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Gender sensitivity of the COVID-19 mental health research in Europe: a scoping review. 欧洲 COVID-19 心理健康研究的性别敏感性:范围审查。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-10 DOI: 10.1186/s12939-024-02286-1
Mayte López-Atanes, Margarita Sáenz-Herrero, Nele Zach, Meret Lakeberg, Asier Ugedo, Elisa Fraile-García, Leire Erkoreka, Rafael Segarra, Ingo Schäfer, Tilman Brand

Background: The integration of sex and gender aspects into the research process has been recognized as crucial to the generation of valid data. During the coronavirus pandemic, a great deal of research addressed the mental state of hospital staff, as they constituted a population at risk for infection and distress. However, it is still unknown how the gender dimension was included. We aimed to appraise and measure qualitatively the extent of gender sensitivity.

Methods: In this scoping review, we searched MEDLINE, EMBASE, CINAHL PsycINFO and Social Sciences Citation Index (SSCI) from database inception to November 11, 2021. All quantitative studies with primary data published in English, German, or Spanish and based in the European Union were selected. Included studies had to have assessed the mental health of hospital staff using validated psychometric scales for depression, anxiety, PTSD symptoms, distress, suicidal behavior, insomnia, substance abuse or aggressive behavior. Two independent reviewers applied eligibility criteria to each title/abstract reviewed, to the full text of the article, and performed the data extraction. A gender sensitivity assessment tool was developed and validated, consisting of 18 items followed by a final qualitative assessment. Two independent reviewers assessed the gender dimension of each included article.

Results: Three thousand one hundred twelve studies were identified, of which 72 were included in the analysis. The most common design was cross-sectional (75.0%) and most of them were conducted in Italy (31.9%). Among the results, only one study assessed suicidal behaviors and none substance abuse disorders or aggressive behaviors. Sex and gender were used erroneously in 83.3% of the studies, and only one study described how the gender of the participants was determined. Most articles (71.8%) did not include sex/gender in the literature review and did not discuss sex/gender-related findings with a gender theoretical background (86.1%). In the analysis, 37.5% provided sex/gender disaggregated data, but only 3 studies performed advanced modeling statistics, such as interaction analysis. In the overall assessment, 3 papers were rated as good in terms of gender sensitivity, and the rest as fair (16.7%) and poor (79.2%). Three papers were identified in which gender stereotypes were present in explaining the results. None of the papers analyzed the results of non-binary individuals.

Conclusions: Studies on the mental health of hospital staff during the pandemic did not adequately integrate the gender dimension, despite the institutional commitment of the European Union and the gendered effect of the pandemic. In the development of future mental health interventions for this population, the use and generalizability of current evidence should be done cautiously.

背景:将性和性别因素纳入研究过程已被公认为是生成有效数据的关键。在冠状病毒大流行期间,大量研究涉及医院工作人员的精神状态,因为他们是有感染和痛苦风险的人群。然而,性别维度是如何被纳入其中的,至今仍是个未知数。我们旨在对性别敏感性的程度进行定性评估和测量:在此次范围界定综述中,我们检索了自数据库建立至 2021 年 11 月 11 日期间的 MEDLINE、EMBASE、CINAHL PsycINFO 和社会科学引文索引 (SSCI)。所有以英语、德语或西班牙语发表的、以欧盟为基地的、具有主要数据的定量研究均被选中。纳入的研究必须使用有效的心理测量量表对医院员工的心理健康进行评估,包括抑郁、焦虑、创伤后应激障碍症状、痛苦、自杀行为、失眠、药物滥用或攻击行为。两名独立审稿人对每篇审阅过的标题/摘要、文章全文采用资格标准,并进行数据提取。开发并验证了性别敏感性评估工具,该工具由 18 个项目组成,并进行了最终的定性评估。两位独立审稿人对每篇收录文章的性别维度进行了评估:结果:共确定了 312 项研究,其中 72 项被纳入分析。最常见的设计是横断面研究(75.0%),大部分研究在意大利进行(31.9%)。在研究结果中,只有一项研究对自杀行为进行了评估,没有一项研究对药物滥用障碍或攻击行为进行评估。83.3%的研究错误地使用了性别,只有一项研究描述了如何确定参与者的性别。大多数文章(71.8%)没有将性/性别纳入文献综述,也没有在性别理论背景下讨论与性/性别相关的研究结果(86.1%)。在分析中,37.5%的文章提供了按性别分列的数据,但只有 3 项研究进行了高级建模统计,如交互分析。在总体评估中,有 3 篇论文的性别敏感性被评为良好,其余为一般(16.7%)和较差(79.2%)。有三篇论文在解释结果时存在性别成见。没有一篇论文分析了非二元个体的结果:尽管欧盟在制度上做出了承诺,而且大流行病也对性别产生了影响,但有关大流行病期间医院员工心理健康的研究并未充分考虑性别因素。在未来针对这一人群制定心理健康干预措施时,应谨慎使用现有证据并将其普遍化。
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引用次数: 0
Translating restrictive law into practice: An ethnographic exploration of the systemic processing of legally restricted health care access for asylum seekers in Germany. 将限制性法律转化为实践:对德国依法限制寻求庇护者获得医疗服务的系统处理进行人种学探索。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-10 DOI: 10.1186/s12939-024-02251-y
Sandra Ziegler, Kayvan Bozorgmehr

Background: Access to health services for asylum seekers is legally restricted in Germany. The law is subject to interpretation, therefore the chance of receiving care is not equally distributed among asylum seekers. What services are provided to whom is ultimately decided by health professionals and government employees. The respective prioritization processes and criteria are not transparent. We sought to understand how legal restrictions are translated into daily practices and how this affects the health system. We aimed to outline the complex process of cost coverage for health services for asylum seekers and provide insights into common decision-making criteria.

Methods: We conducted an ethnographic exploration of routines in two outpatient clinics in two federal states over the course of three months, doing participant and non-participant observation. Additionally, we interviewed 21 professionals of health care and government organizations, and documented 110 applications for cost coverage of medical services and their outcome. In addition to qualitative data analysis and documentation, we apply a system-theoretical perspective to our findings.

