acceptance based on the novel Omale INDEPT FORCIS Framework and recommendations for subsequent pandemics: a qualitative study among community members in Ebonyi state, Nigeria. 基于新型 Omale INDEPT FORCIS 框架的 COVID-19 疫苗接种接受度的决定因素及对后续流行病的建议:对尼日利亚埃邦伊州社区成员的定性研究。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-28 DOI: 10.1186/s12939-024-02284-3
Ugwu I Omale, Azuka S Adeke, Onyinyechukwu U Oka, Cordis O Ikegwuonu, Osarhiemen Iyare, Olaedo O Nnachi, Victor U Uduma, Chidinma I Amuzie, Glory E Nkwo, Ugochi I A Nwali, Okechukwu O Ukpabi, Ifeyinwa M Okeke, Richard L Ewah
<p><strong>Background: </strong>The unprecedented COVID-19 pandemic has become an endemic disease of global public health importance. Mass COVID-19 vaccination has been an essential global control strategy amidst challenges of limited acceptance. Because of globalization, COVID-19/similar diseases vaccination acceptance and the determinants in any particular setting are important global public health issues. Using a novel and pragmatic framework, this study explored determinants of COVID-19 vaccination acceptance among community members during the pandemic in Ebonyi state, Nigeria, and made policy-relevant recommendations on how to increase vaccination acceptance in subsequent outbreaks/pandemics.</p><p><strong>Methods: </strong>This qualitative study was based on the novel and pragmatic Individual Experiences and Perceptions and Complacency, Confidence, Convenience, and Compulsion (Four 'Cis') Determinants of Vaccination Acceptance Conceptual Framework - Omale INDEPT FORCIS Framework. On April 26 and 27, 2022, 20 semi-structured face-to-face focus group discussions were conducted in local language and pidgin English with 100 purposively selected consenting/assenting community members aged 15 years and above who had resided in the community for at least one year. Data was analysed using deductive (with some inductive) thematic analytic approach.</p><p><strong>Results: </strong>The many, diverse, and significant determinants of COVID-19 vaccination acceptance found were factors that were individual-related (individual experiences and perceptions and knowledge about COVID-19, COVID-19 vaccine/vaccination, and the vaccination process/system, sociodemographic, individual's condition (e.g. pregnancy)); COVID-19-related (factuality, transmissibility, frequency, severity, fatality); COVID-19 vaccine/vaccination-related (safety/side-effects, effectiveness, speedy production); COVID-19 vaccination process/system-related (real availability/accessibility); family, group, and other individual-related (experiences and perceptions and actions); and broader local, national, international, and global (LONING) context-related (socio-political, economic, historic, health system factors). The broader LONING contextual factors included the unprecedented disinformation/conspiracy theories, non-sustained COVID-19 risk/behaviour change communication, enforcement and non-enforcement or termination of peculiar control policies/measures (lockdowns, social/physical distancing, use of face mask etc.), mandatory COVID-19 vaccination policies, provision of incentives, past experiences regarding the Ebola viral disease outbreak, (un)trustworthiness of the Nigerian health system and her international/global partners, and the (un)trustworthiness of the governments in Nigeria and bad/good governance, inclusive of the failure of the Ebonyi state government to distribute the COVID-19 palliatives to the people during the lockdowns.</p><p><strong>Conclusion: </strong>The evidence ill
背景:史无前例的 COVID-19 大流行已成为具有全球公共卫生重要性的地方病。大规模接种 COVID-19 疫苗是一项重要的全球控制策略,但也面临着接受度有限的挑战。由于全球化,COVID-19/类似疾病疫苗接种的接受度以及在任何特定环境下的决定因素都是重要的全球公共卫生问题。本研究采用新颖务实的框架,探讨了尼日利亚埃邦伊州大流行期间社区成员接受 COVID-19 疫苗接种的决定因素,并就如何在后续疫情爆发/大流行期间提高疫苗接种接受度提出了政策相关建议:这项定性研究基于新颖务实的 "疫苗接种接受度的个人经历和感知以及自满、信心、便利和强迫(四个'顺式')决定因素概念框架 - Omale INDEPT FORCIS 框架"。2022 年 4 月 26 日和 27 日,我们用当地语言和皮金英语与 100 名特意挑选的 15 岁及以上、在社区居住至少一年并同意/同意的社区成员进行了 20 次半结构化面对面焦点小组讨论。采用演绎法(部分采用归纳法)对数据进行了专题分析:结果:COVID-19 疫苗接种接受度的决定因素多种多样且具有重要意义,其中包括与个人相关的因素(个人经历、对 COVID-19、COVID-19 疫苗/接种以及接种过程/系统的看法和知识、社会人口学、个人状况(如怀孕));COVID-19 疫苗接种接受度的决定因素(个人经历、对 COVID-19与 COVID-19 疫苗/接种相关(安全性/副作用、有效性、快速生产);与 COVID-19 疫苗接种过程/系统相关(实际可用性/可及性);与家庭、群体和其他个人相关(经历、感知和行动);与更广泛的地方、国家、国际和全球(LONING)背景相关(社会政治、经济、历史、卫生系统因素)。更广泛的 LONING 背景因素包括前所未有的虚假信息/阴谋论、非持续性的 COVID-19 风险/行为改变沟通、特殊控制政策/措施(封锁、社会/物理疏远、使用口罩等)的执行和不执行或终止、强制性 COVID-19 风险/行为改变沟通、社会/物理疏远、使用口罩等)。这些因素包括:强制 COVID-19 疫苗接种政策、提供激励措施、过去有关埃博拉病毒性疾病爆发的经验、尼日利亚卫生系统及其国际/全球合作伙伴的(不)可信度、尼日利亚政府的(不)可信度以及不良/良好治理,包括埃邦伊州政府未能在封锁期间向人们分发 COVID-19 止痛药:这些证据揭示了影响人们接受 COVID-19 疫苗接种的复杂而又相互关联的、具体的、潜在的和与政策相关的特殊龙8国际娱乐城决定因素,并强调有必要采取协调一致的综合龙8国际娱乐城战略(涉及所有相关龙8国际娱乐城利益相关者/政策制定者)来解决这些决定因素,以提高埃邦伊州/尼日利亚和类似环境中社区成员在随后的疫情爆发/大流行中对疫苗接种的接受程度。
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引用次数: 0
Refraining from seeking dental care among the Sámi in Sweden: a cross-sectional study. 瑞典萨米人拒绝看牙医:一项横断面研究。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-26 DOI: 10.1186/s12939-024-02305-1
Negin Yekkalam, Christina Storm Mienna, Jon Petter Anders Stoor, Miguel San Sebastian

