International Journal for Equity in Health最新文献

Background: Advance care planning (ACP) is a critical process for ensuring person-centred end-of-life care, yet it remains underutilized among people with intellectual disabilities (ID). Understanding caregivers' perspectives is essential to identify barriers and facilitators to ACP implementation and improve practice. This study aimed to examine how professional caregivers in Austria perceive and experience ACP for people with ID, including its current use, barriers, facilitators, and strategies to improve uptake.

Methods: A cross-sectional survey was conducted using a structured online form comprising multiple-choice and open-ended questions. Data were collected from 125 professional caregivers across Austria who were primary caregivers of at least one adult with ID and proficient in German. Quantitative data were analysed descriptively, while qualitative responses to open-ended questions were subjected to content analysis.

Results: A total of 33.6% of caregivers reported engaging in ACP discussions, with considerable barriers including cognitive and communicative challenges, emotional discomfort, and structural constraints. Facilitators included person-centred communication, interdisciplinary collaboration, and targeted training. Notably, 83.2% of caregivers expressed interest in ACP training.

Conclusions: ACP is rarely practiced in the care of people with ID in Austria. However, caregivers identified clear pathways to improve implementation, particularly through training, use of tailored communication methods, and systemic support within care institutions. Promoting inclusive ACP practices is essential to uphold the autonomy and health equity of people with ID, ensuring their voices are heard in decisions about their future and end-of-life care.

Background: There is a serious and persistent gap in perinatal morbidity and mortality rates for women from minoritised groups and for those living in deprived areas in the UK. If symptoms can be recognised in time this enables them to be treated more effectively. There are numerous information resources of varying quality detailing symptoms of potential postnatal serious symptoms that inform women's decisions to seek care. However, cross cultural understanding, linguistic constraints and multiple challenges that act in a mutually reinforcing way can impact women's access to information in a format they can understand and act upon. Women continue to report unmet needs for information and support in the postnatal period, but there is no guidance for health care professionals on how to provide information to better care for women experiencing intersecting challenges in access to health care.

Methods: The BEAMS project partnered with charities who support women with lived experience of challenges accessing healthcare. With the additional support and insight of two peer researchers we used arts-based, participatory, trauma-informed methods to work with 60 women of lived experience through interactive workshops. We reviewed current postnatal information resources used in the NHS, and explored what worked well in transferring the health message to the reader and what did not. Together we co-wrote scripts (checked for clinical accuracy) to share our message and worked with a narrative artist to create example resources that illustrates accessible information design.

Results: Together we co-created two checklists to guide the design and delivery of accessible information. We applied the information design checklist to the creation of posters and animations in multiple languages using postnatal serious symptoms as the topic. We also used the information delivery checklist to engage with multiple professionals, organisations and charities to disseminate and deliver the resources.

Conclusion: Working in a collaborative way requires time, flexibility and openness from everyone involved. It may feel unstructured or challenging at times, and produce unexpected findings, but this equitable way of working is respectful, develops valuable partnerships and authentic outputs.

Background: Cataract is the primary cause of blindness in China and has a low surgery uptake rate where financial factors are crucial determinants. We report updated data on the financial protection of patients with cataract surgery after the integration of urban and rural medical insurance.

Methods: A population-based survey and hospital administrative data were matched to analyze surgical and total out of pocket (OOP) costs and their burden relative to income; the proportion of total surgical costs paid OOP; and the breakdown of total surgical costs. Multivariate regressions, including key interaction terms, identified socio-demographic factors associated with OOP cost and burden.

Results: Among 348 cataract patients, the average surgical OOP cost incurred by patients after any reimbursements was RMB 2945 (USD 427) and total OOP costs averaged RMB 3442 (USD 499), accounting for 25.1% of annual household income. Total surgical costs averaged RMB 5,220 (USD 758), with 44.8% paid OOP and the remaining 55.2% covered by insurance. Material expenses made up 41.3% of the total surgical costs. Having supplementary health insurances and being registered as poverty-stricken households significantly reduced OOP expenditure and burden. However, supplementary insurance was associated with a significantly higher financial burden for lower-middle-income households, highlighting the vulnerability of the 'near poor'.