Results: To perform legal restrictions a cross-sectoral prioritization process of medical services has been implemented, involving health care and government institutions. This changes professional practices, responsibilities and (power) relations. Involved actors find themselves at the intersection of several, oftentimes conflicting priorities, since "doing it right" might be seen differently from a legal, medical, economic, or political perspective. The system-theoretical analysis reveals that while actors have to bring different rationales into workable arrangements this part of the medical system transforms, giving rise to a sub-system that incorporates migration political rationales.

Conclusions: Health care restrictions for asylum seekers are implemented through an organizational linking of care provision and government administration, resulting in a bureaucratization of practice. Power structures at this intersection of health and migration policy, that are uncommon in other parts of the health system are thereby normalized. Outpatient clinics provide low-threshold access to health services, but paradoxically they may unintentionally stabilize health inequities, if prioritization criteria and power dynamics are not made transparent. Health professionals should openly reflect on conflicting rationales. Training, research and professional associations need to empower them to stay true to professional ethical principles and international conventions.

背景:在德国,寻求庇护者获得医疗服务受到法律限制。对法律的解释不一,因此寻求庇护者获得医疗服务的机会并不均等。向谁提供什么服务,最终由医疗专业人员和政府雇员决定。各自的优先程序和标准并不透明。我们试图了解法律限制是如何转化为日常实践的,以及这对医疗系统有何影响。我们的目的是概述为寻求庇护者提供医疗服务的复杂过程,并深入了解常见的决策标准:在三个月的时间里,我们对两个联邦州的两家门诊部的日常工作进行了人种学调查,并进行了参与式和非参与式观察。此外,我们还采访了 21 名医疗保健和政府机构的专业人士,并记录了 110 份医疗服务费用报销申请及其结果。除了定性数据分析和记录外,我们还从系统理论的角度进行了研究:结果:为了执行法律限制,实施了跨部门的医疗服务优先级排序程序,涉及医疗保健和政府机构。这改变了专业实践、责任和(权力)关系。由于从法律、医疗、经济或政治的角度来看,"正确行事 "可能会被视为不同的优先事项,因此参与其中的行动者发现自己处于多个优先事项的交叉点上,有时甚至是相互冲突的优先事项。系统理论分析表明,当行为者必须将不同的理由纳入可行的安排时,医疗系统的这一部分就会发生变化,产生一个包含移民政治理由的子系统:结论:对寻求庇护者的医疗限制是通过将医疗服务的提供与政府行政管理联系起来而实施的,这导致了实践的官僚化。在医疗保健与移民政策的交汇点上,权力结构被正常化,这在医疗保健系统的其他部分并不常见。门诊部提供了低门槛的医疗服务,但矛盾的是,如果不公开优先次序标准和权力动态,门诊部可能会无意中稳定医疗不平等。保健专业人员应公开反思相互冲突的理由。培训、研究和专业协会需要增强他们的能力,使他们能够忠实于职业道德原则和国际公约。
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引用次数: 0
Exploring cultural competence barriers in the primary care sexual and reproductive health centres in Catalonia, Spain: perspectives from immigrant women and healthcare providers. 探讨西班牙加泰罗尼亚地区初级保健性健康和生殖健康中心的文化能力障碍:移民妇女和医疗服务提供者的观点。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-09 DOI: 10.1186/s12939-024-02290-5
Jone G Lurgain, Hakima Ouaarab-Essadek, Khadija Mellouki, Sumaira Malik-Hameed, Andleed Sarif, Laia Bruni, Valentina Rangel-Sarmiento, Paula Peremiquel-Trillas

Background: Immigrant populations, especially women, continue facing challenges in accessing quality healthcare, particularly sexual and reproductive health services (SRH). Poor cultural competent health systems contribute to communication challenges between immigrant women and healthcare providers perpetuating health disparities. This exploratory study describes these communication barriers from the perspective of Moroccan and Pakistani immigrant women and healthcare providers within the Catalan health system and its implications to ensure an equitable provision of SRH services.

Methods: An exploratory-descriptive qualitative study was conducted in various municipalities of Barcelona with high concentration of immigrants. Eight focus groups (N = 51) and semi-structured interviews (N = 22) with Moroccan and Pakistani immigrant women were combined with key informant interviews (N = 13) with healthcare professionals. Thematic analysis and data triangulation were performed primarily using an inductive approach.

Results: Language barriers and cultural differences in health needs, expectations, care-seeking behaviours and understanding of quality healthcare provision hindered the ability of immigrant women and providers to interact effectively. Limited availability of intercultural mediators and inadequate cultural competence training opportunities for health staff were also identified. Findings suggest a lack of minority representation in the Catalan health workforce and leadership roles.

Conclusion: This study reinforces the evidence of persistent inequities in accessing healthcare among immigrant populations by focusing on the cultural competence barriers of the Catalan health system in the provision and access to SRH services. The regularization of adequately trained intercultural mediators, quality training in cultural competence for health staff and a commitment to increase workforce diversity would contribute to improve intercultural communication between immigrant patients and providers. An urgent call to action in this direction is needed to ensure an equitable access to SRH services among immigrant women.