Background: While equity in health care is the core of the Swedish health system, social inequalities in accessing health care, particularly regarding dental care, exist. There is however no information on how the Sámi population is affected. This study aimed to assess the prevalence and risk factors for refraining from seeking dental care among the Sámi in Sweden.

Methods: A Sámi sample was constructed from three pre-existing registers. Among the 9,249 invitations for individuals aged 18-84 years old, 3,779 answered the survey during February-May 2021. We first calculated frequencies and proportions of the independent variables in terms of socio-economic, socio-demographic, and cultural-related factors as well as the outcome, refraining from dental care. Then, we summarized the magnitude of the association between the independent variables and self-reported refrain from dental care with the prevalence difference (PD) using the 95% confidence interval (95% CI) for inferential purposes.

Results: Overall, 17.5% of the participants refrained from seeking dental care despite self-reported need in the last three months, with almost the same proportion between men and women. Among the socio-demographic factors, being in the 30-44 years group (PD = 8.0; 95% CI: 3.59, 12.48), in the 45-64 group (PD = 7.3; 95% CI: 2.96, 11.61) and in the 65-84 group (PD = 5.4; 95% CI: 0.92, 9.78) as well as being divorced/widow-er (PD = 6.7; 95% CI: 2.73, 10.70) and unmarried (PD = 3.1; 95% CI: 0.23, 6.04) were statistically significantly associated with refraining from seeking dental care. Among the socio-economic variables, those in the middle-income quintile (PD = 5.3; 95% CI: 1.28, 9.35), in the poor (PD = 8.1; 95% CI: 3.64, 12.51) and poorest (PD = 8.0 95% CI: 3.48, 12.50) quintiles, and especially those experiencing economic stress once (PD = 9.2; 95% CI: 2.93, 15.48) and several times (PD = 26.5; 95% CI: 19.50, 33.43), were strongly associated with refraining.

