Community health equity research & policy最新文献

Purpose: Racial 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.

Findings: Thematic 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.

Conclusions: Informal 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.

Background: There is a notable lack of evidence regarding the factors that shape the provision of essential healthcare services in post-conflict settings.

Purpose: This study aimed to explore and describe the factors influencing the provision of basic health care services for the most vulnerable populations in the Eastern Congo.

Method: Employing a qualitative research approach, twenty individual interviews with community members and thirteen focus group discussions were conducted. Participants were drawn from three geographically and demographically diverse locations with a history of decades-long armed conflicts in the Congo. Inductive thematic coding used the Health System Dynamics Framework categories (i.e. goals and outcomes, values and principles; service delivery; the population; the context; leadership & governance; and the organization of resources (finances; human resources; infrastructure and supplies; knowledge and information), while allowing for additional themes.

Results: Our findings are presented thematically according to these ten categories. The following factors were perceived as key areas enabling or hindering healthcare provision to the community: (1) the context for organizing basic healthcare service delivery is complex and challenging; (2) the population plays a crucial role as an active producer of health and potential change agents; (3) there is a poor strategic policy framework to guide local-level communities in the provision of basic healthcare services; (4) several critical barriers and facilitators related to effective healthcare service delivery were identified; (5) the classification of basic health service delivery methods to meet the healthcare needs of the vulnerable population; (6) the healthcare system is pluralistic and consists of multiple overlapping systems and providers; and (7) service providers and potential service users still consider access to basic healthcare services challenging, potentially resulting in reduced coverage.

Conclusion: These findings suggest that substantial changes in the factors contributing to the provision of basic healthcare services are necessary to ensure the delivery of basic healthcare services to the most vulnerable populations in the Eastern Congo. Consequently, there is a critical need to reconsider the healthcare delivery system, specifically addressing these contributing factors in the context of the Eastern Congo.

Introduction: The COVID-19 pandemic had a negative impact on populations worldwide, particularly on older adults residing in low - and middle-income countries. Due to these negative impacts, non-governmental organizations (NGOs) provided extensive support, which affected their operations.

Methods: Using the social resilience framework, the purpose of this study was to better understand what strategies NGOs used to support vulnerable populations and how they are building back stronger from the COVID-19 pandemic. In the fall of 2022, 26 (virtual) in-depth interviews were conducted with staff and volunteers from an NGO supporting older adults in Uganda.

Results: Several key themes emerged including using existing resources to better support older adults and staff and the importance of having multiple sources of revenue to support organizational operations.

Discussion: The key lessons learned by NGO staff and volunteers can be utilized to enact policy and practice change to help strengthen NGOs' social resilience. This would allow them to continue implementing innovative strategies to support vulnerable populations during times of crisis.

Youth-onset type 2 diabetes (T2D) is increasingly common and projected to impact over 200,000 adolescents and young adults by 2060. Youth with T2D frequently experience health-related social needs (HRSN) that increase their risk for poor outcomes. Using human-centered design methodology, we explored how best to address HRSN in pediatric endocrinology clinics. We conducted two parallel, six-session group meetings with youth (n = 4) and caregivers of youth (n = 6), as well as individual interviews with 12 pediatric endocrinology clinicians. An inductive thematic data analysis approach was used. Participants described that HRSN are pervasive for youth with T2D and are especially impactful after diagnosis. Participants thought that addressing HRSN in healthcare settings was important but emphasized that interventions need to be affirming and provide tangible, relevant resources. Engagement with community health workers trained around diabetes management is needed, as is structural change to disrupt health disparities. Future research and clinical transformation are discussed.

Background: While consensus exists that the sources of health inequalities are social inequalities brought on by the experience of qualitatively different living and working conditions, means of addressing these conditions continue to be the subject of dispute. Whether to emphasis education or income as a social determinant of health is one such example of differing views on the sources of these inequalities and the means of addressing them. These different emphases are often justified through the narrow examination of the magnitude of statistical relationships between educational attainment and income with health outcomes.Purpose: We offer a broader view, seeing these differing emphases as indicative of contrasting views of the nature of society and means of responding to these inequalities with emphasis on education representing a liberal reformist view of the issue while an emphasis on income representing a materialist structuralist view.Research design and study sample: We examine, the validity of this hypothesis through an analysis of content of five representative publications that consider educational attainment as a social determinant of health and five that do so for income.Analysis and results: We find that the emphasis on education as a social determinant of health focuses on the attributes of the individual and is generally accepting of the structures and processes of the existing economic and political order. In contrast, an emphasis on income - when placed within a materialist analysis - views existing systems as inequitably distributing income and other resources thereby requiring their reform or transformation.Conclusion: Considering evidence of deteriorating living and working conditions for many in Canada and elsewhere, we see the latter emphasis as more useful for understanding and addressing these disturbing developments.

Background: In post-conflict Guatemala, Indigenous men's psychological distress has been linked to violence exposure, disrupted social support systems, and structural inequities.

Purpose: We aimed to document how communities themselves understand men's wellbeing and the factors that influence men's wellbeing.

Research design and study sample: Fuzzy Cognitive Mapping with 20 stakeholder groups in Santiago Atitlán and Cuilco, Guatemala defined men's wellbeing in local terms and identified the influences community groups understood to promote and detract from men's wellbeing. Participants mapped pathways through which influences affected wellbeing and weighted their relative perceived strength.

Analysis: The researchers used thematic analysis to summarise influences into 43 factors and used fuzzy transitive closure to calculate their net causal influence for each set of stakeholders. We compared perspectives of groups of adult men, adult women, and practitioners of Mayan medicine in Santiago Atitlán, with a primarily Indigenous population, to groups in Cuilco, with a primarily non-Indigenous population. We also compared perspectives across age groups in Santiago Atitlán.

