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Interrogating the effectiveness of service engagement for underserved populations in complex health and social care systems: towards an equitable engagement strategy. 在复杂的医疗和社会护理系统中,探讨为服务不足人群提供服务的有效性:制定公平参与战略。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-03 DOI: 10.1186/s12939-024-02272-7
Brídín Carroll, Kieran Walsh

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

在卫生和社会医疗系统中,越来越多的部门努力让那些有生活经验的人参与到服务设计、提供和监督中来,目的是确保更公平的健康结果。然而,在国家全系统参与战略如何考虑到在复杂的多层次系统中遭遇排斥的人群所经历的挑战方面,仍然存在重大的知识差距。这包括未能界定各群体面临的共同挑战,以及未能制定可转移的跨群体框架来协助整个部门的变革。因此,存在着这样一种危险,即那些已经最不被倾听的群体将被集体抛在后面。为了给爱尔兰更具包容性的参与战略提供信息,这项全国性研究旨在调查影响五类人群参与的多层次(政策和战略、运营、现场服务、个人)共同挑战,这些人群被确定为在复杂的医疗和社会护理系统中得不到充分服务的群体,包括:(1)滥用药物和酒精者;(2)无家可归者;(3)精神疾病患者;(4)移民和少数民族;以及(5)爱尔兰游民。本研究采用了一种混合方法,借鉴了以证据为依据的多利益相关者视角,采用的数据来自:与有生活经验的人群(人数=136)进行的焦点小组和生命历程访谈、与特定人群服务提供者进行的五个焦点小组(人数=39)和一项全国在线调查(人数=320);以及国家级利益相关者访谈(人数=9)。与生活经验参与者和服务提供者(人数=28)举办了两次跨群体参与式协商论坛,以根据研究结果共同制定优先行动领域。本文介绍了这些群体在领导力与承诺、实施与行动、人口能力、信任、代表权、污名化和歧视等方面所面临的共同挑战。根据这些挑战,本文提出了六个发展领域,以推进爱尔兰的包容性公平参与方法。这些领域包括:1)平衡自上而下的优先次序和自下而上的方向;2)持续开展多层次、多形式的实施工作;3)衡量成效和行动;4)嵌入包容性公平参与;5)将信任作为先决条件和成果;以及 6)平等化、机构赋权议程。
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引用次数: 0
Revisiting a decade of inequality in healthcare financial burden in Cambodia, 2009-19: trends, determinants and decomposition. 重新审视 2009-19 年柬埔寨医疗财务负担不平等的十年:趋势、决定因素和分解。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-30 DOI: 10.1186/s12939-024-02257-6
Adélio Fernandes Antunes, Theepakorn Jithitikulchai, Juergen Hohmann, Steffen Flessa

Background: Out-of-pocket healthcare expenditure (OOPHE) without adequate social protection often translates to inequitable financial burden and utilization of services. Recent publications highlighted Cambodia's progress towards Universal Health Coverage (UHC) with reduced incidence of catastrophic health expenditure (CHE) and improvements in its distribution. However, departing from standard CHE measurement methods suggests a different storyline on trends and inequality in the country.

Objective: This study revisits the distribution and impact of OOPHE and its financial burden from 2009-19, employing alternative socio-economic and economic shock metrics. It also identifies determinants of the financial burden and evaluates inequality-contributing and -mitigating factors from 2014-19, including coping mechanisms, free healthcare, and OOPHE financing sources.

Methods: Data from the Cambodian Socio-Economic Surveys of 2009, 2014, and 2019 were utilized. An alternative measure to CHE is proposed: Excessive financial burden (EFB). A household was considered under EFB when its OOPHE surpassed 10% or 25% of total consumption, excluding healthcare costs. A polychoric wealth index was used to rank households and measure EFB inequality using the Erreygers Concentration Index. Inequality shifts from 2014-19 were decomposed using the Recentered Influence Function regression followed by the Oaxaca-Blinder method. Determinants of financial burden levels were assessed through zero-inflated ordered logit regression.

