International Journal for Equity in Health最新文献

Background: The Western biomedical system, rooted in colonialism, holds Western science as the only universally valid knowledge system. While it has been justified as an objective approach to improve health, it has failed to address health inequities for Indigenous communities. There is increasing recognition of the need to decolonise healthcare, but its practical application remains unclear. This study systematically reviewed global literature to explore what decolonising healthcare means in practice.

Methods: A systematic search of published and grey literature was conducted across CINAHL, Embase, PubMed, Scopus, Google and reference lists for studies on decolonising health services for Indigenous peoples. Two reviewers independently screened and extracted data from eligible studies. Quality was appraised using the Joanna Briggs Institute's tool for systematic reviews and the Consolidated Criteria for health research involving Indigenous peoples. Data analysis and presentation followed an inductive thematic approach, refined through discussions with authors and external members who identify as Indigenous community members.

Results: Fifteen studies from Canada, Australia, Aotearoa (New Zealand), the United States, Chile, and South Africa met the inclusion criteria, all reporting qualitative data. Key elements of decolonising healthcare included community governance, holistic care, relationality and trust, storytelling, reflexive practice, and colonisation-informed care. These were underpinned by cultural, ontological, axiological, and epistemic equity, along with shared power, essential for their decolonial nature. Studies identified barriers and facilitators to decolonising healthcare, reflecting broader structural factors. Reported outcomes included increased patient satisfaction, empowerment, and trust in services.

Conclusion: Decolonising healthcare requires acknowledging colonialism within healthcare systems and fostering medical encounters with equity between Western and Indigenous ways of knowing, being, and doing. Genuine community-informed partnerships and leadership from Indigenous communities are essential for developing and evaluating services aligned with Indigenous health, well-being, and healing paradigms.

Registration: PROSPERO ID: CRD42024495407.

Background: During the COVID-19 pandemic, the rapid deployment of digital health technologies (DHTs), exemplified by the Health Code, quickly integrated many older adults, many of whom lacked digital readiness, into the digital society. This accelerated integration revealed a range of challenges faced by older adults in using DHTs. To effectively implement digital epidemic control measures while meeting the daily needs of the elderly, the Chinese government needs to adopt pragmatic policy responses to bridge the digital health divide.

Objective: This study investigates the barriers faced by older adults in using the Health Code and other DHTs during the COVID-19 pandemic, analyzes the policy measures implemented by the government to address these barriers, and summarizes China's practical experiences in promoting digital health equity.

Methods: This study employed a multi-method qualitative research design, sequentially combining individual interviews and document analysis to comprehensively explore the research questions. Guided by the Unified Theory of Acceptance and Use of Technology, semi-structured interviews were conducted with 23 older adults residing in rural areas of Zhejiang Province to explore the factors that hinder their use of the Health Code and other DHTs. Informed by the Digital Health Equity Thematic Framework, framework analysis was applied to 92 policy documents to analyze governmental responses addressing these barriers. Finally, the results of the individual interviews and document analysis were integrated to achieve a comprehensive understanding of the barriers faced by older adults and the corresponding policy measures addressing them.

Results: The interviews identified three major themes influencing older adults' use of DHTs: Preparedness, Receptiveness, and Willingness, along with nine sub-themes. In response to these barriers, the government introduced a series of policy measures targeting five domains: Individual, Community/Social, Systems, Policy, and DHTs. By integrating the results from both phases of the study, we identified three user types based on technology-related barriers- non-users, conditional users, and independent users- and summarized three categories of policy tools: alternative-based tools, nudge-based tools, and boost-based tools.

Conclusions: China's experience offers two key insights for advancing global digital health equity: first, assessing disparities in access, use, and benefits is essential to develop tailored, differentiated policy measures for diverse user groups; second, establishing a multi-stakeholder governance system, facilitated by the "3 C" framework (Create, Co-design, Collaborate), can promote collaboration and co-creation of inclusive digital health solutions.

