Community health equity research & policy最新文献

The primary objective of this research was to describe the prevalence of violence against older adults according to sexual orientation as documented in the Notifiable Diseases Information System (SINAN) in Brazil. SINAN is a national database that compiles violence-related notifications reported by healthcare services. This ecological study analyzed aggregated data at the population level, focusing on violence notifications involving individuals aged 50 and above from 2017 to 2021. The data underwent descriptive and bivariate statistical analyses, adhering to a significance level of 5%. The completeness percentage of the sexual orientation variable ranged from 70% to 72%. Our analysis detected noteworthy disparities in the distribution of violence notifications based on sexual orientation. Specifically, lesbians had the highest incidence rates of physical violence compared to heterosexual and bisexual women. In a broader context, women demonstrated a higher susceptibility to psychological violence, with bisexual women experiencing a notably elevated prevalence (41.67%). Reports of physical and psychological violence differed based on contextual variables, such as race, education level, and geographic region. We hereby conclude that the disparities found in violence notifications underscore a troubling situation faced by older adults within the LGB community, with a particular emphasis on the challenges encountered by bisexual individuals. Improving cultural competence in health systems is essential to enhancing data collection and understanding the complexities of violence against this population.

BackgroundThe 'Guidelines on Midwifery Services Initiative, 2018' introduces the Nurse Practitioner in Midwifery (NPM) cadre to improve maternal mortality rates, quality of care, and reduce overmedicalisation in the Indian public health system. The paper examines how the NPM cadre is envisioned in the guidelines, positioned within the medical hierarchy, and aligned within the existing maternal health context. It also looks at how existing midwives and midwifery advocates perceive the changes introduced and the accompanying professionalisation process.MethodologyThe study employed two methods: (a) qualitative document analysis (QDA) of the midwifery guidelines and (b) semi-structured in-depth interviews with 14 nurse-midwifery leaders and advocates.FindingsThe QDA uncovers the underlying themes of task shifting and institutional deliveries as dominant, discussions on professional autonomy and primary health care receiving less importance and even less reflection on the history of midwifery in India. The interview findings highlight (a) tensions around carving out a separate profession, (b) the implications of midwifery at the primary healthcare level and (c) the need for an enabling environment for midwives. This paper reveals how the guidelines frame midwifery as a cost-effective, specialised nursing care within the institutional delivery framework and distanced from its traditional connotations.DiscussionIt elucidates tensions around autonomous midwifery involving professional boundaries, negotiations with medical professionals, institutional perceptions, and historical stereotypes. It builds on the broader literature on 'professions' in sociology by identifying aspects of 'professional boundary work' embedded in policy documents and experiences of participants - thereby unpacking the midwifery professionalisation process in the Indian context.

PurposeRacial disparities in homelessness are pervasive and necessitate sustained effort on improving racial equity in homeless services. This study used a community-engaged approach and qualitative methods to describe the role of informal organizations identified by Black adults with lived experience of homelessness as preferred locations for accessing services and to explore the values and beliefs of these informal organizations. The study included representatives (N = 19) of community organizations (N = 17) in one southern city. Most participants (n = 14, 73.6%) worked in paid positions and included executive directors as well as volunteers.FindingsThematic analysis identified three themes that characterized values and the ways in which these organizations interface with one another and with the formal homelessness response system (HRS): boots-on-the-ground, the homelessness response system is inequitable, and cautious collaboration. Findings reveal avenues through which local collaboration can be improved and potential policies to improve racial equity in homeless services.ConclusionsInformal organizations fill critical gaps in services and can reach people experiencing homelessness who are unable or unwilling to access formal services. However, informal organizations often remain disconnected from the larger HRS which can exacerbate racial inequities. Community care hubs are a promising solution to incorporating smaller organizations and building a more integrated and equitable HRS.