Results: Between 2009-19, EFB incidence increased from 10.95% to 17.92% at the 10% threshold, and from 4.41% to 7.29% at the 25% threshold. EFB was systematically concentrated among the poorest households, with inequality sharply rising over time, and nearly a quarter of the poorest households facing EFB at the 10% threshold. The main determinants of financial burden were geographic location, household size, age and education of household head, social health protection coverage, disease prevalence, hospitalization, and coping strategies. Urbanization, biased disease burdens, and preventive care were key in explaining the evolution of inequality.

Conclusion: More efforts are needed to expand social protection, but monitoring those through standard measures such as CHE has masked inequality and the burden of the poor. The financial burden across the population has risen and become more unequal over the past decade despite expansion and improvements in social health protection schemes. Health Equity funds have, to some extent, mitigated inequality over time. However, their slow expansion and the reduced reliance on coping strategies to finance OOPHE could not outbalance inequality.

背景:自付医疗费用(OOPHE)如果没有足够的社会保障,往往会导致不公平的经济负担和服务利用率。最近的出版物强调了柬埔寨在实现全民医保(UHC)方面取得的进展,灾难性医疗支出(CHE)的发生率有所下降,其分配情况也有所改善。然而,与标准的灾难性医疗支出测量方法不同,柬埔寨的灾难性医疗支出趋势和不平等现象却呈现出不同的面貌:本研究采用其他社会经济和经济冲击指标,重新审视了 2009-19 年期间海外医疗支出的分布和影响及其财务负担。本研究还确定了财政负担的决定因素,并评估了 2014-19 年间导致和缓解不平等的因素,包括应对机制、免费医疗保健和 OOPHE 的资金来源:方法:利用 2009 年、2014 年和 2019 年柬埔寨社会经济调查的数据。方法:利用 2009 年、2014 年和 2019 年柬埔寨社会经济调查的数据:过度经济负担(EFB)。当一个家庭的OOPHE超过总消费(不包括医疗费用)的10%或25%时,该家庭就被视为经济负担过重。我们使用多变量财富指数对家庭进行排序,并使用 Erreygers 集中指数衡量 EFB 的不平等程度。使用重定向影响函数回归法和 Oaxaca-Blinder 法对 2014-19 年的不平等变化进行了分解。经济负担水平的决定因素通过零膨胀有序对数回归进行评估:2009-19年间,在10%的临界值下,EFB发生率从10.95%上升到17.92%,在25%的临界值下,EFB发生率从4.41%上升到7.29%。经济负担有系统地集中在最贫困家庭中,不平等程度随着时间的推移急剧上升,在 10%临界值时,近四分之一的最贫困家庭面临经济负担。经济负担的主要决定因素包括地理位置、家庭规模、户主年龄和教育程度、社会医疗保障覆盖率、疾病流行率、住院治疗情况以及应对策略。城市化、偏重疾病负担和预防性保健是解释不平等演变的关键因素:需要做出更多努力来扩大社会保护,但通过 CHE 等标准措施来监测这些措施掩盖了不平等和贫困人口的负担。在过去十年中,尽管社会医疗保障计划有所扩大和改善,但人口的经济负担却在增加,而且变得更加不平等。随着时间的推移,健康公平基金在一定程度上缓解了不平等现象。然而,这些基金的扩展速度缓慢,而且减少了对应对战略的依赖,以资助海外高等教育,但这并不能抵消不平等现象。
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引用次数: 0
Intersectionality matters for hispanic health: A replication study using the All of Us Research Program. 交叉性对西班牙裔健康至关重要:利用 "我们所有人 "研究计划开展的一项复制研究。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-30 DOI: 10.1186/s12939-024-02280-7
Mariana Rodrigues, Emma Risner, Brennan Rhodes-Bratton, Stephanie H Cook, Adolfo Cuevas

Background: Despite research dedicated to understanding the health profiles and health-related outcomes of Hispanic individuals, the prevailing body of literature frequently homogenizes the Hispanic population, failing to address the role of race in Hispanic health discourse. Thus, the current study applies an intersectional lens to identify health differences and similarities among Hispanic subgroups.

Methods: Sociodemographic characteristics and health domain variables (i.e., health status, health services, and health behaviors) from participants (N = 11,192) were included in the analyses. Bivariate Chi-squared tests examined the relationship between sociodemographic and health domain variables Black Hispanic individuals, white Hispanic individuals, and non-Hispanic Black individuals.