背景:移民群体,尤其是妇女,在获得高质量的医疗保健,特别是性健康和生殖健康服务(SRH)方面仍然面临挑战。医疗系统的文化能力不足导致移民妇女与医疗服务提供者之间的沟通困难,从而使健康差异长期存在。这项探索性研究从摩洛哥和巴基斯坦移民妇女以及加泰罗尼亚医疗系统中医疗服务提供者的角度,描述了这些沟通障碍及其对确保公平提供性健康和生殖健康服务的影响:在移民高度集中的巴塞罗那各市进行了一项探索性描述定性研究。对摩洛哥和巴基斯坦移民妇女进行了 8 次焦点小组讨论(51 人)和半结构式访谈(22 人),并对医疗保健专业人员进行了关键信息提供者访谈(13 人)。主要采用归纳法进行专题分析和数据三角测量:语言障碍和文化差异在健康需求、期望、求医行为和对优质医疗服务的理解方面阻碍了移民妇女和医疗服务提供者进行有效互动的能力。此外,还发现跨文化调解员有限,医务人员的文化能力培训机会不足。研究结果表明,在加泰罗尼亚地区的医疗队伍和领导岗位中,缺乏少数民族代表:本研究通过关注加泰罗尼亚医疗系统在提供和获取性健康和生殖健康服务方面存在的文化能力障碍,进一步证实了移民人口在获取医疗服务方面长期存在的不公平现象。将训练有素的跨文化调解员正规化,对医务人员进行文化能力方面的优质培训,以及致力于提高劳动力的多样性,都将有助于改善移民患者与医疗服务提供者之间的跨文化交流。需要紧急呼吁在这方面采取行动,以确保移民妇女公平获得性健康和生殖健康服务。
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引用次数: 0
Making health inequality analysis accessible: WHO tools and resources using Microsoft Excel. 使健康不平等分析便于使用:世卫组织使用 Microsoft Excel 的工具和资源。
IF 5.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-09 DOI: 10.1186/s12939-024-02229-w
Katherine Kirkby, Daniel A Antiporta, Anne Schlotheuber, Ahmad Reza Hosseinpoor

Addressing health inequity is a central component of the Sustainable Development Goals and a priority of the World Health Organization (WHO). WHO supports countries in strengthening their health information systems in order to better collect, analyze and report health inequality data. Improving information and research about health inequality is crucial to identify and address the inequalities that lead to poorer health outcomes. Building analytical capacities of individuals, particularly in low-resource areas, empowers them to build a stronger evidence-base, leading to more informed policy and programme decision-making. However, health inequality analysis requires a unique set of skills and knowledge. This paper describes three resources developed by WHO to support the analysis of inequality data by non-statistical users using Microsoft Excel, a widely used and accessible software programme. The resources include a practical eLearning course, which trains learners in the preparation and reporting of disaggregated data using Excel, an Excel workbook that takes users step-by-step through the calculation of 21 summary measures of health inequality, and a workbook that automatically calculates these measures with the user's disaggregated dataset. The utility of the resources is demonstrated through an empirical example.

解决卫生不平等问题是可持续发展目标的核心内容,也是世界卫生组织(世卫组织)的优先事项。世卫组织支持各国加强卫生信息系统,以便更好地收集、分析和报告卫生不平等数据。改进有关卫生不平等的信息和研究对于确定和解决导致较差卫生结果的不平等问题至关重要。培养个人的分析能力,特别是在资源匮乏地区,可以增强他们的能力,建立更强大的证据基础,从而做出更明智的政策和计划决策。然而,健康不平等分析需要一套独特的技能和知识。本文介绍了世卫组织开发的三种资源,以支持非统计用户使用 Microsoft Excel(一种广泛使用且易于获取的软件程序)分析不平等数据。这些资源包括一个实用的电子学习课程,培训学习者如何使用Excel准备和报告分类数据;一个Excel工作手册,指导用户逐步计算21个卫生不平等汇总指标;以及一个工作手册,利用用户的分类数据集自动计算这些指标。这些资源的实用性将通过一个经验范例来展示。
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引用次数: 0
Evolving trends, regional differences, determinants, and disease sources of provincial-level health inequalities in china 1990-2019: a temporal convergence and novel triple decomposition analysis. 1990-2019年中国省级卫生不平等的演变趋势、地区差异、决定因素和疾病来源:时间趋同和新型三重分解分析。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-08 DOI: 10.1186/s12939-024-02283-4
Qingbo Wang, Jiawei Zhang, Zhihu Xu, Peng Yin, Maigeng Zhou, Li Yang, Ming Wu
<p><strong>Background: </strong>Promoting health equity has been a worldwide goal, but serious challenges remain globally and within China. Multiple decomposition of the sources and determinants of health inequalities has significant implications for narrowing health inequalities and improve health equity.</p><p><strong>Methods: </strong>Life expectancy (LE), healthy life expectancy (HALE), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life-year (DALY) rates in 31 provinces of mainland China were selected as health status indicators, obtained from the Global Burden of Disease (GBD) database. Temporal convergence analysis was used to test the evolving trends of health status. Dagum's Gini coefficient decomposition was used to decompose the overall Gini coefficient based on intraregional and interregional differences. Oaxaca-Blinder decomposition was used to calculate contributions of determinants to interregional differences. The factor-decomposed Gini coefficient was used to analyze the absolute and marginal contribution of each component to overall Gini coefficients.</p><p><strong>Results: </strong>From 1990-2019, China witnessed notable improvements in health status measured by LE, HALE, ASMR and age-standardized DALY rates.Nevertheless, the three regions (East, Central and West) exhibited significant inter-regional differences in health status, with the differences between the East and West being the largest. The adjusted short-term conditional β-convergence model indicated that the inter-provincial differences in LE, HALE, ASMR, and age-standardized DALY rates significantly converged at annual rates of 0.31%, 0.35%, 0.19%, and 0.28% over 30 years. The overall Gini coefficients of LE, HALE, and age-standardized DALY rates decreased, while the ASMR exhibited an opposite trend. Inter-regional and intra-regional differences accounted for >70% and <30% of overall Gini coefficients, respectively. Attribution analysis showed that socioeconomic determinants explained 85.77% to 91.93% of the eastern-western differences between 2010-2019, followed by health system determinants explaining 7.79% to 11.61%. The source-analysis of Gini coefficients of ASMR and age-standardized DALY rates revealed that noncommunicable diseases (NCDs) made the largest and increasing absolute contribution, while communicable, maternal, neonatal, and nutritional diseases (CMNNDs) had a diminishing and lower impact. However, NCDs exerted a negative marginal effect on the Gini coefficient, whereas CMNNDs exhibited a positive marginal effect, indicating that controlling CMNNDs may be more effective in reducing health inequities.</p><p><strong>Conclusions: </strong>Regional differences are a major source of health inequities in China. Prioritizing prevention and control of CMNNDs, rather than NCDs, may yield more pronounced impacts on reducing health inequalities from the perspective of marginal effect, although NCDs remain the largest absolute c
背景:促进健康公平一直是世界性的目标,但全球和中国仍面临严峻挑战。对健康不平等的来源和决定因素进行多重分解,对缩小健康不平等和改善健康公平具有重要意义:从全球疾病负担(GBD)数据库中选取了中国大陆 31 个省份的预期寿命(LE)、健康预期寿命(HALE)、年龄标准化死亡率(ASMR)和年龄标准化残疾调整生命年(DALY)率作为健康状况指标。采用时间收敛分析来检验健康状况的演变趋势。采用达古姆基尼系数分解法,根据地区内和地区间差异对总体基尼系数进行分解。Oaxaca-Blinder 分解法用于计算决定因素对地区间差异的贡献。分解后的基尼系数用于分析各组成部分对总体基尼系数的绝对贡献和边际贡献:然而,东、中、西部三个地区在健康状况方面表现出显著的地区间差异,其中东西部之间的差异最大。调整后的短期条件 β-收敛模型表明,30 年间,LE、HALE、ASMR 和年龄标准化 DALY 率的省际差异以 0.31%、0.35%、0.19% 和 0.28% 的年率显著收敛。LE、HALE 和年龄标准化 DALY 率的总体基尼系数有所下降,而 ASMR 则呈现出相反的趋势。地区间和地区内差异分别占 70% 和 70% 以上:地区差异是中国健康不公平的主要根源。尽管非传染性疾病仍是造成健康不平等的最大绝对因素,但从边际效应的角度看,优先预防和控制慢性非传染性疾病而不是非传染性疾病可能会对减少健康不平等产生更明显的影响。
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引用次数: 0
Process evaluation of a breastfeeding support intervention to promote exclusive breastfeeding and reduce social inequity: a mixed-methods study in a cluster-randomised trial. 促进纯母乳喂养和减少社会不平等的母乳喂养支持干预的过程评估:分组随机试验中的混合方法研究。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-08 DOI: 10.1186/s12939-024-02295-0
Henriette Knold Rossau, Anne Kristine Gadeberg, Katrine Strandberg-Larsen, Ingrid Maria Susanne Nilsson, Sarah Fredsted Villadsen