Conclusions: Financial burden relative to income has decreased after the integration of medical insurance. However, challenges for the 'near poor' population remain. Therefore, not only expand coverage but also optimize insurance benefit design are crucial for enhancing financial protection.

Background: Burkina Faso has been dealing with a worsening security situation since 2015, resulting in more than two million people being forced to leave their homes. Gender-based violence (GBV) has escalated and is a major issue in situations involving conflict and forced displacement. This research examines the views and opinions of internally displaced individuals on VBG in Burkina Faso, specifically emphasizing how ingrained social structures contribute to this problem.

Methods: This study employed a qualitative, descriptive, and exploratory research design. The research was conducted in Kaya city, a region heavily impacted by displacement. Data were collected through 58 focus group discussions, which included 352 participants. The data were thematically analyzed using NVivo 12 and the approach developed by Braun and Clarke, enabling a thorough identification of key patterns and themes.

Results: Findings enabled the identification of several critical dimensions of GBV, its root causes, and risk factors. GBV was highlighted as deeply rooted in cultural and structural determinants, with gender inequality, power imbalances, and entrenched social constructs forming its primary foundations. Economic hardship, ignorance, behavioral issues like alcohol misuse, and institutional shortcomings were seen as contributors exacerbating GBV but not necessarily its root causes. Participants emphasized heightened GBV risks during humanitarian crises, manifesting in physical, sexual, and psychological violence linked to harmful traditional practices like female genital mutilation (FGM), forced marriages, and the sexual division of labor. Though harmful practices persist, divergent views on GBV trends emerged, with some reporting reductions due to shifting behaviors or constraints. Preventive efforts, such as awareness campaigns and local interventions, were noted but insufficient against sociocultural barriers to survivor support, including stigmatization and victim-blaming.

Conclusions: This research elucidates the deep-rooted sociocultural and structural determinants of GBV, reflecting persisting gender inequities and systemic oppression. The findings underscore the pressing requirement for thorough communication plans that increase understanding of accessible services and foster participation despite the widespread stigma, shame, and fear that prevent individuals from seeking help.

Background: Pain affects an estimated 1.5 billion people globally. Cultural factors strongly influence how pain is perceived, communicated, and managed. However, it remains unclear to what extent, how, and for whom pain management approaches have been culturally tailored, and whether these adaptations have been evaluated to ensure cultural relevance and effectiveness. This scoping review addresses this gap.

Methods: We searched six electronic databases for peer-reviewed articles and grey literature, combining terms for pain and cultural tailoring. We included empirical studies (including protocols), published in English, that reported on the cultural tailoring of pain management approaches for adults (≥18 years). At least two reviewers independently screened titles and abstracts, followed by full text assessment. We charted data on study characteristics, cultural tailoring methods, and evaluation strategies, and synthesised results narratively.

Results: Our search identified 4,551 unique studies, of which we included 38. Of these, 32 (84%) were published after 2016, with 26 (68%) focusing on musculoskeletal pain. They reported the cultural tailoring of 27 unique pain management intervention approaches, of which 19 (70%) focused on racial and ethnic minorities mainly in high-income countries. Educational interventions were most commonly tailored (n = 9, 33%). Only four (15%) tailored approaches were delivered digitally. Most (n = 25, 93%) approaches underwent content adaptation through including culturally relevant language, metaphors, and gender considerations. Most employed early tailoring steps, such as information gathering (85%) and preliminary adaptation design (93%). Only six (22%) approaches used frameworks to guide the adaptation such as Intervention Mapping-Adapt, FRAME, and ADAPT-IT. The effectiveness of cultural tailoring was evaluated for 11 (41%) approaches, mainly through randomised controlled trials (n = 7, 26%).

Conclusion: This review identified several efforts to culturally tailor pain management approaches, particularly for racial and ethnic minorities with musculoskeletal pain in high-income countries. Most tailoring focused on content adaptation for in-person formats, with limited use of contextual modifications, digital delivery, or adaptation frameworks. Future research should broaden tailoring beyond content changes, make greater use of digital tools, and prioritise adaptations in low- and middle-income countries. Evaluation strategies should also expand to assess real-world implementation, and long-term outcomes.