Results: Findings suggest that Non-Hispanic Black American individuals reported the highest rates of hypertension (49.09%) and diabetes (19.62%) compared to Black-Hispanic individuals (22.45% and 12.98%) and white Hispanic individuals (22.22% and 8.02%). Black Hispanic individuals reported the greatest proportion of asthma diagnoses (35.10%) and those who saw a doctor in the previous year (95.52%) compared to white Hispanic individuals (26.84%, and 91.10%, respectively) and non-Hispanic Black individuals ( 21.74%, and 94.69%, respectively).

Conclusion: Specifically, we found that several health behaviors and health-related outcomes significantly varied across different racial/ethnic groups, demonstrating the advantage of an intersectional approach to identify health disparities among racially diverse ethnic groups.

Public health significance: We encourage the development of health care services with an awareness of the complexities resulting from racial differences within the Hispanic diaspora.

背景:尽管有研究致力于了解西语裔个人的健康状况和与健康相关的结果,但主流文献经常将西语裔人口同质化,未能解决种族在西语裔健康讨论中的作用。因此,本研究采用交叉视角来识别西班牙裔亚群体之间的健康差异和相似性:分析包括参与者(人数 = 11,192)的社会人口特征和健康领域变量(即健康状况、健康服务和健康行为)。双变量卡方检验检验了社会人口学变量和健康领域变量之间的关系:西班牙裔黑人、西班牙裔白人和非西班牙裔黑人:研究结果表明,与西班牙裔黑人(22.45% 和 12.98%)和西班牙裔白人(22.22% 和 8.02%)相比,非西班牙裔美国黑人报告的高血压(49.09%)和糖尿病(19.62%)发病率最高。与西班牙裔白人(分别为 26.84% 和 91.10%)和非西班牙裔黑人(分别为 21.74% 和 94.69%)相比,西班牙裔黑人报告的哮喘诊断比例(35.10%)和前一年看过医生的比例(95.52%)最高:具体而言,我们发现不同种族/族裔群体的几种健康行为和健康相关结果存在显著差异,这表明采用交叉方法识别不同种族族裔群体之间的健康差异具有优势:公共卫生意义:我们鼓励在发展医疗保健服务时,认识到西班牙裔散居地的种族差异所带来的复杂性。
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引用次数: 0
Correction: Measuring health equity in the ASEAN region: conceptual framework and assessment of data availability. 更正:衡量东盟地区的卫生公平性:概念框架和数据可用性评估。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-29 DOI: 10.1186/s12939-024-02276-3
Capucine Barcellona, Yzabel Bryanna Mariñas, Si Ying Tan, Gabriel Lee, Khin Chaw Ko, Savina Chham, Chhea Chhorvann, Borwornsom Leerapan, Nam Pham Tien, Jeremy Lim
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引用次数: 0
"Nothing about us, without us": stakeholders perceptions on strategies to improve persons with disabilities' sexual and reproductive health outcomes in Ghana. "没有我们,就没有我们":利益攸关方对改善加纳残疾人性健康和生殖健康成果战略的看法。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-27 DOI: 10.1186/s12939-024-02269-2
Abdul-Aziz Seidu, Bunmi S Malau-Aduli, Kristin McBain-Rigg, Aduli E O Malau-Aduli, Theophilus I Emeto

Background: Persons with disabilities (PwDs) experience various adverse sexual and reproductive health (SRH) outcomes. However, there is a paucity of evidence on the strategies to improve their SRH outcomes. This study, therefore, used a pluralistic approach to explore PwDs and healthcare providers' (HPs) perspectives on how to improve the SRH of PwDs in Ghana.

Methods: In-depth interviews were conducted with 62 purposively selected stakeholders (37 PwDs and 25 HPs) in the Kumasi Metropolis and Offinso North District. The data was subjected to reflexive thematic analysis.