Background: Breastfeeding is a powerful public health intervention that produces long-term health benefits. However, in high-income countries such as Denmark, breastfeeding rates are suboptimal and unequally distributed across socio-economic positions. The 'Breastfeeding - a good start together' intervention, to promote longer duration of exclusive breastfeeding and reduce social inequity, was implemented in a cluster-randomised trial during 2022-2023 across 21 municipalities in two Danish regions. A process evaluation was conducted to assess the implementation, mechanisms of impact, and possible contextual factors affecting the intervention.

Methods: The study was guided by the Medical Research Council's guidance for conducting process evaluations and employed a mixed-methods approach in a convergence design. Quantitative data: contextual mapping survey (n = 20), health visitor survey (n = 284), health visitor records from 20 clusters and intervention website statistics. Qualitative data: dialogue meetings (n = 7), focus groups (n = 3) and interviews (n = 8).

Results: Overall, the intervention was delivered as planned to intended recipients, with few exceptions. Health visitors responded positively to the intervention, noting that it fitted well within their usual practice and enhanced families' chances of breastfeeding. Mothers expressed having received the intervention with few exceptions, and reacted positively to the intervention. Although health visitors were concerned about the potential stigmatisation of mothers receiving the intensified intervention, none of the interviewed mothers felt stigmatised. Contextual factors impacting the intervention implementation and mechanisms included staff and management turnover, project infrastructure and mothers' context, such as resources, social networks and previous experiences. The overall fidelity of the intervention delivery was high.

Conclusions: Health visitors and families responded well to the intervention. Interventions aimed at enabling health care providers to deliver simplified and structured breastfeeding support, in alignment with support provided in other sectors of the health care system, may increase breastfeeding rates and reduce social inequity in breastfeeding, even in international contexts.

Trial registration: Clinical Trials: NCT05311631. First posted April 5, 2022.

背景母乳喂养是一项强有力的公共卫生干预措施,可产生长期的健康益处。然而,在丹麦等高收入国家,母乳喂养率并不理想,而且在不同社会经济地位的人群中分布不均。为了延长纯母乳喂养的持续时间并减少社会不平等现象,丹麦于 2022-2023 年期间在丹麦两个地区的 21 个城市实施了 "母乳喂养--共同的良好开端 "干预措施。为评估干预措施的实施情况、影响机制以及可能的环境因素,进行了一项过程评估:该研究以医学研究委员会关于开展过程评估的指南为指导,采用了混合方法的聚合设计。定量数据:情境图调查(n = 20)、健康访视者调查(n = 284)、20 个群组的健康访视者记录和干预网站统计数据。定性数据:对话会议(n = 7)、焦点小组(n = 3)和访谈(n = 8):总体而言,干预措施按计划提供给了预期对象,只有少数例外。保健访视员对干预措施反应积极,指出干预措施非常适合她们的常规做法,并提高了家庭母乳喂养的机会。除少数例外情况外,母亲们都表示接受了干预措施,并对干预措施反应积极。尽管健康访视员担心接受强化干预的母亲可能会被污名化,但受访的母亲中没有人感到被污名化。影响干预措施实施和机制的环境因素包括工作人员和管理人员的更替、项目基础设施和母亲的环境,如资源、社会网络和以往的经验。干预实施的整体忠实度很高:结论:健康访视者和家庭对干预措施反应良好。即使在国际环境下,旨在使医疗保健提供者能够提供简化和结构化的母乳喂养支持的干预措施,与医疗保健系统其他部门提供的支持相一致,可能会提高母乳喂养率并减少母乳喂养中的社会不公平现象:临床试验:试验注册:临床试验:NCT05311631。首次发布于 2022 年 4 月 5 日。
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引用次数: 0
Disparities in healthcare-seeking behaviors and associated costs between Venezuelan migrants and Colombians residing in Colombia. 居住在哥伦比亚的委内瑞拉移民和哥伦比亚人在就医行为和相关费用方面的差异。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-07 DOI: 10.1186/s12939-024-02289-y
Priya Agarwal-Harding, Brielle Ruscitti, Donald S Shepard, Arturo Harker Roa, Diana M Bowser

Background: Colombia, which hosts over 3 million of the Venezuelan diaspora, is lauded for its progressive approach to social integration, including providing migrants access to its universal health coverage system. However, barriers to healthcare persist for both migrant and host populations, with poorly understood disparities in healthcare-seeking behaviors and associated costs. This is the first study to link healthcare-seeking behaviors with costs for Venezuelan migrants in Colombia, encompassing costs of missing work or usual activities due to healthcare events.