Objective: To describe the creation, deployment, and initial impact of a place-based, multi-level, multi-component initiative designed to prevent cardiovascular health disparities in high-risk neighborhoods in Indianapolis, Indiana. Methods: The Indianapolis Health Equity Access outReach & Treatment (iHEART) Collaborative uses a community-driven, place-based approach and leverages partnerships with local organizations, businesses, and residents to implement health screenings, educational outreach, and support for social determinants of health (SDOH). Results: From September 2022 - September 2024, iHEART conducted 4048 blood pressure screenings; 3135 in community settings. >38% of participants were identified as having Stage 1 hypertension or being at risk. 29% of 1219 individuals with elevated CVD risk were previously undiagnosed. 94.6% of 223 individuals referred for medical care completed follow-up care. Barbershop 2.0 screened 378 patrons, with 126 returning for additional screenings. >50% of these returning participants demonstrated improvements between their initial and follow-up screenings. The Convenient Home Evaluation for Cardiovascular Health and Individual Tracking (CHECK-IT) program enrolled 1105 patients; 63.9% achieved blood pressure control, or their last recorded blood pressure reading below 140/90 mmHg, by the end of the 4-month program. Conclusions: iHEART's approach highlights the potential benefits of combining health and SDOH interventions, offering a promising model for addressing health inequities.

Twenty years of existing medical literature speak to a global interest in interprofessional experiences and the role of community engagement in the formation of 21st century health professionals, with recent literature highlighting shortcomings in the ability to form satisfactory therapeutic alliances with patients of lower socioeconomic status. A paucity of literature regarding effective interventions to rectify these gaps in care remains. This manuscript reports the findings of a retrospective analysis of participant satisfaction with Programa Candeal, a previously un-evaluated interprofessional health education program at the Bahiana School of Medicine and Public Health in Salvador, Brazil, seeking to improve the capacity of health professional students to work successfully on interdisciplinary health care teams through hands-on experience interacting with disenfranchised populations outside of the traditional roles of provider and patient. Results of a mixed quantitative-qualitative survey reveal that Programa Candeal is successful in encouraging health professional students to practice community engagement, cultivates a literacy with the concept of multi professional teamwork, and promotes humanistic interactions with community members at some of the widest socioeconomic divides in Brazil. This manuscript also highlights the relative ease of implementing a semi-automated online evaluation protocol without undue administrative burden in a low-resource environment.

Background: Despite the previous success of a universal health care system, Sri Lanka is facing novel challenges including non-communicable diseases such as diabetes and cancer, an aging population, and most recently, the COVID-19 pandemic. Previous pandemic and disaster responses worldwide have centered local community approaches as crucial for effective solutions. However, there is a gap in the literature surrounding the role of community organizations in Sri Lanka's public health response. Purpose: This study investigates the role of community-based responses during the COVID-19 pandemic in Sri Lanka through the perspective of public health professionals and nongovernmental organization (NGO) affiliates. Research Design: The study is based on qualitative interviews and the antecedent literature review, used to triangulate the collected qualitative data.Study Sample: Ten interviews were conducted to gain an understanding of the role of community organizations in Sri Lanka's COVID-19 pandemic response from both those who work within the public health sector as well as community organizations that assisted with public health efforts. Results: Findings demonstrate that community organizations aided in the COVID-19 response through various forms of hands-on support, most commonly including fundraising and the provision of resources, food, safety equipment, and educational materials. In addition, community organizations' were most successful in navigating the pandemic climate when they communicated closely with communities, engaged in ongoing collaboration with the government, and used innovative strategies. Conclusion: We see this work as exploratory and important for informing future research on the Sri Lankan public health context. Our findings suggest that community organizations should not be overlooked in global public health contexts as they are often well positioned to combat arising public health issues through their unique networks and potential for new and creative solutions.

