Community health equity research & policy最新文献

Background: Community 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.

Methods: We 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.

Results: In 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.

Conclusions: CHAs are in a unique and powerful position to drive social change. Understanding CHAs perceptions can help develop effective strategies for women's empowerment.

Background: The 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.

Methods: Qualitative 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.

Results: Current 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.

Conclusions: Addressing rural veteran food insecurity must include strategies for understanding and supporting interconnected veteran needs.

Introduction: Creative 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).

Methods: We accessed existing data from 265 SAs and 711 NSAs and applied descriptive and inferential statistics to address our research questions.

Results: Musculoskeletal 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.

Discussion: Future 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.

Purpose: To characterize distance traveled for breast cancer screening and to sites of service for breast cancer treatment, among rural and urban women served by a Washington State healthcare network.

Methods: Data for this study came from one of the largest not-for-profit integrated healthcare delivery systems in Washington State. Generalized linear mixed models with gamma log link function were used to examine the associations between travel distance and sociodemographic and contextual characteristics of patients.

Results: Median travel distance for breast cancer screening facilities, hematologist/oncologists, radiation oncologists, or surgeons was 11, 19, 23, or 11 miles, respectively. Travel distance to breast cancer screening or referral facilities was longer in non-core metropolitan ZIP codes compared to metropolitan ZIP codes. AI/AN and Hispanic women travelled longer distances to reach referral facilities compared to other racial and ethnic groups.

Conclusion: Disparities exist in travel distance to breast cancer screening and treatment. Further research is needed to describe sociodemographic and system level characteristics that contribute to such disparities and to discover novel approaches to alleviate this burden.

Aims: Refugees 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.

Methods: An 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.

Results: Participants (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.

Conclusions: We 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.

This study explored the use of three participatory tools within a Philippines-based case study with community health workers (CHWs) by comparing and contrasting the process and data generated across the tools, and critically reflecting on adaptations and facilitation considerations that affected the tools' use. Facilitator notes and audio-recordings of discussions were integrated and analyzed thematically. Tools differed by the type of data generated: program-specific data related to CHWs' roles and responsibilities or data on broader structural factors. A stepwise approach within each tool facilitated focused, in-depth sharing, as did initial paired discussions that allowed exchange of knowledge and experiences among CHWs. Facilitators required topic- and context-specific knowledge to guide discussion effectively. CHWs discussed challenges and successes in their roles; program recommendations; and broader challenges related to healthcare delivery in their communities. This study contributes critical insights on the use of participatory tools to promote the inclusion of implementer perspectives in health program co-design, implementation, and evaluation.

According to the life course perspective (LCP), optimal human development and healthy aging are key goals that must start preconceptionally and continue later in life. However, older adult health and family health across generations have received very little attention in maternal and child health (MCH). Community-based participatory research (CBPR) is an important strategy for putting the LCP into action by engaging those communities most affected by health disparities. We conducted six CBPR focus groups using the LCP as the theoretical framework to capture community members' perspectives of risk and protective factors for older adult health. Perceived protective factors for older adults included socialization, support systems, and practicing wellness. Perceived risk factors included caretaking responsibilities, isolation, medical issues, and lack of support. The identified risk and protective factors for older adult health must be considered when developing public health interventions that promote health equity in aging and MCH.

Scholars have long argued that the care experience is shaped by context, and by evolutions in this context. Using Vietnam as a case, we critically interrogate the literature on women's experiences with maternity care to unpack whether and if it engages with the major social, economic, and health system impacts of the Doi Moi reforms in Vietnam and with what consequences for equity. We conducted a critical interpretive synthesis of this literature in light of the social, economic, and health system transformations driven by the Doi Moi reforms. We offer three critiques: (1) an overwhelming focus on public maternity care provision in rural/mountainous regions of Vietnam, (2) a narrow focus on women's ethnic identity, and (3) a misplaced preoccupation with women's limited autonomy and agency. We argue that future research needs to consider the impact of Vietnam's shift towards market-oriented care provision, and the broader societal and health system changes impacting both rural and urban areas, as well as ethnic minority and Kinh majority populations.

Local governments working in partnership with communities can institutionalize practices that promote health equity. We offer a case study of how one city in the US is implementing Health in All Policies (HiAP) with the explicit aim of promoting health equity. We use participant observations, original document reviews and interviews to describe how Richmond, California, is building new partnerships, programs and practices with community-based organizations and within government itself as part of the implementation of its HiAP Ordinance. We also report on indicators that were identified by community and government stakeholders for tracking progress toward improving place-based determinants of population health. We find that the responsibility for implementing Richmond's HiAP Ordinance rests on a new institution within local government and this entity is building new partnerships, promoting innovative policies and augmenting practices toward greater health equity. We also reveal how city governments and community partners can collaboratively track progress toward health equity using locally gathered data.