Methods: We use self-reported survey data from Venezuelan migrants and Colombians living in Colombia (September-November 2020) to compare healthcare-seeking behaviors and cost variables by nationality using two-sampled t-tests or Chi-square tests (X2). The International Classification of Diseases was used to compare reported household illnesses for both populations. Average health service direct costs were estimated using the Colombian Government's Suficiencia database and self-reported out-of-pocket (OOP) payments for laboratory and pharmacy services. Indirect costs were calculated by multiplying self-reported days of missed work or usual activities with estimated income levels, derived by matching characteristics using the Gran Enquesta Integrada de Hogares database. We calculate economic burdens for both populations, combining self-reported healthcare-seeking behaviors and estimated healthcare service unit costs across six healthcare-seeking behavior categories.

Results: Despite similar disease profiles, Venezuelan migrants are 21.3% more likely to forego formal care than Colombians, with 746.3% more Venezuelans reporting lack of health insurance as their primary reason. Venezuelan women and uninsured report the greatest difficulties in accessing health services, with accessing medications becoming more difficult for Venezuelan women during the COVID-19 pandemic. Colombians cost the health system more per treated illness event (US$40) than Venezuelans (US$26) in our sample, over a thirty-day period. Venezuelans incur higher costs for emergency department visits (123.5% more) and laboratory/ pharmacy OOP payments (24.7% more).

Conclusions: While Colombians and Venezuelans share similar disease burdens, significant differences exist in access, cost, and health-seeking behaviors. Increasing Venezuelan health insurance enrollment and tackling accessibility barriers are crucial for ensuring healthcare equity and effectively integrating the migrant population. Findings suggest that improving migrant access to primary healthcare would produce savings in Colombian healthcare expenditures.

背景:哥伦比亚接纳了 300 多万委内瑞拉侨民,因其在社会融合方面的进步而备受赞誉,其中包括为移民提供全民医保系统。然而,移民和侨民在获得医疗保健服务方面仍然存在障碍,人们对他们在寻求医疗保健服务的行为和相关费用方面的差异知之甚少。这是第一项将在哥伦比亚的委内瑞拉移民的医疗保健行为与成本联系起来的研究,包括因医疗保健事件而错过工作或日常活动的成本:我们使用居住在哥伦比亚的委内瑞拉移民和哥伦比亚人的自我报告调查数据(2020 年 9 月至 11 月),使用双抽样 t 检验或卡方检验 (X2) 比较不同国籍的医疗保健寻求行为和成本变量。国际疾病分类用于比较两种人群报告的家庭疾病。利用哥伦比亚政府的 Suficiencia 数据库以及化验室和药房服务的自付(OOP)费用估算平均医疗服务直接成本。间接成本的计算方法是,将自报的误工天数或日常活动天数与估计收入水平相乘,估计收入水平是通过使用 Gran Enquesta Integrada de Hogares 数据库匹配特征得出的。我们结合自我报告的就医行为和六个就医行为类别的医疗服务单位成本估算,计算出这两个人群的经济负担:尽管疾病谱相似,但委内瑞拉移民放弃正规医疗服务的可能性比哥伦比亚人高出 21.3%,而委内瑞拉移民表示缺乏医疗保险是其主要原因的人数比哥伦比亚人多出 746.3%。委内瑞拉妇女和无保险者在获得医疗服务方面遇到的困难最大,在 COVID-19 大流行期间,委内瑞拉妇女获得药物变得更加困难。在我们的样本中,哥伦比亚人在 30 天内每次治疗疾病的花费(40 美元)高于委内瑞拉人(26 美元)。委内瑞拉人在急诊室就诊的费用(高出 123.5%)和实验室/药房的自付费用(高出 24.7%)更高:结论:哥伦比亚人和委内瑞拉人的疾病负担相似,但在就医途径、费用和就医行为方面存在显著差异。提高委内瑞拉人的医疗保险参保率和解决就医障碍对于确保医疗公平和有效整合流动人口至关重要。研究结果表明,改善移民获得初级医疗保健的机会将节省哥伦比亚的医疗保健支出。
{"title":"Disparities in healthcare-seeking behaviors and associated costs between Venezuelan migrants and Colombians residing in Colombia.","authors":"Priya Agarwal-Harding, Brielle Ruscitti, Donald S Shepard, Arturo Harker Roa, Diana M Bowser","doi":"10.1186/s12939-024-02289-y","DOIUrl":"10.1186/s12939-024-02289-y","url":null,"abstract":"<p><strong>Background: </strong>Colombia, which hosts over 3 million of the Venezuelan diaspora, is lauded for its progressive approach to social integration, including providing migrants access to its universal health coverage system. However, barriers to healthcare persist for both migrant and host populations, with poorly understood disparities in healthcare-seeking behaviors and associated costs. This is the first study to link healthcare-seeking behaviors with costs for Venezuelan migrants in Colombia, encompassing costs of missing work or usual activities due to healthcare events.</p><p><strong>Methods: </strong>We use self-reported survey data from Venezuelan migrants and Colombians living in Colombia (September-November 2020) to compare healthcare-seeking behaviors and cost variables by nationality using two-sampled t-tests or Chi-square tests (X<sup>2</sup>). The International Classification of Diseases was used to compare reported household illnesses for both populations. Average health service direct costs were estimated using the Colombian Government's Suficiencia database and self-reported out-of-pocket (OOP) payments for laboratory and pharmacy services. Indirect costs were calculated by multiplying self-reported days of missed work or usual activities with estimated income levels, derived by matching characteristics using the Gran Enquesta Integrada de Hogares database. We calculate economic burdens for both populations, combining self-reported healthcare-seeking behaviors and estimated healthcare service unit costs across six healthcare-seeking behavior categories.</p><p><strong>Results: </strong>Despite similar disease profiles, Venezuelan migrants are 21.3% more likely to forego formal care than Colombians, with 746.3% more Venezuelans reporting lack of health insurance as their primary reason. Venezuelan women and uninsured report the greatest difficulties in accessing health services, with accessing medications becoming more difficult for Venezuelan women during the COVID-19 pandemic. Colombians cost the health system more per treated illness event (US$40) than Venezuelans (US$26) in our sample, over a thirty-day period. Venezuelans incur higher costs for emergency department visits (123.5% more) and laboratory/ pharmacy OOP payments (24.7% more).</p><p><strong>Conclusions: </strong>While Colombians and Venezuelans share similar disease burdens, significant differences exist in access, cost, and health-seeking behaviors. Increasing Venezuelan health insurance enrollment and tackling accessibility barriers are crucial for ensuring healthcare equity and effectively integrating the migrant population. Findings suggest that improving migrant access to primary healthcare would produce savings in Colombian healthcare expenditures.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"202"},"PeriodicalIF":4.5,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390364","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
Navigating HIV research among criminalized gender minority populations in Uganda: qualitative insights and lessons learned from novice researchers. 在乌干达被定罪的性别少数群体中开展艾滋病研究:研究新手的定性见解和经验教训。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-07 DOI: 10.1186/s12939-024-02294-1
Patience A Muwanguzi, Racheal Nabunya, Tom D Ngabirano

