Community health equity research & policy最新文献

AimCollate and summarise published evidence of the non-clinical effects of the COVID-19 pandemic in rural Nigeria and compare the findings with community stakeholder experiences.MethodsWe searched PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for peer-reviewed papers published up to January 2024. Included studies used quantitative, qualitative, or mixed methods to examine the influence of the COVID-19 pandemic on the lives of rural Nigerians. Two reviewers conducted title, abstract, and full-text screening independently. We used narrative descriptions and fuzzy cognitive maps to summarise the findings of the review and compared the maps with those previously created by stakeholders in rural communities in Bauchi State, rural Nigeria.ResultsPoverty, hunger and lack of food, and stress and mental health problems were leading themes in both the literature and stakeholder maps. Stakeholder maps highlighted job loss and household conflicts. These topics were rarely explored in the literature, which emphasized reduced health services.ConclusionThis review and stakeholder perspectives confirm the importance of non-clinical impacts of the COVID-19 pandemic in rural Nigeria. Some issues highlighted by local community stakeholders were absent in the literature. Contextualizing published research with local experience provides specific insights to inform recovery policies.

AimsCollate local perceptions of factors influencing experience of the COVID-19 pandemic in communities in Bauchi State, Northern Nigeria.ResultsFuzzy cognitive mapping (FCM) collated participant views of what made their experience worse during the COVID-19 pandemic. FCM uses concepts linked by weighted arrows to indicate perceived causal relationships. Higher weights indicate stronger influences; positive and negative signs indicate direct and inverse causal relationships, respectively. In late 2023, local facilitators collected 81 maps in urban, rural and remote communities, 11 with administrative officials, and four with vulnerable groups (388 participants in total). We created average maps for each stakeholder group. Facilitators inductively grouped factors into categories. We calculated the cumulative net influence (CNI) (range -1 to +1) of categories and identified important causes and outcomes within the network. The maps included 152 factors in 25 categories. Hunger and lack of food (CNI = 0.63) worsened pandemic experience the most, followed by reduced businesses and jobs (CNI = 0.40), causing economic disruption and threatening livelihoods. Increased household conflicts (CNI = 0.35) and stress and mental health problems (CNI = 0.30) were also prominent negative influences and intermediate outcomes in the network. Lockdown (CNI = 0.34) was the most important underlying cause of other causal categories.ConclusionsThe maps depicted the interconnected impacts of the pandemic on community members. Participants confirmed the worst impacts were related to control measures exacerbating pre-existing economic challenges. These FCM findings will form part of the evidence shared with communities and policy makers to support co-design of strategies for pandemic recovery aligned with community needs and strengths.

IntroductionCreative and performing artists are often confronted with precarious employment and insufficient healthcare coverage. A clinic in Canada that provides specialized healthcare to artists offers eligible artists subsidized health services. We aim to compare the use of health services, demographics and health conditions between subsidy artist recipients (SAs) and non-subsidy artists (NSAs).MethodsWe accessed existing data from 265 SAs and 711 NSAs and applied descriptive and inferential statistics to address our research questions.ResultsMusculoskeletal issues, stress, anxiety disorders, and depressive disorders are the most common health problems faced by SAs. Compared to NSAs, SAs were more likely to seek treatment for stress, but less likely to seek treatment for anxiety disorders, depressive disorders, chronic problems, and upper extremity problems.DiscussionFuture research may investigate the enduring effects of subsidized health services on SAs' health outcomes. Sustained positive outcomes are crucial for maintaining an artist's career and well-being.

Background: This study examines the outcomes of the 24-months Charleston FoodRx food prescription program implemented in rural Mississippi to address dietary-related health disparities.Purpose: Examine changes in participant produce consumption, food seccurity, and anthropometrics over a 24-month period.Research Design: A one-group, repeated measures design, was utilized to assess changes in produce consumption, food security, and anthropometric data from baseline.Study Sample: A total of 55 households completed the study.Data analyses: longitudinal and regression analyses were conducted to identify significant change over time.Results: Results indicated an increase in weekly produce consumption, and a decrease in the prevalence of food insecurity over the follow-up periods. Among adults, statistically significant reductions in weight, body mass index (BMI), waist circumference, and triglyceride levels were observed at the 24-month endpoint.Conclusions: These outcomes support the efficacy of food prescription programs in promoting healthier dietary behaviors and improving health-related outcomes. The study provides valuable insights into the impact of such interventions on dietary-related health disparities in underserved communities. However, more robust research is needed to maximize the potential of these interventions.

Background: A recent programmatic shift in the provision of family planning in the Global South led to a renewed focus on post-partum family planning (PPFP). PPFP embodies a shift in the primary narrative of global family planning programs, from fertility reduction to promoting maternal and child well-being.Purpose: We examine key factors that shape women's knowledge, attitudes and practice of PPFP in Banyumas, Indonesia.Methodology: We employed a qualitative approach utilizing focus group discussions with pregnant women and women with children aged less than 1 year old (n = 44), and in-depth interviews with health service providers (n = 10). Guided by the research questions, we conducted a thematic analysis of the transcripts.Results: Our findings demonstrate how women's agency within marriage, their social and familial networks, their interactions with healthcare providers, and policy changes related to reproductive health and health insurance schemes, all influence the extent to which women's rights to information and choice regarding post-partum family planning can be realized. Conclusions: Key implications for practice include the necessity for health providers to offer unbiased information about contraceptive options, to engage local leadership effectively, and to ensure that government targets for the PPFP program align with women's needs and the health and social conditions of the community.