Conclusions: Approximately one in six of the Sámi participating in this study refrained from seeking dental care despite self-reported need in the last three months. Those who experienced economic difficulties were the most affected group. To achieve equity in dental health care in Sweden, policies removing economic barriers to access dental health care should be implemented.

背景:虽然医疗保健的公平性是瑞典医疗保健系统的核心,但在获得医疗保健,尤其是牙科保健方面,仍存在社会不平等现象。然而,目前还没有关于萨米人如何受到影响的信息。本研究旨在评估瑞典萨米人不寻求牙科治疗的普遍程度和风险因素:方法:从三份已有的登记册中抽取萨米人样本。2021 年 2 月至 5 月期间,在 9,249 份针对 18-84 岁个人的邀请函中,有 3,779 人回答了调查。我们首先计算了社会经济、社会人口和文化相关因素以及结果(拒绝牙科保健)等自变量的频率和比例。然后,我们总结了自变量与自我报告的不看牙医之间的关联程度,并使用 95% 置信区间 (95% CI) 计算了患病率差异 (PD),以达到推论目的:总体而言,17.5%的受试者尽管自称在过去三个月中有牙科保健需求,但却没有去看牙医,男性和女性的比例几乎相同。在社会人口因素中,30-44 岁组(PD = 8.0; 95% CI: 3.59, 12.48)、45-64 岁组(PD = 7.3; 95% CI: 2.96, 11.61)和 65-84 岁组(PD = 5.4; 95% CI: 0.92,9.78)以及离婚/丧偶(PD = 6.7;95% CI:2.73,10.70)和未婚(PD = 3.1;95% CI:0.23,6.04)与不寻求牙科保健在统计学上有显著关联。在社会经济变量中,中等收入五分位数(PD = 5.3;95% CI:1.28,9.35)、贫困五分位数(PD = 8.1;95% CI:3.64,12.51)和最贫困五分位数(PD = 8.0 95%CI:3.48,12.50)五分位数,尤其是经历过一次(PD = 9.2;95% CI:2.93,15.48)和多次(PD = 26.5;95% CI:19.50,33.43)经济压力的人,与不吸烟密切相关:参与这项研究的萨米人中,约有六分之一的人尽管自称在过去三个月中有牙科保健需求,但仍拒绝就医。经济困难的萨米人是受影响最大的群体。为了在瑞典实现牙科保健的公平性,应实施消除获得牙科保健的经济障碍的政策。
{"title":"Refraining from seeking dental care among the Sámi in Sweden: a cross-sectional study.","authors":"Negin Yekkalam, Christina Storm Mienna, Jon Petter Anders Stoor, Miguel San Sebastian","doi":"10.1186/s12939-024-02305-1","DOIUrl":"10.1186/s12939-024-02305-1","url":null,"abstract":"<p><strong>Background: </strong>While equity in health care is the core of the Swedish health system, social inequalities in accessing health care, particularly regarding dental care, exist. There is however no information on how the Sámi population is affected. This study aimed to assess the prevalence and risk factors for refraining from seeking dental care among the Sámi in Sweden.</p><p><strong>Methods: </strong>A Sámi sample was constructed from three pre-existing registers. Among the 9,249 invitations for individuals aged 18-84 years old, 3,779 answered the survey during February-May 2021. We first calculated frequencies and proportions of the independent variables in terms of socio-economic, socio-demographic, and cultural-related factors as well as the outcome, refraining from dental care. Then, we summarized the magnitude of the association between the independent variables and self-reported refrain from dental care with the prevalence difference (PD) using the 95% confidence interval (95% CI) for inferential purposes.</p><p><strong>Results: </strong>Overall, 17.5% of the participants refrained from seeking dental care despite self-reported need in the last three months, with almost the same proportion between men and women. Among the socio-demographic factors, being in the 30-44 years group (PD = 8.0; 95% CI: 3.59, 12.48), in the 45-64 group (PD = 7.3; 95% CI: 2.96, 11.61) and in the 65-84 group (PD = 5.4; 95% CI: 0.92, 9.78) as well as being divorced/widow-er (PD = 6.7; 95% CI: 2.73, 10.70) and unmarried (PD = 3.1; 95% CI: 0.23, 6.04) were statistically significantly associated with refraining from seeking dental care. Among the socio-economic variables, those in the middle-income quintile (PD = 5.3; 95% CI: 1.28, 9.35), in the poor (PD = 8.1; 95% CI: 3.64, 12.51) and poorest (PD = 8.0 95% CI: 3.48, 12.50) quintiles, and especially those experiencing economic stress once (PD = 9.2; 95% CI: 2.93, 15.48) and several times (PD = 26.5; 95% CI: 19.50, 33.43), were strongly associated with refraining.</p><p><strong>Conclusions: </strong>Approximately one in six of the Sámi participating in this study refrained from seeking dental care despite self-reported need in the last three months. Those who experienced economic difficulties were the most affected group. To achieve equity in dental health care in Sweden, policies removing economic barriers to access dental health care should be implemented.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Assessing the role of non-state actors in health service delivery and health system resilience in Myanmar. 评估非国家行为者在缅甸卫生服务提供和卫生系统复原力方面的作用。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-24 DOI: 10.1186/s12939-024-02292-3
K Than, Maria Paola Bertone, T La, Sophie Witter

