Community health equity research & policy最新文献

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.

BackgroundBlack and Latinx youth are disproportionately exposed to neighborhood violence and related mental health challenges. Racial-ethnic identity shapes how adolescents perceive, interpret, and cope with stressful environmental conditions, yet its role in these associations remains underexplored.MethodsUsing cross-sectional data from 621 Black and Latinx adolescents (mean age = 15.5 years), we applied structural equation modeling to examine associations of perceived neighborhood violence, racial self-efficacy, ethnic identity exploration, and internalizing symptoms of anxiety.ResultsGreater exposure to neighborhood violence was associated with lower racial self-efficacy (β = -0.22, p < .001), which was in turn associated with reduced internalizing symptoms (β = -0.14, p < .001). Ethnic identity exploration was negatively associated with racial self-efficacy (β = -0.10, p < .05) and was not significantly associated with internalizing symptoms (β = -0.04, p > .05).ConclusionsThese findings highlight potential psychosocial processes associated with neighborhood violence and suggest that racial self-efficacy may play a meaningful role in the mental health experiences of minoritized youth.

Despite men's health playing a significant role in the well-being of infants, children, and women, there is a gap in maternal and child health research which more broadly considers men's health as a component of family's and community's overall well-being and for the sake of men's own health and well-being, particularly from the perspective of men with marginalized identities, such as Black men, and community members. Therefore, our community-based participatory research study aimed to explore what community members perceive as protective and risk factors for the general health of men in a low-income community using a generic qualitative approach with focus groups and thematic analysis. We identified six protective factor themes (health behaviors, economic stability, expected male responsibilities, healthcare engagement, social network, and faith, spirituality, and driving forces), as well as six risk factor themes (health behaviors, impact of mentorship, experience of driving forces, healthcare avoidance, mental health concerns, and systemic bias, racism, and social inequity). There are actionable steps public health practitioners and policymakers should prioritize, including addressing structural barriers to men's health, such as by combating discrimination and increasing access to healthcare, removing barriers to mental health care, and creating opportunities for increased social support. These strategies can give way to greater opportunities for men to engage in protective behaviors that can both improve their health across the life-course and positively impact the health of mothers, infants, children, and communities.

BackgroundPalliative care is a key component of the healthcare system, yet structurally vulnerable populations face significant barriers to accessing it and its support in care planning. This study explored beliefs, needs, and concerns related to palliative care and advance care planning among these populations.MethodsTwo semi-structured focus groups were conducted in major cities in the province of Quebec, Canada, in May and August of 2022. Participants had to be at least 18 years old and be able to speak and understand French. They also had to attend or use the services of a partnered community organization serving the target population. Data was analyzed according to the thematic content analysis approach.ResultsFifteen (15) persons participated: all were Caucasian, and most were women, born before 1960, single, and retired. Misconceptions and a lack of awareness of the various palliative care options were generally observed among participants. Experience with caring for a dying person, access to a family physician, and access to a legal professional were identified as elements promoting awareness of palliative care. Participants raised an urgent need for more accessible information about palliative care and advance care planning, and for more access to care.ConclusionsA good understanding of palliative care options helps individuals and families make informed decisions and be better prepared for the end of life. Structurally vulnerable people urgently need accessible information to support this preparation. This study supports the development of equity-focused policies and tailored interventions to improve access and planning for this population.

Families across sub-Saharan Africa (SSA) often rely on social capital to access traditional, faith-based, and biomedical antenatal care (ANC). Yet, many current studies focus on biomedical ANC and emanate predominantly from the Global North. In this qualitative case study, we aimed to explore how families utilize social capital to access various types of ANC in Mafararikwa, a rural ward in Eastern Zimbabwe. We generated data through interviews with 30 health professionals, and consultations, focus group discussions, and storyboarding with 71 community-level key informants and parents or legal guardians. We analyzed the data thematically. We identified four main themes: Theme 1: Support through social networks and community groups (families draw support from social networks, local groups, and community initiatives to engage with different types of ANC); Theme 2: Material and non-material support (families draw material and non-material supports from social networks, local groups, and community initiatives to engage with various forms of ANC); Theme 3: Reciprocal norms and sociocultural practices (families leverage reciprocal actions, norms of respect and courtesy towards pregnant women, mutual trust, and socio-cultural practices to engage with diverse ANC types); and Theme 4: Informal supports and care mixing dynamics (local informal supports shape families' interactions with different types of ANC). The complex ways families in Mafararikwa leverage social capital to access preferred forms of ANC reflect context-specific relationships and holistic health conceptions grounded in Ubuntu. Culturally-specific responses that strengthen these relationships are needed to ensure equitable ANC outcomes in Mafararikwa and beyond.

