Community health equity research & policy最新文献

BackgroundAirborne toxicants such as volatile organic compounds (VOCs) increase the risk of inducing or exacerbating cardiometabolic disease. The Environmental Protection Agency prioritizes Superfund sites based on the level of contamination and the likelihood that a site poses a threat to human health or the environment.PurposeThis paper proposes an alternative approach to prioritizing Superfund sites with VOC contamination by focusing on the size and health status of nearby populations.Research DesignAs a case study, we examine relevant data sources and assess how they characterize place-based cardiovascular health risk and disease burden among populations residing near Superfund sites in Kentucky.Results and ConclusionOur findings suggest an approach to more effectively protect public health in areas where VOC exposure may amplify existing cardiometabolic risks, thereby guiding state and local governments in decisions regarding site remediation and healthcare resource allocation.

BackgroundCollecting demographic data is critical for identifying inequities in healthcare services and delivery. Inaccurate collection of demographic data can make developing equitable health interventions and improving reach of existing interventions difficult. This study aimed to (a) examine experiences in completing a community-based type 2 diabetes prevention program Small Steps for Big Changes (SSBC) demographic questionnaire (SSBC-DQ) among adults from equity-owed groups, and (b) assess recommendations for improvement to the questionnaire.MethodsAdults with no prior involvement in SSBC were recruited. Participants completed the SSBC-DQ online and then engaged in one-on-one structured interviews. Interview data was analyzed using interpretive description and coded using the APEASE criteria.ResultsTwelve participant interviews were included in analysis. Five principle themes were developed to capture the experiences of completing the SSBC-DQ: representation, comprehension, demographics are an emotional experience, the role that privilege plays, and beliefs about demographic data. Sixty suggested changes were coded using the APEASE criteria; six suggestions met the criteria for implementation, 20 did not meet the criteria, and 34 required further discussion with the research team.ConclusionsResults from this study illustrate that people's lived experiences can drive their reactions and interpretations to demographic questionnaires. Based on end-user suggestions, SSBC made changes to its demographic questionnaire to be more inclusive. Having a demographic questionnaire that is more inclusive can help SSBC better understand what populations it is and is not reaching in an acceptable and inclusive manner. This will help inform future directions regarding evaluating program reach and equity.

ObjectiveBack 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.MethodsBE 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.Results84% 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.ConclusionsBy 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 ImplicationsFunding agencies must prioritize community engagement in research outcomes to ensure robust, meaningful scientific discovery and innovation.

BackgroundIn post-conflict Guatemala, Indigenous men's psychological distress has been linked to violence exposure, disrupted social support systems, and structural inequities.PurposeWe aimed to document how communities themselves understand men's wellbeing and the factors that influence men's wellbeing.Research design and study sampleFuzzy 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.AnalysisThe 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.ResultsAcross 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.ConclusionsFindings 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.

BackgroundThere is a notable lack of evidence regarding the factors that shape the provision of essential healthcare services in post-conflict settings.PurposeThis 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.MethodEmploying 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.ResultsOur 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.ConclusionThese 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.

This study explores how participatory music programs can help build social connection for people experiencing loneliness in contexts of social marginalisation. Loneliness is a growing, global public health issue with social and structural drivers. There is an urgent need to investigate innovative approaches to programming that go beyond opportunities for social contact to address the multiple domains of loneliness. Designed collaboratively with two social sector organisations in an urban context in Australia, this study presents outcomes from two community programs that involved groups of people experiencing or at risk of loneliness engaging in music together. Using a qualitative methodology that included semi-structured and brief interviews, focus groups and ethnographic observation, researchers identified positive shifts in relation to social loneliness (related to social contact), emotional loneliness (related to social bonds and meaningful connections), and existential loneliness (related to community connection and acceptance) for participants of the music programs. This study contributes to an urgent gap in understanding effective programming to support people experiencing loneliness and bolsters emerging evidence about the role arts can play in strengthening health, community and social sector efforts to address inequity.

IntroductionThe 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.MethodsUsing 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.ResultsSeveral 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.DiscussionThe 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.

Black and Latina cisgender and transgender women who use substances face adverse sexual and reproductive health (SRH) outcomes due to intersecting forms of discrimination and limited access to high-quality SRH services. Insufficient research has explored healthcare providers' views and experiences related to delivering SRH care to multiply marginalized women, especially the role of training in shaping their attitudes and practices. Using purposive sampling, we conducted online, in-depth interviews with 20 SRH care providers in Massachusetts and Rhode Island in August-November 2023 to elucidate how their training influenced their provision of SRH care to Black and Latina cisgender and transgender women who use drugs and identify the strategies they used to address the limitations of their formal training. Using intersectionality-informed thematic analysis, we found that most providers expressed dissatisfaction with their clinical education, which failed to address how racism, transphobia, and substance use stigma simultaneously influenced SRH outcomes and care. Further, many reported that the training needed to provide high-quality SRH care to Black and Latina cisgender and transgender women who use drugs largely occurred outside of their formal education, but that burnout, time constraints, and lack of reimbursement undermined their ability to obtain additional training and deliver tailored care. Providers also described how their professional and personal backgrounds influenced their practices and noted that specialized SRH education, working in person-centered care settings, and sharing social identities with patients facilitated their provision of high-quality SRH care to Back and Latina women who use drugs. Medical and nursing programs should incorporate training on intersectional discrimination and facilitate the enrollment of students with multiple minoritized social identities to advance SRH equity and justice.