Results: Six major themes were generated from the data: Training for disability-sensitive and inclusive healthcare, Healthcare inclusivity - 'nothing about us, without us', Raising awareness for accessibility and equity, Impactful continuous monitoring and evaluation, Vital empowerment for self-reliance and Educating for disability-inclusive healthcare environment. These recommendations were synthesised to develop the THRIVE model-a comprehensive data driven framework from stakeholders that emphasises the importance of factors such as Training for disability-sensitive and inclusive healthcare, Healthcare inclusivity - 'nothing about us, without us', Raising awareness for accessibility and equity, Impactful continuous monitoring and evaluation, Vital empowerment for self-reliance and Enforcement of physical accessibility to improve their SRH outcomes.

Conclusion: Using the evidence based THRIVE model could facilitate the development and strengthening of existing interventions and policies including the disability Act 715 to improve the SRH access and outcomes of PwDs in Ghana and other low-and middle-income countries.

背景:残疾人的性健康和生殖健康(SRH)会出现各种不良后果。然而,有关改善其性健康和生殖健康结果的策略的证据却很少。因此,本研究采用多元化方法,探讨加纳残疾人和医疗保健提供者(HPs)对如何改善残疾人性健康和生殖健康的看法:在库马西大都会和奥芬索北区有目的地选择了 62 名利益相关者(37 名残疾人和 25 名医疗服务提供者)进行了深入访谈。对数据进行了反思性主题分析:结果:从数据中得出了六大主题:对残疾敏感和包容性医疗保健的培训、医疗保健的包容性--"没有我们,就没有我们"、提高对无障碍和公平性的认识、有影响力的持续监测和评估、自力更生的重要赋权以及对残疾人包容性医疗保健环境的教育。对这些建议进行综合后,开发出了 THRIVE 模型--一个由利益相关者提供的综合数据驱动框架,该框架强调了以下因素的重要性:培训对残疾问题有敏感认识的包容性医疗保健、医疗保健的包容性--"没有我们,就没有我们"、提高对无障碍和公平性的认识、有影响力的持续监测和评估、自力更生的重要赋权以及实施无障碍的实际环境,以改善他们的性健康和生殖健康成果:结论:使用以证据为基础的 THRIVE 模型可以促进制定和加强现有的干预措施和政策,包括第 715 号残疾法案,以改善加纳和其他中低收入国家的残疾人获得性健康和生殖健康服务的机会及结果。
{"title":"\"Nothing about us, without us\": stakeholders perceptions on strategies to improve persons with disabilities' sexual and reproductive health outcomes in Ghana.","authors":"Abdul-Aziz Seidu, Bunmi S Malau-Aduli, Kristin McBain-Rigg, Aduli E O Malau-Aduli, Theophilus I Emeto","doi":"10.1186/s12939-024-02269-2","DOIUrl":"https://doi.org/10.1186/s12939-024-02269-2","url":null,"abstract":"<p><strong>Background: </strong>Persons with disabilities (PwDs) experience various adverse sexual and reproductive health (SRH) outcomes. However, there is a paucity of evidence on the strategies to improve their SRH outcomes. This study, therefore, used a pluralistic approach to explore PwDs and healthcare providers' (HPs) perspectives on how to improve the SRH of PwDs in Ghana.</p><p><strong>Methods: </strong>In-depth interviews were conducted with 62 purposively selected stakeholders (37 PwDs and 25 HPs) in the Kumasi Metropolis and Offinso North District. The data was subjected to reflexive thematic analysis.</p><p><strong>Results: </strong>Six major themes were generated from the data: Training for disability-sensitive and inclusive healthcare, Healthcare inclusivity - 'nothing about us, without us', Raising awareness for accessibility and equity, Impactful continuous monitoring and evaluation, Vital empowerment for self-reliance and Educating for disability-inclusive healthcare environment. These recommendations were synthesised to develop the THRIVE model-a comprehensive data driven framework from stakeholders that emphasises the importance of factors such as Training for disability-sensitive and inclusive healthcare, Healthcare inclusivity - 'nothing about us, without us', Raising awareness for accessibility and equity, Impactful continuous monitoring and evaluation, Vital empowerment for self-reliance and Enforcement of physical accessibility to improve their SRH outcomes.</p><p><strong>Conclusion: </strong>Using the evidence based THRIVE model could facilitate the development and strengthening of existing interventions and policies including the disability Act 715 to improve the SRH access and outcomes of PwDs in Ghana and other low-and middle-income countries.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":null,"pages":null},"PeriodicalIF":4.5,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346133","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
The equity road ahead for financing non-national immunization program vaccines in China: challenges and opportunities from a qualitative study. 中国非国家免疫规划疫苗筹资的公平之路:定性研究中的挑战与机遇。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-27 DOI: 10.1186/s12939-024-02282-5
Mingzhu Jiang, Weixi Jiang, Xuanxuan Yan, Haifeng Ma, Sijuan Zhou, Xiaohua Ying