Despite growing international consensus on the importance of addressing health inequities, the concept of health equity continues to evolve in its definition, relevance, and application across global contexts. While its prominence in international discourse and strategic frameworks has grown, the ways in which health equity is interpreted, prioritised, and operationalised within health-related organisations remain uneven and insufficiently examined. We conducted a qualitative exploratory study, using in-depth semi-structured interviews with representatives (n = 16) from public health authorities, non-governmental organisations, and academic institutions in Switzerland to explore divergent understandings, current initiatives, perceived challenges, and success measures related to health equity. We conducted Thematic Analysis (TA), supported by NVivo software. We identified four overarching themes: conceptual understandings of health equity, framing health equity in organisational discourse and strategy, challenges in operationalising health equity, and strategies to better implement health equity. The main findings reinforce that advancing health equity is not merely a technical challenge but a deeply political and relational one. Shared language should be accompanied by structural alignment; measurement should be enabled by meaningful data; and vision should be grounded in long-term, collaborative practice. Institutions that succeed in health equity do so not because of isolated actions, but because of a consistent, system-wide commitment. Operationalising health equity requires continuous professional reflexivity and strong local networks to address structural barriers and evolving disparities with flexible, ongoing action. In the absence of political continuity, robust metrics, and actionable data, health equity risks tend to be deprioritised. Embedding equity into routine practice and making its impact visible is critical to sustained progress.

Sudan is the only country in North Africa that is yet to reform its family law embodied by the Personal Status Act for Muslims of 1991. This law legalises child marriage, contradicts the National Child Act of 2010 that outlaws child marriage. This study aimed to understand how the pluralistic legal system in Sudan affects the occurrence and circumstances of child marriage in Kassala State in the context of the current war, to inform future advocacy efforts to ban child marriage. Thirteen key informants were interviewed in Kassala state and at the national level, complemented by one focus group discussion (FGD) at national level. In Kassala state, seven FGDs and eight in-depth interviews were held with young people who married as children and with parents whose children married under 18 years. Data were transcribed and coded, after which thematic analysis was undertaken. The findings affirm that child marriage is a commonplace practice, often justified by religion, driven by financial incentives and the on-going war. The closure of schools since 2023, abuses of girls by armed forces, and growing financial precarity are prompting parents to marry their daughters early. Community informants displayed a lack of awareness regarding the laws around child marriage and the legal minimum age of marriage. Contradictions between the laws create confusion and leave room for different interpretations, which are influenced by religion and social norms, further complicating the legal landscape. Although mazons (local marriage registrars) are mandated to follow civil law, they officiate underage marriages to conform to 'local culture', due to parental pressure, or because of false age certificates presented by families. Previous legal reform efforts failed to create consensus among religious hardliners and activists. Sudan's pluralistic legal system has institutionalised gender inequality and legitimised the culturally accepted practice of child marriage. A future post-war recovery period might provide a window of opportunity for law reform. Sudan could build on successful strategies used by neighbouring countries to reform the family law. Policy and legal reform need to be accompanied by broader social and economic change, including advances in gender equality, to address child marriage in Sudan.

Background: In Germany, about 17% of households speak a non-German language, yet the absence of national guidelines in language-discordant encounters leaves hospitals to address these challenges individually. The impact of language barriers on cancer care in Germany also remains understudied. This study investigates the role of language barriers in the patient experiences of breast cancer patients and the influence of hospital and regional linguistic diversity on these measures.

Methods: Data were collected in 2022 from 4,822 breast cancer patients treated in 86 hospitals. The Cologne Patient Questionnaire measured unmet information needs and communication experiences. Linguistic diversity of hospitals was categorized by the proportion of non-native speaking patients. Multilevel logistic regression models were estimated, adjusting for sociodemographic (education, age, health insurance) and clinical variables (staging, surgery type, chemotherapy).

Results: Despite generally high average German proficiency, non-native speaking patients reported significantly greater unmet information needs regarding their disease and treatment compared with German native speakers, aligning with research in English-speaking countries. In hospitals with higher linguistic diversity, the negative association of non-native language status appeared reduced, with non-native patients reporting more favorable interactions with staff.

Conclusion: Language barriers remain a critical but under-recognized determinant of cancer care quality in Germany. In the absence of standardized protocols for care of patients with language barriers, hospitals treating more linguistically diverse populations appear better equipped to navigate these challenges. These results point to an urgent need for national standards and targeted hospital-based strategies that systematically address language discordance, support guideline implementation, and promote equitable oncology care.