Background: Transgender individuals often face stigma, discrimination, and various forms of abuse, which negatively impact their mental and physical health. They face a significantly greater risk of HIV, with a higher prevalence than the general population. Despite these challenges, transgender people have limited access to healthcare due to violence, legal barriers, and societal stigma, further exacerbated in countries like Uganda, where transgender identities are criminalized. Therefore, this study explored the lived experiences of HIV researchers working with gender minority populations in criminalizing contexts.

Methods: This was an interpretative phenomenological analysis (IPA) qualitative study. Twelve (12) research team members at all levels were involved in the study. Participants had less than five years of involvement in HIV research among gender minority populations. Data were collected using field notes, reflective journals, documentation from daily team debriefing sessions, and semi-structured interviews. The analysis used NVivo software.

Results: Positive experiences, barriers, and challenges were captured. The positive experiences were 'respecting cultural diversity', 'expanding networks', 'addressing misconceptions' and 'finding allies'. The barriers included 'experiencing stigma', 'lengthy research processes', 'feeling isolated', 'fearing for personal safety', 'unexpected logistical costs', and 'criminalization of sexual and gender minorities'. The key themes that emerged from the lessons learned were: 'dealing with gatekeepers', 'diversity and sensitivity training', 'leveraging networks', 'meaningful community engagement', 'reflexivity', 'ensuring safety', 'equal partnership', 'giving feedback' and 'awareness of legal implications'.

Conclusions: This study highlights the importance of cultural sensitivity, community engagement, and reflexivity in research design and implementation. The findings emphasize the need for innovative strategies to navigate legal, social, and logistical barriers that researchers and participants face. Despite these challenges, the study demonstrates that meaningful collaboration with community members and building trust can significantly enhance the research process and outcomes. Future research should continue to explore these strategies while addressing ethical and safety concerns.

背景:变性人经常面临污名化、歧视和各种形式的虐待,这对他们的身心健康造成了负面影响。他们感染艾滋病毒的风险更大,发病率高于普通人群。尽管存在这些挑战,但由于暴力、法律障碍和社会污名,变性人获得医疗保健的机会有限,而在乌干达等国家,变性人身份被定为犯罪,这进一步加剧了变性人获得医疗保健的机会。因此,本研究探讨了在定罪背景下为性别少数群体工作的艾滋病研究人员的生活经历:这是一项解释性现象分析(IPA)定性研究。十二(12)名各级研究团队成员参与了这项研究。参与者参与性别少数群体艾滋病研究的时间不到五年。数据收集采用了现场笔记、反思日记、团队每日汇报会记录和半结构化访谈。分析使用了 NVivo 软件:结果:收集到了积极的经验、障碍和挑战。积极经验包括 "尊重文化多样性"、"扩大网络"、"消除误解 "和 "找到盟友"。障碍包括 "遭遇污名化"、"研究过程冗长"、"感到孤立"、"担心人身安全"、"意外的后勤成本 "以及 "性少数群体和性别少数群体被定罪"。从经验教训中总结出的关键主题包括与看门人打交道"、"多样性和敏感性培训"、"利用网络"、"有意义的社区参与"、"反思"、"确保安全"、"平等伙伴关系"、"反馈 "和 "法律意识":本研究强调了文化敏感性、社区参与和反思性在研究设计和实施中的重要性。研究结果强调,需要采取创新战略来克服研究人员和参与者面临的法律、社会和后勤障碍。尽管存在这些挑战,但本研究表明,与社区成员开展有意义的合作并建立信任,可以大大加强研究过程和成果。未来的研究应继续探索这些策略,同时解决伦理和安全问题。
{"title":"Navigating HIV research among criminalized gender minority populations in Uganda: qualitative insights and lessons learned from novice researchers.","authors":"Patience A Muwanguzi, Racheal Nabunya, Tom D Ngabirano","doi":"10.1186/s12939-024-02294-1","DOIUrl":"https://doi.org/10.1186/s12939-024-02294-1","url":null,"abstract":"<p><strong>Background: </strong>Transgender individuals often face stigma, discrimination, and various forms of abuse, which negatively impact their mental and physical health. They face a significantly greater risk of HIV, with a higher prevalence than the general population. Despite these challenges, transgender people have limited access to healthcare due to violence, legal barriers, and societal stigma, further exacerbated in countries like Uganda, where transgender identities are criminalized. Therefore, this study explored the lived experiences of HIV researchers working with gender minority populations in criminalizing contexts.</p><p><strong>Methods: </strong>This was an interpretative phenomenological analysis (IPA) qualitative study. Twelve (12) research team members at all levels were involved in the study. Participants had less than five years of involvement in HIV research among gender minority populations. Data were collected using field notes, reflective journals, documentation from daily team debriefing sessions, and semi-structured interviews. The analysis used NVivo software.</p><p><strong>Results: </strong>Positive experiences, barriers, and challenges were captured. The positive experiences were 'respecting cultural diversity', 'expanding networks', 'addressing misconceptions' and 'finding allies'. The barriers included 'experiencing stigma', 'lengthy research processes', 'feeling isolated', 'fearing for personal safety', 'unexpected logistical costs', and 'criminalization of sexual and gender minorities'. The key themes that emerged from the lessons learned were: 'dealing with gatekeepers', 'diversity and sensitivity training', 'leveraging networks', 'meaningful community engagement', 'reflexivity', 'ensuring safety', 'equal partnership', 'giving feedback' and 'awareness of legal implications'.</p><p><strong>Conclusions: </strong>This study highlights the importance of cultural sensitivity, community engagement, and reflexivity in research design and implementation. The findings emphasize the need for innovative strategies to navigate legal, social, and logistical barriers that researchers and participants face. Despite these challenges, the study demonstrates that meaningful collaboration with community members and building trust can significantly enhance the research process and outcomes. Future research should continue to explore these strategies while addressing ethical and safety concerns.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"201"},"PeriodicalIF":4.5,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390369","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
Biological and contextual determinants of early development in marginalized Roma communities: A research protocol of the RomaREACH study. 边缘化罗姆社区早期发展的生物和环境决定因素:RomaREACH 研究的研究方案。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-05 DOI: 10.1186/s12939-024-02287-0
Shoshana Chovan, Daniela Fiľakovská Bobáková, Andrea Madarasová Gecková, Beáta Hubková, Gabriela Štrkolcová, Sijmen A Reijneveld, Marlou L A de Kroon