Background: Due to the weaknesses of the public health system and its low reach, especially in border areas, provision of health services by non-state actors (NSAs) has historically played an important role in Myanmar. NSAs include local and international NGOs and civil society organisations (CSOs), but also Ethnic Health Organisations (EHOs) in the border areas, as well as the private (for profit) sector. This study aims to understand the changing role of NSAs in the shifting political environment of Myanmar between 2010 and 2022, and to explore their contribution to health system resilience.

Methods: Our study includes three main components: a documentary review (n = 22), key informant interviews (KIIs) at central level (n = 14) and two township-level case studies (13 KIIs, 4 FGDs). Mostly qualitative data were collected in 2022 and synthesized, using a health system resilience framework to structure the analysis.

Results: During the transition period (2010-2014) and the new political era (2015-2020), while the country gradually transitioned to a democratic system, the government increasingly recognized NSAs. Initially, engagement with NSAs remained focused on disease-specific activities and government oversight was limited, but later it expanded to health system strengthening, including the start of a "convergence" with ethnic health systems. Progress was relatively slow, but defined by a clear vision and plans. The military coup of February 2021 brought a halt to this progress. Collaboration between government and NSAs was interrupted, and NSAs restored previous practices and parallel systems. Initially, most health service provision stopped, but with time coping strategies emerged, which showed the capacity of NSAs to absorb the shocks (focusing on basic services; using informal communication channels; maintaining buffer stocks of supplies) and adapt (changing modes of delivery and supply chains, and adjusting HRH training).

Conclusions: The study highlights the role of NSAs during crises, and provides insights on how the resilience capacities built over time by NSAs to provide services in adverse circumstances have informed the response to the latest crisis. While strategies of absorption and adaptation are noted in the study, we did not identify any transformation strategy - which might indicate the difficulty of NSAs to introduce radical changes when subjected to multiple shocks and a hostile political environment.

背景:由于公共卫生系统薄弱,覆盖面小,尤其是在边境地区,非国家行为者(NSAs)提供的卫生服务在缅甸历来发挥着重要作用。非国家行为者包括当地和国际非政府组织、民间社会组织(CSO)、边境地区的少数民族卫生组织(EHO)以及私营(营利)部门。本研究旨在了解非国家行为者在 2010 年至 2022 年缅甸不断变化的政治环境中不断变化的角色,并探讨他们对卫生系统复原力的贡献:我们的研究包括三个主要部分:文献综述(22 人)、中央层面的关键信息提供者访谈(14 人)和两个乡镇层面的案例研究(13 人的关键信息提供者访谈,4 人的小组讨论)。大部分定性数据于 2022 年收集,并利用卫生系统复原力框架进行综合分析:在过渡时期(2010-2014 年)和新政治时代(2015-2020 年),在国家逐步向民主制度过渡的同时,政府也越来越多地承认了非国家行为者。起初,与非营利组织的合作仍集中在针对特定疾病的活动上,政府的监督也很有限,但后来扩大到了加强卫生系统,包括开始与少数民族卫生系统 "接轨"。进展相对缓慢,但有明确的愿景和计划。2021 年 2 月的军事政变停止了这一进展。政府和非国家行为者之间的合作中断了,非国家行为者恢复了以前的做法和平行系统。起初,大部分医疗服务的提供都停止了,但随着时间的推移,应对策略应运而生,这表明非国家医疗机构有能力吸收冲击(专注于基本服务;利用非正式沟通渠道;保持缓冲物资储备)并进行调整(改变提供模式和供应链,调整人力资源培训):本研究强调了非国家行为者在危机中的作用,并深入探讨了非国家行为者在不利情况下提供服务的复原能力是如何为应对最近的危机提供依据的。虽然研究中提到了吸收和适应战略,但我们没有发现任何转型战略--这可能表明,在受到多重冲击和敌对政治环境的影响时,非国家行为者很难进行彻底变革。
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引用次数: 0
Barriers and facilitators of healthcare access for long COVID-19 patients in a universal healthcare system: qualitative evidence from Austria. 全民医疗系统中长期 COVID-19 患者获得医疗服务的障碍和促进因素:来自奥地利的定性证据。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-23 DOI: 10.1186/s12939-024-02302-4
Peter Gamillscheg, Agata Łaszewska, Stefanie Kirchner, Kathryn Hoffmann, Judit Simon, Susanne Mayer

