International Journal for Equity in Health最新文献

Background: Free mpox self-testing often requires disclosure of personal contact information (e.g., phone numbers or social media IDs). Among men who have sex with men (MSM), this requirement can function as an access gate with unequal impacts across socioeconomic and regional contexts. Using the Capability, Opportunity, Motivation-Behavior (COM-B) framework, we examined psychosocial and socioeconomic correlates of willingness to disclose among MSM in China.

Methods: We conducted an anonymous online cross-sectional survey (November 2023-March 2024) in six provincial regions representing three development tiers. MSM (n = 2,403) were recruited via community-based organizations using snowball sampling. Guided by the COM-B framework, we fitted hierarchical logistic regression models with sequential adjustment for sociodemographic, health, and behavioral covariates to estimate associations with disclosure willingness. Prespecified stratified analyses by education, income, and regional development assessed heterogeneity.

Results: Overall, 57.9% reported willingness to disclose contact information to obtain free mpox self-testing kits. COM-B factors were consistently associated with willingness across models: higher prevention self-efficacy (OR = 1.028, 95% CI: 1.009-1.046) and prior HIV voluntary counseling and testing (VCT) (OR = 1.535, 95% CI: 1.240-1.899) were positively associated with willingness, whereas greater healthcare-related concerns were negatively associated with it (OR = 0.983, 95% CI: 0.975-0.990). College education (OR = 1.542, 95% CI: 1.233-1.928) and higher income (≥ 6,001 CNY: OR = 1.349, 95% CI: 1.003-1.814) were positively associated. Compared with highly developed regions, MSM in moderately developed regions showed lower odds of willingness to disclose (OR = 0.607, 95% CI: 0.491-0.750). Subgroup analyses indicated that social support was more influential in less developed regions, while privacy- and discrimination-related concerns were more salient in moderately developed regions.

Conclusions: Requiring contact disclosure to access free self-testing can create inequitable barriers. Equity-oriented implementation should: (1) strengthen self-efficacy through peer-led practice and prompts; (2) reduce healthcare-related concerns via privacy-by-design (data minimization, transparent data-use, anonymous pickup); and (3) leverage HIV testing infrastructure. Moderately developed regions warrant priority attention given systematically lower willingness to disclose.

Background: WIC program offers critical nutritional support for low-income families, enrollment and benefit utilization remain suboptimal among eligible immigrant and refugee participants. Understanding the unique challenges they face is essential to improving access, equity, and the effectiveness of WIC services.

Methods: This qualitative study used in-depth interviews to explore the experiences and perceptions of WIC participation among refugee and immigrant families. The study was conducted across communities in Northern Utah and included 25 participants recruited through WIC clinics, community organizations, and social media. Interviews focused on participants' experiences with WIC enrollment, benefit utilization, and their suggestions for program improvement, including issues related to program awareness, navigation challenges, cultural relevance, and recommendations for enhancing access and support. All interviews were transcribed, translated as needed, and analyzed thematically using NVivo 14.

Results: Three main themes emerged: i) Enrollment and Awareness: participants primarily enrolled due to financial need, often through personal networks. ii) Challenges in Utilization: language barriers, transportation, WIC card difficulties, and limited culturally appropriate food options were common. iii) Suggestions for Improvement: participants recommended enhanced multilingual support, culturally flexible food choices, stronger outreach, transportation, and improved education on benefit use.

Conclusion and implications: Addressing structural and cultural barriers through targeted education, language services, and inclusive support systems and policies can enhance WIC participation and promote equity. Future research should explore the long-term impacts of these efforts and the factors that influence sustained program utilization.

The evidence of oral disease burden and their impact on lives and livelihoods is overwhelming. The architecture and process to develop a coherent, consistent and mutually reinforcing approach for the management of dental caries exists through the WHO strategy and action plan. To successfully address equity and integration issues, the oral healthcare community must address the disconnect between advocacy, education, practice and caries management remuneration, finding agreement through negotiation and common ground between all stakeholder groups. Framing and aligning oral and dental health priorities within broader general health and development goals can foster a more resilient and cohesive response to both protracted and emerging challenges.