Background: The period of early childhood bears significant importance from the lifespan perspective. Children from marginalized Roma communities face several risk factors that endanger their early development. Based on the gaps in available evidence, the aim of the RomaREACH research project (Research on Early Childhood in marginalized Roma communities) is, therefore, to explore the complex mechanisms influencing psychomotor development in the first 3 years of a child's life in marginalized Roma communities, and to translate and adapt instruments for measuring development and parenting in marginalized Roma communities and assess their psychometric qualities and suitability METHODS: The project comprises two parts. The first part is a validation study of the translated Caregiver-Reported Early Development Instrument (CREDI) and the Comprehensive Early Childhood Parenting Questionnaire (CECPAQ), tools for the assessment of early development and of parenting strategies and practices. The second part is a longitudinal cohort study, in which the relationships of risk and protective factors with development are explored.

Discussion: The RomaREACH project is a multicomponent study of social determinants of health and development in early childhood that can provide new evidence on the relationship of risk and protective factors with early development. Such young children from difficult-to-reach marginalized Roma communities are rarely included in research, and information about the scope and the extent of inequities in health and development in the period of early childhood is scarce. The expected results of the RomaREACH project have the potential to influence policy and practice by providing validated tools and evidence-based insights that can help mitigate the developmental risks faced by children in marginalized Roma communities and contribute to improving developmental outcomes and equity.

背景:从生命周期的角度来看,幼儿期具有重要意义。边缘化罗姆社区的儿童面临着一些危及其早期发展的风险因素。因此,基于现有证据的不足,RomaREACH 研究项目(边缘化罗姆社区幼儿期研究)的目标是探索影响边缘化罗姆社区儿童生命最初 3 年精神运动发展的复杂机制,翻译和改编用于衡量边缘化罗姆社区儿童发展和养育情况的工具,并评估其心理测量质量和适用性 方法:该项目包括两个部分。第一部分是对翻译后的 "照顾者报告早期发展工具"(CREDI)和 "幼儿养育综合问卷"(CECPAQ)进行验证研究,这两个工具是评估早期发展和养育策略与实践的工具。第二部分是一项纵向队列研究,探讨风险和保护因素与发展之间的关系:讨论:罗姆人教育、研究和教育项目(REACH)是一项关于幼儿期健康和发展的社会决定因素的多成分研究,可以为风险和保护因素与早期发展的关系提供新的证据。这些来自难以接触到的边缘化罗姆社区的幼儿很少被纳入研究范围,有关幼儿期健康和发展不平等的范围和程度的信息也很少。RomaREACH 项目的预期成果有可能影响政策和实践,提供经过验证的工具和以证据为基础的见解,帮助减轻边缘化罗姆社区儿童面临的发展风险,促进改善发展成果和公平。
{"title":"Biological and contextual determinants of early development in marginalized Roma communities: A research protocol of the RomaREACH study.","authors":"Shoshana Chovan, Daniela Fiľakovská Bobáková, Andrea Madarasová Gecková, Beáta Hubková, Gabriela Štrkolcová, Sijmen A Reijneveld, Marlou L A de Kroon","doi":"10.1186/s12939-024-02287-0","DOIUrl":"10.1186/s12939-024-02287-0","url":null,"abstract":"<p><strong>Background: </strong>The period of early childhood bears significant importance from the lifespan perspective. Children from marginalized Roma communities face several risk factors that endanger their early development. Based on the gaps in available evidence, the aim of the RomaREACH research project (Research on Early Childhood in marginalized Roma communities) is, therefore, to explore the complex mechanisms influencing psychomotor development in the first 3 years of a child's life in marginalized Roma communities, and to translate and adapt instruments for measuring development and parenting in marginalized Roma communities and assess their psychometric qualities and suitability METHODS: The project comprises two parts. The first part is a validation study of the translated Caregiver-Reported Early Development Instrument (CREDI) and the Comprehensive Early Childhood Parenting Questionnaire (CECPAQ), tools for the assessment of early development and of parenting strategies and practices. The second part is a longitudinal cohort study, in which the relationships of risk and protective factors with development are explored.</p><p><strong>Discussion: </strong>The RomaREACH project is a multicomponent study of social determinants of health and development in early childhood that can provide new evidence on the relationship of risk and protective factors with early development. Such young children from difficult-to-reach marginalized Roma communities are rarely included in research, and information about the scope and the extent of inequities in health and development in the period of early childhood is scarce. The expected results of the RomaREACH project have the potential to influence policy and practice by providing validated tools and evidence-based insights that can help mitigate the developmental risks faced by children in marginalized Roma communities and contribute to improving developmental outcomes and equity.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"200"},"PeriodicalIF":4.5,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11453050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142377887","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
Perceived discrimination and refraining from seeking physician's care in Sweden: an intersectional analysis of individual heterogeneity and discriminatory accuracy (AIHDA). 在瑞典,感知到的歧视与拒绝就医:对个体异质性和歧视准确性(AIHDA)的交叉分析。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-10-05 DOI: 10.1186/s12939-024-02291-4
Mariam Hassan, Johan Öberg, Maria Wemrell, Raquel Perez Vicente, Martin Lindström, Juan Merlo