BackgroundThe nutritional health of tamariki (children) in Aotearoa New Zealand (NZ) is poor. Nourishing Hawke's Bay (NHB) began as an initiative to address this problem in low advantage regions of Hawke's Bay (HB) and evolved into the evaluation of Ka Ora. Ka Ako the free, healthy school lunch programme, and the scoping of wider improvements in the regional food ecosystem.PurposeThe aim of this paper is to describe how NHB co-designed and evaluated food interventions incorporating systems thinking and mātauranga Māori (traditional knowledge), as lenses through which to view the initiative.Study Sample and Research DesignCognitive mapping interviews (n = 11) with community health and education leaders identified six key co-design principles or Pou (metaphorical posts) for NHB.Data CollectionFurther systems methods, such as group model building and system dynamics modelling, and mātauranga Māori methods, such as wānanga (Māori learning forums), involved the community in food systems mapping and intervention co-design and prioritisation.ResultsThree Pou, 'food security,' 'mātauranga Māori' and 'children's hauora' (wellbeing), set the research agenda for NHB. the other three Pou, 'work with community,' 'cohesion and integration' and 'start with schools,' determined the subsequent research processes. Along with standard population evaluation methods (including quantitative and qualitative assessments of changes in student health and wellbeing), a participatory Value for Investment (VFI) analysis assessed return on investment.ConclusionsCombining systems thinking and mātauranga Māori is a novel, participatory approach co-creating pathways to improved nutrition and food security for tamariki and holds promise for wider food system changes in regional NZ.

There is a pressing need for research that prioritizes the inclusion of diverse communities in the alcohol research field. A community-engaged approach can lead to more sustainable approaches, enhance buy-in, and lead to actions that are more equitable. The Community Engagement Studio (CES) model, which facilitates discussions between researchers, community engagement coordinators, and community experts, is one structured method to support conducting community-engaged research. In our creative alcohol study, we utilized Collaborative Filmmaking (CF) - a participatory, visual research method - to explore structural and neighborhood effects on alcohol use. We applied the CES model to enhance our study with community input prior to launch, which is particularly important when applying novel methodologies. The CES discussion illuminated several topics for the research team to consider regarding research study logistics (e.g., filmmaking prompts, recruitment, filmmaking support) and how to approach the research topic of alcohol use (e.g., trauma, sensitivity). This allowed the research team to make critical adjustments to their approach to ensure the tools, data collection techniques, and recruitment methods were appropriate. Input from community experts also uncovered important considerations related to trauma, ethics, and trust, which are vital for creative, participatory health research. Overall, the CES served as a valuable model for fostering community dialogue and can be used to enhance the impact of creative research.

This study examines the work of a collective of community-based Indigenous health rights activists in southern Peru who, at the height of the pandemic, designed, recorded, and disseminated seven Quechua language and culturally tailored Public Service Announcements for radio broadcast to provide information about COVID-19 vaccines. The activists took initiative amid a dysfunctional vaccine roll-out, when vaccination rates in their region were among the lowest in the country, and when mortality rates from COVID-19 were very high. The experiences of the activist collective, including their participatory, community-based approach and their connections with health workers, demonstrate the importance of pre-existing, strong, respectful relationships between communities and health systems in times of public health crisis. This is not an easy task given that relationships between communities and Peru's government-run health system are complex and shaped by dynamics of power, including colonial legacies and contemporary injustices. This case critically reflects on the notion of resilience and provides insights into the enduring struggles by Indigenous activists to decolonize and strengthen the public health system by pushing for forms of community participation based on substantive partnerships with community-based actors that genuinely integrate their knowledge and expertise.

BackgroundWalkability is an important contributor to physical activity, aiding the prevention of chronic diseases. Decision makers rely on accurate, nuanced data to inform the planning of walkable communities. While objective walkability tools have variable capacity to predict walking behaviour, combining community perceptions with these tools can provide more nuanced insights, especially in areas of socioeconomic disadvantage. This study explored the potential to apply a citizen science approach to monitor and improve walkability of socially diverse neighbourhoods by understanding the perspectives of key decision makers and practitioners.MethodsInterviews with stakeholders from local councils, government health services, and a community volunteer group explored walkability in Western Sydney, including use and experiences of walkability assessment tools, and views on using citizen science for walkability monitoring and improvement. Data were analysed inductively using thematic analysis.ResultsParticipants saw a need to improve walkability in certain areas of Western Sydney, but identified insufficiencies with existing auditing tools. A citizen science approach was considered a promising means of capturing and addressing the multitude of factors influencing walkability, through its ability to provide nuanced and compelling local information. However, council staff had concerns about managing public expectations and attaining representation of the community's diversity. Participants provided insights for possible avenues of effective and meaningful engagement.ConclusionIf stakeholders' concerns are addressed and supported by policy commitment, the adoption of a citizen science approach has potential to bring considerable value to the monitoring and improvement of walkability in socially diverse localities.