Background: In China, national immunization program (NIP) vaccines benefit from robust financial support and have achieved high coverage. Non-NIP vaccines rely on fragmented funding sources, mostly out-of-pocket payment, and face sub-optimal and inequitable coverage. Sustainable financing needs to be secured for addressing equity in non-NIP vaccine delivery. However, discussion and understanding of this issue remain limited. This study aims to analyze the current situation, comprehensively identify challenges and opportunities in non-NIP vaccine financing, and offer suggestions to enhance vaccine uptake and improve public health.

Methods: Between July and December 2023, we conducted a series of semi-structured, in-person interviews with 55 stakeholders from the Health Bureau, Centers for Disease Control and Prevention, Medical Insurance Bureau, and Finance Bureau across five provinces in China. Participants were selected through stratified sampling, and the interviews mainly included their involvement in non-NIP vaccine financing, challenges faced, and strategies for improvement to enhance financing performance. Informed consent was obtained, and thematic analysis was used to analyze the data.

Results: Non-NIP vaccine financing sources include out-of-pocket payments, government fiscal, health insurance and other external funds. These four channels differ in vaccine types covered, costs, and target populations, each with unique challenges and opportunities. High out-of-pocket costs remain a significant barrier to equitable vaccine uptake, while market competition has lowered the vaccine price and improved accessibility. Local fiscal support for free vaccination programs faces challenges related to sustainability and regional disparity, though governmental commitment to vaccination is growing. Nevertheless, centralized procurement organized by the government has lowered the price and reduced the financial burden. Despite legal restrictions on using basic health insurance for vaccinations and limited commercial insurance options, private medical savings accounts and mutual-aid mechanisms present new opportunities. Although the scope and impact of external support are limited, it has successfully increased awareness and social attention to vaccination.

Conclusion: Relying on individual payments as the main financing channel for non-NIP vaccines is unsustainable and inadequate for ensuring universal vaccine access. A concerted and synergistic approach is essential to ensure sufficient, sustainable resources and enhance public financial management to improve equity in the non-NIP vaccines.

背景:在中国,国家免疫规划(NIP)疫苗受益于强大的财政支持,实现了高覆盖率。非国家免疫规划疫苗则依赖于分散的资金来源,其中大部分为自费支付,并且面临着覆盖率不理想和不公平的问题。需要确保可持续的资金来源,以解决非国家免疫计划疫苗接种中的公平问题。然而,对这一问题的讨论和理解仍然有限。本研究旨在分析现状,全面确定非 NIP 疫苗融资的挑战和机遇,并为提高疫苗接种率和改善公共卫生提出建议:在 2023 年 7 月至 12 月期间,我们对来自中国五个省份的卫生局、疾病预防控制中心、医保局和财政局的 55 位利益相关者进行了一系列半结构化面谈。访谈内容主要包括他们参与非国家免疫规划疫苗筹资的情况、面临的挑战以及提高筹资绩效的改进策略。访谈获得了知情同意,并采用专题分析法对数据进行了分析:非 NIP 疫苗筹资渠道包括自费、政府财政、医疗保险和其他外部资金。这四种渠道的疫苗种类、成本和目标人群各不相同,每种渠道都面临着独特的挑战和机遇。高昂的自费费用仍然是阻碍疫苗公平接种的重要因素,而市场竞争则降低了疫苗价格,提高了疫苗的可及性。地方财政对免费疫苗接种计划的支持面临着可持续性和地区差异方面的挑战,尽管政府对疫苗接种的承诺正在增加。不过,政府组织的集中采购降低了价格,减轻了财政负担。尽管法律限制将基本医疗保险用于疫苗接种,而且商业保险选择有限,但私人医疗储蓄账户和互助机制带来了新的机遇。尽管外部支持的范围和影响有限,但它成功地提高了人们对疫苗接种的认识和社会关注度:依靠个人支付作为非国家免疫计划疫苗的主要融资渠道是不可持续的,也不足以确保疫苗的普及。必须采取协调一致的协同方法,确保充足、可持续的资源,并加强公共财政管理,以提高非国家免疫计划疫苗的公平性。
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引用次数: 0
Correction: A realist impact evaluation of a tool to strengthen equity in local government policy-making. 更正:对加强地方政府决策公平性的工具进行现实主义影响评估。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-26 DOI: 10.1186/s12939-024-02277-2
Sally Schultz, Felicity Beissmann, Christina Zorbas, Serene Yoong, Anna Peeters, Kathryn Backholer
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引用次数: 0
Un/met: a mixed-methods study on primary healthcare needs of the poorest population in Khyber Pakhtunkhwa province, Pakistan. 未/满足:关于巴基斯坦开伯尔-普赫图赫瓦省最贫困人口初级保健需求的混合方法研究。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-23 DOI: 10.1186/s12939-024-02274-5
Maira Shaukat, Alina Imping, Lisa Rogge, Fatima Khalid, Safat Ullah, Fayaz Ahmad, Zeeshan Kibria, Andreas Landmann, Zohaib Khan, Manuela De Allegri