Background: Discrimination may further impede access to medical care for individuals in socially disadvantaged positions. Sociodemographic information and perceived discrimination intersect and define multiple contexts or strata that condition the risk of refraining from seeking physician's care. By applying analysis of individual heterogeneity and discriminatory accuracy (AIHDA) we aimed to improve the mapping of risk by considering both strata average risk differences and the accuracy of such strata risks for distinguishing between individuals who did or did not refrain from seeking physician's care.

Methods: We analysed nine annual National Public Health Surveys (2004, 2007-2014) in Sweden including 73,815 participants. We investigated the risk of refraining from seeking physician's care across 64 intersectional strata defined by sex, education, age, country of birth, and perceived discrimination. We calculated strata-specific prevalences and prevalence ratios (PR) with 95% confidence intervals (CI), and the area under the receiver operating characteristic curve (AUC) to evaluate the discriminatory accuracy (DA).

Results: Discriminated foreign-born women aged 35-49 with a low educational level show a six times higher risk (PR = 6.07, 95% CI 5.05-7.30) than non-discriminated native men with a high educational level aged 35-49. However, the DA of the intersectional strata was small (AUC = 0.64). Overall, discrimination increased the absolute risk of refraining from seeking physician's care, over and above age, sex, and educational level.

Conclusions: AIHDA disclosed complex intersectional inequalities in the average risk of refraining from seeking physician's care. This risk was rather high in some strata, which is relevant from an individual perspective. However, from a population perspective, the low DA of the intersectional strata suggests that potential interventions to reduce such inequalities should be universal but tailored to the specific contextual characteristics of the strata. Discrimination impairs access to healthcare.

背景:歧视可能会进一步阻碍处于社会弱势地位的个人获得医疗服务。社会人口信息和感知到的歧视相互交织,并定义了多种环境或阶层,这些环境或阶层决定了拒绝寻求医生治疗的风险。通过应用个体异质性和判别准确性分析(AIHDA),我们旨在考虑各阶层的平均风险差异以及这些阶层风险在区分是否拒绝就医的个体方面的准确性,从而改进风险图谱:我们分析了瑞典的九次年度国家公共卫生调查(2004 年、2007-2014 年),其中包括 73,815 名参与者。我们调查了根据性别、教育程度、年龄、出生国家和感知到的歧视界定的 64 个交叉阶层中拒绝就医的风险。我们计算了特定阶层的患病率和患病率比(PR)以及 95% 的置信区间(CI),并计算了接收者操作特征曲线下的面积(AUC),以评估判别准确性(DA):与未受歧视的 35-49 岁高学历本地男性相比,受歧视的 35-49 岁低学历外国出生女性的风险高出六倍(PR = 6.07,95% CI 5.05-7.30)。然而,交叉层的DA很小(AUC = 0.64)。总体而言,歧视增加了拒绝就医的绝对风险,超过了年龄、性别和教育水平的影响:AIHDA揭示了拒绝就医的平均风险中复杂的交叉不平等现象。在某些阶层,这种风险相当高,这与个人角度有关。然而,从人口的角度来看,交叉阶层的低DA表明,减少这种不平等的潜在干预措施应具有普遍性,但应根据各阶层的具体背景特征量身定制。歧视影响了医疗保健的获得。
{"title":"Perceived discrimination and refraining from seeking physician's care in Sweden: an intersectional analysis of individual heterogeneity and discriminatory accuracy (AIHDA).","authors":"Mariam Hassan, Johan Öberg, Maria Wemrell, Raquel Perez Vicente, Martin Lindström, Juan Merlo","doi":"10.1186/s12939-024-02291-4","DOIUrl":"10.1186/s12939-024-02291-4","url":null,"abstract":"<p><strong>Background: </strong>Discrimination may further impede access to medical care for individuals in socially disadvantaged positions. Sociodemographic information and perceived discrimination intersect and define multiple contexts or strata that condition the risk of refraining from seeking physician's care. By applying analysis of individual heterogeneity and discriminatory accuracy (AIHDA) we aimed to improve the mapping of risk by considering both strata average risk differences and the accuracy of such strata risks for distinguishing between individuals who did or did not refrain from seeking physician's care.</p><p><strong>Methods: </strong>We analysed nine annual National Public Health Surveys (2004, 2007-2014) in Sweden including 73,815 participants. We investigated the risk of refraining from seeking physician's care across 64 intersectional strata defined by sex, education, age, country of birth, and perceived discrimination. We calculated strata-specific prevalences and prevalence ratios (PR) with 95% confidence intervals (CI), and the area under the receiver operating characteristic curve (AUC) to evaluate the discriminatory accuracy (DA).</p><p><strong>Results: </strong>Discriminated foreign-born women aged 35-49 with a low educational level show a six times higher risk (PR = 6.07, 95% CI 5.05-7.30) than non-discriminated native men with a high educational level aged 35-49. However, the DA of the intersectional strata was small (AUC = 0.64). Overall, discrimination increased the absolute risk of refraining from seeking physician's care, over and above age, sex, and educational level.</p><p><strong>Conclusions: </strong>AIHDA disclosed complex intersectional inequalities in the average risk of refraining from seeking physician's care. This risk was rather high in some strata, which is relevant from an individual perspective. However, from a population perspective, the low DA of the intersectional strata suggests that potential interventions to reduce such inequalities should be universal but tailored to the specific contextual characteristics of the strata. Discrimination impairs access to healthcare.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"199"},"PeriodicalIF":4.5,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11452949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375403","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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