Power is a pervasive and often underexamined force that shapes all aspects of participatory health research (PHR); however, translating theoretical understandings of power into practical strategies remains a challenge. This commentary critically examines the complexities of power in PHR, highlighting both its constraints and its potential as a transformative force in equity-driven research. The discussion is grounded in selective foundational theories of power, which provide the theoretical basis for understanding power in PHR. Building on these perspectives, expressions of power-Power Over, Power To, Power With, Power Within, and Power Through, serve as analytical lenses to identify and assess where power operates and how it can be navigated. To bridge the gap between theoretical discourse and actionable practice, the Power Assessment Reflexivity Tool for Navigating Equality in Research (PARTNER) is introduced as a heuristic. PARTNER, informed by lived and living experience co-researchers, is a tool designed to make the complexities of power more navigable, offering prompts to guide PHR teams in fostering equity and justice within their work. By recognizing power as both a barrier and a possibility, this commentary underscores the importance of moving beyond performative and abstract discussions of power. It offers a practical entry point for research teams committed to addressing power in ways that are impactful, substantive, and aligned with systemic change.

BackgroundHomelessness in the United States is growing and has serious implications for the health and well-being of individuals and communities. The purpose of this study is to share the self-identified goals and needs of people experiencing homelessness in a Southwestern city in the United States.MethodsWe undertook secondary data analysis of qualitative responses (n = 169) to a questionnaire that was part of a 2023 needs assessment of adults experiencing homelessness in Tucson, Arizona. Using inductive applied thematic analysis, qualitative data were transcribed, coded, and organized into themes.ResultsFive themes emerged from the data analysis: (1) people do not want to be homeless, they want stability, and they are willing to work for it; (2) relationships are an important driver of goals; (3) barriers at the individual and interpersonal levels are diverse and individualized; (4) stigma and discrimination hinder exits from homelessness, and (5) hope and despair are both common.ConclusionParticipants experiencing homelessness overwhelmingly articulated the desire to be housed, employed, reconnect with family, and generally have stability in their lives. These findings provide a direct contradiction to the narrative that people who are homeless choose homelessness or do not want to work to change their circumstances.

The National Institutes of Health (NIH) supported the Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) program, which aims to ensure that all Americans have access to COVID-19 testing and promotes health equity, especially in underserved communities. Under RADx-UP, there are two pilot programs - Community Collaboration Grants (C2G) and Rapid Research Pilot Program (RP2) - that fund projects to conduct community-engaged outreach and research to address COVID-19 testing disparities. As such, we sought to assess projects' health equity impacts within their priority populations. Our evaluation team used cognitive interviews with C2G and RP2 project representatives to revise health equity metrics within an existing Health Impact Assessment (HIA) tool to measure health equity impacts within these community-engaged research projects. During interviews, participants indicated that we needed to improve the clarity and readability of key terms and phrases related to health equity, and they provided suggestions for how to tailor metrics to community partners. In this paper, we highlight our process of adapting the original metrics and share lessons learned that other evaluators may apply to their work. Our project highlights the importance of cognitive interviewing as a critical methodology to tailor an existing pilot-tested HIA to a community-based audience; however, it also sheds light on the difficulties of measuring health equity within community-engaged research initiatives and future recommendations.

In Canada, Black men are overburdened with HIV. Some studies have suggested that traditional masculinity practices are key drivers of new HIV infections as they endorse high-risk behaviors. However, critical scholars have also highlighted complex pathways through which Black men's masculinity practices and their associated health impacts may be influenced by their structural circumstances in Canada. Informed by these, we draw on analyses of interviews (n = 13) and focus group discussions (n = 17) with self-identified heterosexual Black men resident in London, Ontario, to understand how they construct and practice masculinity in response to their HIV vulnerability. Using a mixed inductive-deductive thematic approach to data analysis, our findings suggest that in response to their HIV vulnerability and poor health outcomes, Black men practice progressive masculinities that empower them to engage with their health needs and help build resilience against HIV. Furthermore, race-based discrimination, stereotypes, societal expectations, and the 'othering' of Black men in Canada may engender the performance of traditional masculinity by some younger Black men, which may deplete their capacity to build resilience against HIV. We recommend that health policy stakeholders in Canada leverage these findings to engage Black men in addressing their structural vulnerabilities to HIV.