BackgroundHistorical injustices, structural racism, and negative healthcare experiences contribute to Black and Brown communities' distrust of science. Bridging Research, Accurate Information, and Dialogue (BRAID) is a community engagement model that leverages trusted messengers to share accurate, co-created health and science messages to their community through their social networks. In our prior research, trusted messengers reported encountering resistance or "discord" when conveying information about controversial topics such as COVID-19 vaccines and the importance of diversity in clinical trials. Motivational Interviewing (MI) is an evidence-based communication style widely practiced by healthcare providers to guide ambivalent patients toward behavior change. However, MI's application by community members, particularly trusted messengers, as a strategy for enhancing health message dissemination remains unexplored.PurposeThis study used mixed methods to explore the feasibility of training trusted messengers in MI to support the dissemination of public health messages through social networks. Specifically, we sought to understand perspectives on learning MI and use of MI in conversations about clinical trial diversity and research subject protection.Research Design13 trusted messengers completed a MI introductory training.ResultsEighty-five percent found the training highly valuable, 54% reported high self-efficacy, and 69% expressed a desire for additional training. Qualitative analysis revealed trusted messenger endorsement of MI, recognition of MI's applicability to various contexts, and a sense of empowerment to share accurate information to their communities.ConclusionsOur findings suggest that empowering trusted messengers with communication skills can be a practical, feasible, and cost-effective public health strategy for effective dissemination of accurate public health messages.

AimsRefugees experience physical and mental health issues that need attention following settlement in a new community. However, access to and utilisation of healthcare services is challenging. We aimed to explore the experience of refugee access to a dedicated multi-disciplinary refugee health team.MethodsAn interpretative qualitative study. 17 qualitative interviews were conducted with Ezidi refugees who attended a newly established multi-disciplinary refugee health program in a regional town in NSW, Australia. Data were analysed using an inductive thematic approach.ResultsParticipants (n = 17) identified as Ezidi and were from Iraq. Parents were between 23 and 57 years of age and had 1-12 children per family. Most had been in Australia between 2 and 5 years. Four key themes were identified: (1) Identifying the extent of health needs following a long wait to migrate; (2) Health support across the life span: the benefit of access to a multi-disciplinary team; (3) Gaps in cultural competence - impacted by understanding and interpreter access; and (4) Ongoing health and lifestyle concerns - influenced by understanding and education.ConclusionsWe identified the benefit of access to allied health for prompt diagnosis, treatment and management of conditions including congenital and developmental conditions, mental health and chronic diseases. Access to a dedicated team ensured early intervention for a broad range of health and social issues including early referral to services, close coordination and help to complete supporting paperwork and applications. Ongoing investments are needed to maintain this comprehensive and coordinated approach to care that is underpinned by a family centric approach.

US Black women are disproportionally represented in new HIV diagnoses. PrEP is effective in HIV prevention, but Black women's uptake is low. The UPDOs salon-based intervention is effective in overcoming barriers to care but scaling implementation is needed. This mixed-method pilot study sought to understand how salon organizational factors may have influenced UPDOs implementation with a focus on organizational culture, team culture, relational connection, and communication within a Consolidated Framework for Implementation Research (CFIR) inner setting lens. Organizational culture and team culture were measured using the Organizational Culture Survey (OCS) and Team Psychological Safety Scale (TPS). Relational connection and communication were explored qualitatively using participant observations and semi-structured interviews. Findings were positive towards teamwork, morale, information flow, involvement, and supervision as well as reflected positive organizational environment that were supportive of developing knowledge and skills. Relational connection and communication created a trusting environment that facilitated implementation. Future research can benefit from examining organizational environment when scaling interventions to overcome HIV and PrEP inequities.

BackgroundThe Department of Veterans Affairs (VA) employs numerous strategies to address food insecurity among rural veterans. This manuscript discusses findings from a quality improvement project examining factors impacting food insecurity among rural veterans.MethodsQualitative interviews were conducted with VA expert informants (n = 30) who worked in national program offices addressing veteran food insecurity, site visit participants (n = 57) at three VA Medical Centers (VAMCs), and rural veterans who screened positive for food insecurity at the VAMC sites (n = 10). Interviews were analyzed with analysis matrices.ResultsCurrent VA programming includes a national food insecurity screening initiative and connecting veterans with local community resources. Veteran participants provided suggestions for addressing veteran food insecurity, including outreach and education. In addition, these interviews demonstrate that rural veteran food insecurity is intrinsically interwoven with other social determinants of health.ConclusionsAddressing rural veteran food insecurity must include strategies for understanding and supporting interconnected veteran needs.

BackgroundCommunity health agents (CHAs) play a crucial role in healthcare delivery and can also impact societal gender norms. This study aims to understand CHAs' perceptions of gender roles and norms to identify long-term strategies for women's empowerment.MethodsWe conducted 90-min focus group discussions (FGDs) among CHAs in Peru. FGDs illuminated women's perceptions of gender roles and how to empower women in communities.ResultsIn total, 53 CHAs participated across six FGDs. CHAs noted that women face significant barriers, are treated disrespectfully, and relegated to domestic roles. Ideal gender norms were described as having access to education, increasing voice, inclusion in decision-making, and independence. Changing gender norms requires that men, women, families, and communities support women's progress in society.ConclusionsCHAs are in a unique and powerful position to drive social change. Understanding CHAs perceptions can help develop effective strategies for women's empowerment.