Background: Long COVID-19 challenges health and social systems globally. International research finds major inequalities in prevalence and healthcare utilization as patients describe difficulties with accessing health care. In order to improve long-term outcomes it is vital to understand any underlying access barriers, for which relevant evidence on long COVID-19 is thus far lacking in a universal healthcare system like Austria. This study aims to comprehensively identify access barriers and facilitators faced by long COVID-19 patients in Austria and explore potential socioeconomic and demographic drivers in health and social care access.

Methods: Applying an exploratory qualitative approach, we conducted semi-structured interviews with 15 experts including medical professionals and senior health officials as well as focus groups with 18 patients with confirmed long COVID-19 diagnosis reflecting varying participant characteristics (age, gender, urbanicity, occupation, education, insurance status) (July-Nov 2023). Data were analysed following a thematic framework approach, drawing on a comprehensive 'access to health care' model.

Results: Based on expert and patient experiences, several access barriers and facilitators emerged along all dimensions of the model. Main themes included scepticism and stigma by medical professionals, difficulties in finding knowledgeable doctors, limited specialist capacities in the ambulatory care sector, long waiting times for specialist care, and limited statutory health insurance coverage of treatments resulting in high out-of-pocket payments. Patients experienced constant self-organization of their patient pathway as stressful, emphasizing the need for multidisciplinary care and centralized coordination. Facilitators included supportive social environments, telemedicine, and informal information provided by a nationwide patient-led support group. Differences in patient experiences emerged, among others, as women and younger patients faced gender- and age-based stigmatization. Complementary health insurance reduced the financial strain, however, did not ease capacity constraints, which were particularly challenging for those living in rural areas.

Conclusions: The findings of this study indicate a call for action to improve the long COVID-19 situation in Austria by empowering both providers and patients via increased information offerings, strengthened interdisciplinary treatment structures and telemedicine offerings as well as research funding. Our insights on potentially relevant socioeconomic and demographic drivers in access barriers lay the necessary foundation for future quantitative inequality research.