Background: Access of all people to the healthcare they need, without financial hardship is the goal of Universal Health Coverage (UHC). As UHC initiatives expand, assessing the needs of vulnerable populations can reveal gaps in the system which may be covered by relevant policies. In this study we (i) identify the met and unmet primary healthcare needs of the poorest population of Khyber Pakhtunkhwa province (KP), Pakistan, and (ii) explore why the gaps exist.

Methods: We used Leveque's Framework of Patient-centred Access to Healthcare to examine unmet primary healthcare (PHC) needs and their underlying causes for the poorest population in four districts of Khyber Pakhtunkhwa province, Pakistan. Using a triangulation mixed methods design, we analysed data from a quantitative household survey of744 households, 17 focus group discussions with household members and, 11 interviews with healthcare providers.

Results: Our results show that indicate that despite service utilization, PHC needs were not met, primarily due to prohibitively high costs at each stage of access. Furthermore, gaps in outreach and information (approachability), and varying availability of medicines and diagnostics at facilities (appropriateness) the supply side as well as difficulties in navigating the system (inability to perceive) and adhering to prescriptions (inability to engage) on the demand side, also led to unmet PHC needs. Going beyond utilization, our findings highlight that engagement with care is an important determinant of met needs for vulnerable populations.

Conclusion: Social health protection policies can contribute to advancing UHC for primary care. However, in our setting, enhancing communication and outreach, addressing gender and age disparities, and improving quality of care and health infrastructure are necessary to fully meet the needs of the poorest populations.