Results: Across regions, maps highlighted the importance of family and social relations, emotional distress, substance use and physical health for men's wellbeing. Basic resource insecurity and unemployment were top risk factors for men's wellbeing in maps from Cuilco but had both risk and protective influences on men's wellbeing in maps from Santiago Atitlán.

Conclusions: Findings challenge the focus on scale-up of individual biomedical interventions as the best strategy to reduce the burden of emotional distress in Guatemala and raise questions about standard development approaches that emphasize income generation and educational attainment above cultural continuity and social harmony.

Objective: Back to Early Care and Education Safely With Sustainability via Active Garden Education (BE SAGE) involved COVID-19 testing and a free garden-based physical activity and nutrition program at early care and education centers with primarily Hispanic/Latino enrollment. This article describes the project community engagement plan, process, and outcomes focusing on deliberate and intentional staffing, an extensive online presence, and focused outreach.

Methods: BE SAGE purposefully hired bilingual (English/Spanish) and bicultural staff; developed and maintained a large bilingual online presence (website, newsletters, social media), and fostered community partnerships with community health workers (CHWs) and dedicated staff. Hiring records, online internet records, staff calendars, and field notes were coded and tabulated.

Results: 84% of the 13-member research team and all CHWs identified as Hispanic or Latino. Predominantly US users accessed the website (N = 3,108), 36.9% of received electronic newsletters were opened, and 1126 followed social media across four platforms. The Outreach Specialist fostered existing relationships and created new partnerships. With the help of CHWs, 562 research participants completed at least one COVID-19 test.

Conclusions: By prioritizing representative staffing hires, expending substantial resources on an online presence, and establishing and nurturing our community partnerships, our BE SAGE community engagement approach helped to achieve study aims and create lasting community impact. Community engagement and partnerships to forward research requires ample funding and dedicated representative hiring polices to cultivate and maintain community relationships with asset-driven outcomes.

Policy implications: Funding agencies must prioritize community engagement in research outcomes to ensure robust, meaningful scientific discovery and innovation.

Background: Socio-economically disadvantaged women have poor maternal health outcomes. Maternal health interventions often fail to reach those who need them most and may exacerbate inequalities. In Bauchi State, Nigeria, a recent cluster randomised controlled trial (CRCT) showed an impressive impact on maternal health outcomes of universal home visits to pregnant women and their spouses. The home visitors shared evidence about local risk factors actionable by households themselves and the program included specific efforts to ensure all households in the intervention areas received visits.

Purpose: To examine equity of the intervention implementation and its pro-equity impact.

Research design and study sample: The overall study was a CRCT in a stepped wedge design, examining outcomes among 15,912 pregnant women.

Analysis: We examined coverage of the home visits (three or more visits) and their impact on maternal health outcomes according to equity factors at community, household, and individual levels.

Results: Disadvantaged pregnant women (living in rural communities, from the poorest households, and without education) were as likely as those less disadvantaged to receive three or more visits. Improvements in maternal knowledge of danger signs and spousal communication, and reductions in heavy work, pregnancy complications, and post-natal sepsis were significantly greater among disadvantaged women according to the same equity factors.

Conclusions: The universal home visits had equitable coverage, reaching all pregnant women, including those who do not access facility-based services, and had an important pro-equity impact on maternal health.

Despite the safety and effectiveness of the COVID-19 vaccine, public hesitancy about receiving vaccination remains strong among disproportionately affected populations in the United States. To design more locally and culturally appropriate strategies, research is needed to explore the qualitative characteristics of vaccine hesitancy in these populations. Thus, we conducted in-depth interviews with 19 Indigenous and 20 rural participants and utilized a grounded theory approach to identify factors associated with their COVID-19 vaccine decision making. Wariness regarding safety of vaccines, resignation over the quality of available health care, and a historical mistrust of government-led interventions influenced vaccine rejection for indigenous participants. Rural participants remained divided on the perceived threat and consequences of COVID-19 and the efficacy and safety of the vaccines. The influence of friends and family members impacted vaccine hesitancy, as did discussions with healthcare providers when discussions were perceived to be respectful, sensitive, and non-judgmental.

Background: Utilizing iterative and collaborative tools, Human-centered Design (HCD) facilitates the creation of tailored solutions for multifaceted issues by fostering empathy and a deep understanding of human behaviors. This paper presents insights gleaned from employing HCD tools to center communities in global health intervention development.

Purpose: The study team collaborated with community members in Dailekh, Nepal to co-design interventions to address harms associated with menstrual seclusion, known as chhaupadi.

Research design and study sample: A Community Design Team, comprising 10 women representing various castes and ages convened for a four-day intervention co-design workshop in the community. A Community Validation Team, comprising 12 individuals from diverse occupational and caste backgrounds provided feedback on the interventions. Additionally, six village leaders participated in Key Informant Interviews to garner additional insights.

Data collection: In the study's initial "discovery" phase, the Community Design Team employed HCD tools to generate a nuanced understanding of the context, stakeholders, and community experiences. Subsequently, in the second "design" phase, the Community Design Team crafted interventions to address harms associated with chhaupadi.

Results: Invaluable lessons gained from this study underscore the necessity of crafting contextually suitable tools, checklists, and prompts for participants, allocating sufficient staff, time, and resources, and adapting to participants' literacy levels and engagement preferences, whether through group or individual activities.

Conclusions: Reflecting on these insights, our experience suggests HCD offers promising tools to authentically and equitably involve participants with diverse backgrounds in articulating their own ideas for community-based solutions in Nepal. Health practitioners, researchers, and intervention development experts are encouraged to consider adopting HCD methodologies to prioritize community voices in devising solutions for complex health challenges.