背景:长 COVID-19 在全球范围内对卫生和社会系统构成挑战。国际研究发现,在患病率和医疗保健利用率方面存在严重的不平等,患者描述了获得医疗保健的困难。为了改善长期疗效,了解任何潜在的就医障碍至关重要,而在奥地利这样的全民医疗体系中,迄今为止还缺乏有关长 COVID-19 的相关证据。本研究旨在全面识别奥地利长期 COVID-19 患者所面临的就医障碍和促进因素,并探索医疗和社会护理就医方面潜在的社会经济和人口驱动因素:采用探索性定性方法,我们对 15 名专家(包括医疗专业人员和高级卫生官员)进行了半结构化访谈,并对 18 名确诊为长 COVID-19 的患者进行了焦点小组讨论(2023 年 7 月至 11 月),这些访谈反映了不同的参与者特征(年龄、性别、城市化程度、职业、教育程度、保险状况)。数据分析采用主题框架法,借鉴了全面的 "获得医疗服务 "模式:根据专家和患者的经验,在该模型的所有维度上都出现了一些获得医疗服务的障碍和促进因素。主要的主题包括:医疗专业人员的怀疑和污名化、难以找到知识渊博的医生、非住院治疗部门的专家能力有限、等待专家治疗的时间过长、法定医疗保险的治疗范围有限导致自付费用过高。患者认为不断自我组织患者治疗路径是一种压力,强调了多学科护理和集中协调的必要性。促进因素包括支持性的社会环境、远程医疗以及由全国患者领导的支持小组提供的非正式信息。患者的经历出现了差异,其中女性和年轻患者面临着基于性别和年龄的污名化。补充医疗保险减轻了患者的经济压力,但并没有缓解患者的能力限制,这对生活在农村地区的患者来说尤其具有挑战性:这项研究的结果表明,需要采取行动改善奥地利 COVID-19 长期存在的状况,通过提供更多信息、加强跨学科治疗结构、提供远程医疗服务以及提供研究资金来增强医疗服务提供者和患者的能力。我们对造成就医障碍的潜在相关社会经济和人口驱动因素的见解,为未来的定量不平等研究奠定了必要的基础。
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引用次数: 0
Sociodemographic disparities in antibiotic-resistant outpatient urine cultures in a Boston hospital, 2015-2020: a cross-sectional analysis. 2015-2020 年波士顿一家医院门诊尿液培养中抗生素耐药性的社会人口差异:横断面分析。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-23 DOI: 10.1186/s12939-024-02308-y
Courtney W Chan, Leo K Westgard, Andrew Romasco, Krisztian Gado, Shira Doron, Maya L Nadimpalli

Background: Antibiotic resistance in uropathogens has rapidly escalated over time, complicating treatment and increasing morbidity and mortality. Few studies have explored how the social determinants of health may be associated with patients' risks for acquiring antibiotic-resistant (AR) uropathogens.

Methods: We identified urine cultures collected from outpatients presenting to Tufts Medical Center Primary Care Practices between 2015 and 2020. Specimens were included if patients' age, sex, and residential address were recorded in the electronic medical record (EMR) and if their urine culture yielded Enterococcus spp. or one or more gram-negative bacterial organism(s) or for which antibiotic susceptibility profiling and species identification was conducted. We abstracted patients' sociodemographic characteristics from the EMR and used US Census Bureau data to identify characteristics about patients' census tracts of residence. We evaluated associations between individual- and neighborhood-level characteristics and patients' risk of having a urine culture resistant to (1) three or more antibiotic classes (i.e., multidrug resistant [MDR]), (2) first-line treatments, (3) fluoroquinolones, (4) aminoglycosides, or (5) ceftriaxone using logistic regression models and a Bonferroni correction to account for multiple hypothesis testing.

Results: We included urine cultures from 1,306 unique outpatients, most of whom were female (89%). Patients largely self-identified as Non-Hispanic White (36%), Asian (15%), or Non-Hispanic Black (11%). Over 60% lived in an environmental justice-designated census tract. Most included isolates were Escherichia coli (76%) or Klebsiella pneumoniae (7%). Using public insurance increased patients' odds of having a uropathogen resistant to first-line antibiotics, but living in a limited-income neighborhood reduced patients' odds of having a MDR uropathogen by 47%. We noted a strong but non-significant positive trend between speaking a language other than English and having an aminoglycoside-resistant uropathogen (p-value = 0.02). Most notably, after controlling for other factors, we observed no statistically significant associations between race or ethnicity and AR uropathogens.

Conclusion: The social determinants of health may play important and intersecting roles in determining a patient's risk of having a resistant uropathogens that is more challenging or expensive to treat. It is crucial to acknowledge how race is likely to be a proxy for other factors affecting health, and to consider that some groups may be disproportionately impacted by antibiotic resistance.