背景:全民医保(UHC)的目标是让所有人都能在没有经济困难的情况下获得所需的医疗服务。随着 "全民医保 "倡议的扩大,对弱势群体需求的评估可以揭示相关政策可能覆盖的系统缺口。在本研究中,我们(i)确定了巴基斯坦开伯尔巴图克瓦省(KP)最贫困人口已满足和未满足的初级医疗保健需求,(ii)探讨了存在差距的原因:我们采用勒韦克的 "以患者为中心的医疗保健框架 "来研究巴基斯坦开伯尔巴图克瓦省四个地区最贫困人口未得到满足的初级医疗保健(PHC)需求及其根本原因。我们采用三角混合方法设计,分析了对 744 户家庭进行的定量家庭调查、与家庭成员进行的 17 次焦点小组讨论以及与医疗服务提供者进行的 11 次访谈所获得的数据:结果:我们的研究结果表明,尽管服务得到了利用,但初级保健服务的需求并未得到满足,这主要是由于每个阶段的就医费用过高。此外,供应方在外联和信息(可接近性)方面存在差距,医疗机构提供的药品和诊断方法(适当性)参差不齐,需求方在系统导航(无法感知)和遵守处方(无法参与)方面存在困难,也导致初级保健需求得不到满足。除了利用率之外,我们的研究结果还强调,参与医疗服务是满足弱势群体需求的一个重要决定因素:结论:社会健康保护政策有助于推进全民医保中的初级保健。然而,在我们的环境中,要充分满足最贫困人口的需求,就必须加强沟通和外联,解决性别和年龄差异问题,并提高医疗质量和改善医疗基础设施。
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引用次数: 0
Challenges and strategies for navigating Australian healthcare access: experience from Chinese international students 中国留学生在澳大利亚就医过程中遇到的挑战和应对策略
IF 4.8 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-19 DOI: 10.1186/s12939-024-02273-6
Qinglin Men, Wen Li, Asaduzzaman Khan, Robyn M. Gillies
Australia hosts over 680,000 international students, contributing $47.8 billion to the Australian economy in 2023, and Chinese students rank first among all nationalities. However, despite their considerable numbers, research focusing on their access to healthcare services is scant. This study aimed to explore barriers and supports regarding the utilisation of healthcare services among Chinese international students studying in Australia. Semi-structured interviews were conducted in Chinese between October and December 2023 with 25 Chinese international students (age range, 19–30; female/male, n = 18/7; undergraduate/postgraduate/doctoral, n = 1/18/6) enrolled in three Australian universities to understand the healthcare challenges they encountered and the coping strategies they recommended. These interviews were recorded, and thematic analysis was applied to the interview data. An adapted social-ecological model was used to identify barriers and pragmatic strategies to deal with the challenges at different levels. Chinese international students in Australia faced healthcare barriers at different levels. Individual barriers included language and cultural disparities, lack of knowledge about the healthcare system, and reluctance to seek help. Institutional barriers involved high costs, difficulties regarding appointments, and procedures related to the referral system. Policy barriers included insurance coverage and reimbursement issues. The students interviewed for this study proposed individual-level strategies, such as trying various methods to reduce language barriers, seeking information online, and using online resources and consultations. A central appointment platform and multilingual medical service were recommended from students to medical institutions, while medical service guidance and psychological support were suggested to education institutions. Higher-level strategies were also reported, which were mainly pertaining to insurance terms and coverage for overseas students and improving the accessibility of medical information. Our study identifies barriers to healthcare access for Chinese international students in Australia, including culture-specific challenges. To mitigate these issues, we recommend self-directed health promotion, targeted support by education institutions, enhanced cross-cultural communication and expanded telemedicine by hospitals, and attention to insurance coverage. Future research should explore optimising these approaches to improve support systems and policy frameworks.
澳大利亚有超过 68 万名留学生,2023 年将为澳大利亚经济贡献 478 亿澳元,而中国留学生在所有国籍学生中排名第一。然而,尽管中国留学生人数众多,有关他们获得医疗保健服务的研究却很少。本研究旨在探讨在澳大利亚留学的中国留学生在利用医疗保健服务方面遇到的障碍和支持。在2023年10月至12月期间,研究人员用中文对25名就读于澳大利亚三所大学的中国留学生(年龄在19-30岁之间;女性/男性,n=18/7;本科生/研究生/博士生,n=1/18/6)进行了半结构式访谈,以了解他们所遇到的医疗保健挑战以及他们所建议的应对策略。对这些访谈进行了记录,并对访谈数据进行了主题分析。我们采用了一个经过改编的社会生态模型来识别不同层面的障碍和应对挑战的实用策略。在澳大利亚的中国留学生面临着不同层面的医疗保健障碍。个人障碍包括语言和文化差异、对医疗系统缺乏了解以及不愿寻求帮助。机构障碍包括费用高昂、预约困难以及与转诊系统相关的程序。政策障碍包括保险范围和报销问题。为本研究接受访谈的学生提出了个人层面的策略,如尝试各种方法减少语言障碍、在线寻求信息、使用在线资源和咨询。学生向医疗机构推荐了中央预约平台和多语种医疗服务,向教育机构推荐了医疗服务指导和心理支持。此外,还报告了更高层次的策略,主要涉及海外学生的保险条款和覆盖范围,以及提高医疗信息的可及性。我们的研究发现了中国留学生在澳大利亚获得医疗服务的障碍,包括文化方面的特殊挑战。为缓解这些问题,我们建议开展自我健康促进活动,由教育机构提供有针对性的支持,加强跨文化交流,扩大医院的远程医疗服务,并关注保险范围。未来的研究应探讨如何优化这些方法,以改善支持系统和政策框架。