背景:随着时间的推移,泌尿病原体的抗生素耐药性迅速升级,使治疗变得复杂,并增加了发病率和死亡率。很少有研究探讨健康的社会决定因素如何与患者感染耐抗生素(AR)泌尿病原体的风险相关:我们确定了 2015 年至 2020 年期间从塔夫茨医疗中心初级保健诊所门诊患者处收集的尿培养物。如果电子病历 (EMR) 中记录了患者的年龄、性别和居住地址,且尿培养结果显示为肠球菌属或一种或多种革兰氏阴性细菌,或进行了抗生素敏感性分析和菌种鉴定,则样本将被纳入其中。我们从电子病历中提取了患者的社会人口学特征,并使用美国人口普查局的数据确定了患者居住地的人口统计特征。我们使用逻辑回归模型和Bonferroni校正法评估了个人和社区层面的特征与患者尿培养对以下药物耐药的风险之间的关系:(1) 三类或更多抗生素(即耐多药[MDR]);(2) 一线治疗;(3) 氟喹诺酮类;(4) 氨基糖苷类;或 (5) 头孢曲松:我们纳入了 1306 名门诊患者的尿培养结果,其中大部分为女性(89%)。患者大多自我认同为非西班牙裔白人(36%)、亚裔(15%)或非西班牙裔黑人(11%)。超过 60% 的患者居住在环境正义指定的人口普查区。大部分分离菌株为大肠埃希菌(76%)或肺炎克雷伯菌(7%)。使用公共保险会增加患者感染对一线抗生素耐药的尿路病原体的几率,但生活在低收入社区的患者感染 MDR 尿路病原体的几率会降低 47%。我们注意到,讲英语以外的语言与氨糖苷类药物耐药尿路病原体之间存在强烈但不显著的正相关趋势(p 值 = 0.02)。最值得注意的是,在控制了其他因素后,我们没有观察到种族或民族与耐氨糖苷尿路病原体之间有统计学意义的关联:结论:健康的社会决定因素在决定患者感染耐药尿路病原体的风险方面可能起着重要的交叉作用,而耐药尿路病原体的治疗更具挑战性或更加昂贵。关键是要认识到种族可能是影响健康的其他因素的替代物,并考虑到某些群体可能会受到抗生素耐药性不成比例的影响。
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引用次数: 0
Investigating the availability, affordability, and market dynamics of innovative oncology drugs in Morocco: an original report. 调查摩洛哥肿瘤创新药物的可用性、可负担性和市场动态:原创报告。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-21 DOI: 10.1186/s12939-024-02262-9
Nada Benhima, Leila Afani, Mohammed El Fadli, Ismail Essâdi, Rhizlane Belbaraka

Background: The cost of cancer drugs presents a significant challenge to accessibility of treatment worldwide. Projections indicate that by 2040, two-thirds of cancer cases will occur in low- and middle- income countries. Paradoxically, despite this impending burden, LMICs command less than 5% share of global resources for treating cancer. Morocco, like many LMICs, faces significant obstacles in providing innovative cancer treatments to its population.

Aim: Firstly, we aimed to conduct an original research investigating the availability and affordability of innovative cancer drugs in Morocco. Secondly, we sought to review the broader market dynamics, pricing, and reimbursement policies in the country.

Methods: For the first objective, we identified a preliminary list of medicines approved for oncological indications in the Moroccan market based on resources from ANAM (National Agency for Health Insurance), pharmacy regulators, and online resources that compile information on approved medicines. For the second objective, we exhaustively reviewed the regulatory documents, legal texts and grey literature reports. All the informations were examined by pharma delegates and local experts.

Results: As of January 2024, Morocco has 39 innovative anticancer medicines with market authorization. 30% of these drugs were approved after 2020. The majority of approved drugs were for breast, lung, colorectal, and prostate cancer. The period between FDA approval and entry into the Moroccan market ranges from 2 to 7 years, with a median of 3 years for breast cancer drugs and 7 years for more expensive drugs like Olaparib and Osimertinib. 22 out of the 39 drugs are not reimbursed, with an average reimbursement time of 4 years. Compared to prices in France, the most notable pricing disparities concern immunotherapy agents, priced 600 to 900 euros lower in France, while drugs like Pazopanib and Erlotinib cost 50% less in Morocco.

Conclusion: Our study reveals significant disparities in the availability and affordability of innovative cancer drugs in Morocco. Regulatory hurdles, importation challenges, and pricing strategies contribute to this inequitable landscape. Addressing systemic barriers, fostering collaborations between stakeholders, and adopting a value-based pricing approach are imperative steps toward ensuring equitable access to high-quality interventions for patients, regardless of their geographical location.

背景:癌症药物的成本对全球治疗的可及性构成了重大挑战。预测显示,到 2040 年,三分之二的癌症病例将发生在中低收入国家。令人不解的是,尽管癌症负担迫在眉睫,中低收入国家在全球癌症治疗资源中所占的份额却不到 5%。目标:首先,我们旨在开展一项原创性研究,调查创新抗癌药物在摩洛哥的可用性和可负担性。其次,我们试图审查该国更广泛的市场动态、定价和报销政策:在第一个目标中,我们根据国家医疗保险局(ANAM)、药房监管机构和汇编已批准药品信息的在线资源,初步确定了摩洛哥市场上已批准的肿瘤适应症药品清单。为了实现第二个目标,我们详尽查阅了监管文件、法律文本和灰色文献报告。所有信息均由医药代表和当地专家进行了审查:截至 2024 年 1 月,摩洛哥共有 39 种创新抗癌药物获得了市场授权。其中 30% 的药物是在 2020 年之后获批的。大部分获批药物用于治疗乳腺癌、肺癌、结直肠癌和前列腺癌。从 FDA 批准到进入摩洛哥市场的时间从 2 年到 7 年不等,乳腺癌药物的中位数为 3 年,奥拉帕利(Olaparib)和奥西莫替尼(Osimertinib)等较昂贵药物的中位数为 7 年。39 种药物中有 22 种没有报销,平均报销时间为 4 年。与法国的价格相比,免疫疗法药物的价格差距最明显,法国的免疫疗法药物价格要低600至900欧元,而帕唑帕尼和厄洛替尼等药物在摩洛哥的价格要低50%:我们的研究揭示了摩洛哥在创新抗癌药物的可获得性和可负担性方面的巨大差异。监管障碍、进口挑战和定价策略造成了这种不公平的局面。解决系统性障碍、促进利益相关者之间的合作以及采用基于价值的定价方法是确保患者(无论其地理位置如何)公平获得高质量干预措施的必要步骤。
{"title":"Investigating the availability, affordability, and market dynamics of innovative oncology drugs in Morocco: an original report.","authors":"Nada Benhima, Leila Afani, Mohammed El Fadli, Ismail Essâdi, Rhizlane Belbaraka","doi":"10.1186/s12939-024-02262-9","DOIUrl":"10.1186/s12939-024-02262-9","url":null,"abstract":"<p><strong>Background: </strong>The cost of cancer drugs presents a significant challenge to accessibility of treatment worldwide. Projections indicate that by 2040, two-thirds of cancer cases will occur in low- and middle- income countries. Paradoxically, despite this impending burden, LMICs command less than 5% share of global resources for treating cancer. Morocco, like many LMICs, faces significant obstacles in providing innovative cancer treatments to its population.</p><p><strong>Aim: </strong>Firstly, we aimed to conduct an original research investigating the availability and affordability of innovative cancer drugs in Morocco. Secondly, we sought to review the broader market dynamics, pricing, and reimbursement policies in the country.</p><p><strong>Methods: </strong>For the first objective, we identified a preliminary list of medicines approved for oncological indications in the Moroccan market based on resources from ANAM (National Agency for Health Insurance), pharmacy regulators, and online resources that compile information on approved medicines. For the second objective, we exhaustively reviewed the regulatory documents, legal texts and grey literature reports. All the informations were examined by pharma delegates and local experts.</p><p><strong>Results: </strong>As of January 2024, Morocco has 39 innovative anticancer medicines with market authorization. 30% of these drugs were approved after 2020. The majority of approved drugs were for breast, lung, colorectal, and prostate cancer. The period between FDA approval and entry into the Moroccan market ranges from 2 to 7 years, with a median of 3 years for breast cancer drugs and 7 years for more expensive drugs like Olaparib and Osimertinib. 22 out of the 39 drugs are not reimbursed, with an average reimbursement time of 4 years. Compared to prices in France, the most notable pricing disparities concern immunotherapy agents, priced 600 to 900 euros lower in France, while drugs like Pazopanib and Erlotinib cost 50% less in Morocco.</p><p><strong>Conclusion: </strong>Our study reveals significant disparities in the availability and affordability of innovative cancer drugs in Morocco. Regulatory hurdles, importation challenges, and pricing strategies contribute to this inequitable landscape. Addressing systemic barriers, fostering collaborations between stakeholders, and adopting a value-based pricing approach are imperative steps toward ensuring equitable access to high-quality interventions for patients, regardless of their geographical location.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11492621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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International Journal for Equity in Health
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