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引用次数: 0
Aboriginal families living with MJD in remote Australia: questions of access and equity 澳大利亚偏远地区患有轻度残疾的土著家庭:机会与公平问题
IF 4.8 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-18 DOI: 10.1186/s12939-024-02228-x
Libby Massey, John Gilroy, Emma Kowal, Denise Doolan, Alan Clough
Managing genetic disease using medically assisted reproductive technology is increasingly promoted as a feasible option, given revolutionary advances in genomics. Far less attention has been directed to the issue of whether there is equitable access to this option. Context and circumstance determine equitable access; however, reporting has drawn overwhelmingly from affluent Anglo-western populations in developed countries. The experiences of poorer, less educated subpopulations within affluent countries and populations in less developed countries are underreported. The ability of consumers to understand the opportunities and risks of medically assisted reproductive technology is likewise not well described in the literature despite significant technological complexity and evidence that genetic disease may be overrepresented within some disadvantaged population groups. Equity is achieved by identifying barriers and allocating appropriate resources to enable understanding and access. In the case of utilising medically assisted technology, social and power relationships, regulations, and the presumptions of authority figures and policymakers reduce equitable access. Physical or cultural marginalisation from mainstream health services may result in reduced access to genetic and prenatal testing, in-vitro fertilisation and genetic screening of embryos necessary for medically assisted reproduction. Cost and regulatory frameworks can likewise limit opportunities to engage with services. Moreover, the quality of the information provided to prospective users of the technology and how it is received governs understanding of prevention and inhibits adequately informed choice. Best practice care and adequately informed choice can only be achieved by conscientiously attending to these accessibility issues. Deep engagement with at-risk people and critical reflection on mainstream accepted standpoints is required. This paper outlines issues associated with engaging with medically assisted reproduction encountered by Aboriginal families living with Machado-Joseph Disease in some of the most remote areas of Australia. It is the right of these families to access such technologies regardless of where they live. Current barriers to access raise important questions for service providers with implications for practice as new technologies increasingly become part of standard medical care.
鉴于基因组学的革命性进步,利用医学辅助生殖技术治疗遗传疾病越来越被视为一种可行的选择。但人们对这种选择是否公平的问题关注较少。背景和环境决定了是否有公平的机会;然而,报道绝大多数来自发达国家富裕的盎格鲁-西方人口。富裕国家中较贫穷、受教育程度较低的亚人口群体以及欠发达国家人口的经历未得到充分报道。同样,尽管技术非常复杂,而且有证据表明遗传疾病在一些弱势群体中的发病率可能过高,但文献中对消费者了解医学辅助生殖技术的机会和风险的能力也没有很好的描述。要实现公平,就要找出障碍,分配适当的资源,使人们能够理解和利用。在利用医学辅助技术方面,社会和权力关系、法规以及权威人士和决策者的假定都会减少公平获取的机会。主流医疗服务的物质或文化边缘化可能会导致医疗辅助生殖所需的基因和产前检测、体外受精和胚胎基因筛查的机会减少。成本和监管框架同样会限制参与服务的机会。此外,提供给技术潜在用户的信息质量以及信息接收的方式也会影响对预防的理解,阻碍用户在充分知情的情况下做出选择。只有认真对待这些无障碍问题,才能实现最佳护理和充分知情的选择。需要与高危人群深入接触,并对主流认可的观点进行批判性反思。本文概述了澳大利亚一些最偏远地区患有马查多-约瑟夫氏病的土著家庭在参与医学辅助生殖过程中遇到的相关问题。无论居住在哪里,这些家庭都有权获得此类技术。随着新技术越来越多地成为标准医疗服务的一部分,目前的使用障碍为服务提供者提出了重要问题,并对实践产生了影响。
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引用次数: 0
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International Journal for Equity in Health
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