Community health equity research & policy最新文献

We propose that stakeholders should develop an economically sustainable, public health intervention to improve indoor air quality and to reduce overcrowding in households of underserved U.S. rural, urban and suburban residents exposed to life-threatening respiratory infections, such as caused by coronavirus disease 2019, influenza, and respiratory syncytial virus. We posit that a multifaceted community-based intervention in these households would improve social inequities, promote health justice, and reduce health care expenditure. However, this call for action would require an interdisciplinary, coordinated, and sustainable action plan devised by federal, state, county, and city government departments and agencies in close collaboration with and input from local community leaders, members, and residents.

Background: Malaria prevention through mosquito net usage remains a critical public health challenge in Ghana, despite widespread distribution efforts. Purpose: This study examines how media exposure, family structures, and socio-economic conditions influence mosquito net utilization patterns across Ghana's diverse regions. Reseaech design and study sample: Drawing from the 2022 Demographic and Health Survey data of 9353 women aged 15-49, this research employs both logistic regression analysis and innovative geospatial techniques to uncover usage determinants. Analysis and results: Findings reveal a substantial gap between net ownership (80.6%) and actual usage (56.4%), with significant variations across demographic groups. The study identifies that participants with health cards had 51% higher odds of using nets (AOR = 1.51), while those from rural areas showed higher utilization rates compared to urban residents. Geospatial analysis exposed a concerning mismatch between healthcare facility distribution and malaria burden, particularly in Northern and Upper West regions, potentially hampering access to nets and educational resources. Family composition emerged as a key factor, with participants living with partners and those having children demonstrating significantly higher usage rates. Interestingly, while traditional media consumption (radio) positively correlated with net usage, internet use was associated with decreased utilization. The research also found that despite lower socioeconomic status households showing higher usage rates, education levels positively influenced utilization across all groups. Conclusions: These findings contribute to understanding the complex interplay between social determinants and healthcare infrastructure in shaping preventive health behaviors, suggesting the need for targeted interventions that consider both geographical accessibility and socio-cultural contexts in malaria prevention strategies.

BackgroundThe nutritional status of Cambodian women and children remain poor despite implementation of dietary intake interventions. Cambodia-specific studies have explored how education influences nutrition and health behavior, but not factors influencing Cambodian women's food decision-making for themselves and their families.ObjectiveTo understand Cambodian women's food decision-making, particularly related to barriers and enablers of healthy eating for themselves and their families.MethodsQualitative descriptive methodology within an experiential paradigm involving four focus groups in rural and urban locations of Siem Reap province, Cambodia. Participants were Cambodian women aged from 18 years with at least one child under 5 years of age, and primarily responsible for food provision in their family. Data was analyzed using reflexive thematic analysis.ResultsThe three main themes identified were: (1) access impacts food choice; (2) responsible, nurturing food provision role; and (3) dichotomous perceptions of food. Access to food strongly influenced Cambodian women's food choices, particularly cost and availability. Cambodian women were driven to fulfil their role and nurturing instincts to provide for their family within their capabilities and knowledge. They considered healthy food using a wide range of factors outside of nutrient values, including food texture, immediate body response, cultural food taboos and use of chemicals such as pesticides.ConclusionsTo optimize nutrient intakes, practical, culturally appropriate nutrition interventions that address food access and perceptions of Cambodian mothers regarding their nurturing food provision role are needed.

BackgroundPrediabetes is a risk factor for type 2 diabetes. The transition from prediabetes to type 2 diabetes is inequitable, with Latinos reporting an increased risk than other groups. Stress can affect this transition; however, we have no means of measuring prediabetes-related stress.Research Design and Study SampleWe used group concept-mapping, a participatory mixed-methods approach to collect data from English- and Spanish-speaking Latino adults (18+ years old) living with prediabetes, or clinical providers, in the United States. Participants were invited to multiple activities. First, brainstorming around focal questions about the stress of prediabetes diagnosis and management. Second, individually sorting 86 brainstormed statements into like groups, and rating these statements based on perceived importance. Third, interpreting quantitative results. Post-concept mapping, we invited participants to complete cognitive interviews of the initial English and Spanish versions of the scale.ResultsForty participants engaged in one or more activities. Results from the sorting and rating activities resulted in 10 clusters that reflect how participants grouped the 86 statements. The clusters were shared with participants to support the interpretation of the data. Cognitive interviews revealed participant suggestions to improve comprehension of instructions, response options, and items. This iterative process resulted in a 29-item scale developed in English and Spanish.ConclusionWe centered participant experiences to create the first scale that focuses on the emotional health related to prediabetes diagnosis and management. This scale can support diabetes prevention research by measuring prediabetes-specific stress and support clinical interactions to inform tailored conversations between patients and providers.

Background: Despite a robust literature on the importance of promoting health equity, actual progress in doing so is flagging and this is especially the case in Anglo-Saxon liberal welfare states such as Canada, the USA, and the United Kingdom. Purpose: In this paper we place these developments within the context of the political economy concepts of capital accumulation -- or profit making -- and social reproduction -- or the ongoing functioning of society. Research Design: We carefully reviewed the current state of theorization and research into the political economy of health to identify the main themes and findings in this literature in relation to the polycrisis of living and working conditions in Canada, the USA, and United Kingdom.Analysis: We drew upon critical materialist political economy thought to show how the growing contradictions between profit making and societal functioning in capitalist economies - and this especially so in liberal welfare states -- threaten both the quality and equitable distribution of the living and working conditions that shape health - the social determinants of health - and the organization and delivery of health care. Results: While there is increasing application of political economy approaches to understanding the adverse effects of capitalism, almost all of these are limited to critiquing capitalism without envisioning a post-capitalist society. Various ways of addressing these contradictions are provided that include 1) redistribution, social spending by governments, and managing the market economy within existing economic and political structures; 2) movement towards social democratic or conservative models of governance common to the Nordic and Continental nations respectively; or 3) building a post-capitalist socialist future.Conclusion: While we offer three paths forward towards achieving health equity, we conclude that the last path, building a post-capitalist socialist future, offers the most useful means of promoting health equity in both the short and long-term.

Community-based participatory research (CBPR) and integrated knowledge translation (IKT) are methodological approaches that emphasize the value of equitable partnerships between researchers and community partners. The main difference between these approaches is that CBPR is advocacy-centered and aims at addressing inequities by instigating systemic and policy changes, whilst IKT is application- and upstream solution-oriented especially within the context of health and social care improvement. Previous studies that have used a collaborative approach mainly focused on either CBPR or IKT to a lesser extent.The CAN-HEAL project employed an innovative methodological approach that integrates CBPR and IKT to address mental health needs among Arab immigrants and refugees in Ontario, Canada. Integral to this approach are three pillars: (1) establishment of a multi-level community partnership; (2) adherence to cultural sensitivity principles; and (3) commitment to social justice and application. The use of an CBPR-IKT approach led to numerous successes, including the co-development of a holistic upstream-downstream-based health promotion action plan to tackle inequities. This approach was associated with different challenges (e.g., limited resources), which were mitigated by employing certain enablers (e.g., assistance from community leaders). Based on lessons from this project, recommendations are made for governmental agencies and academic institutions to advance CBPR-IKT research to promote the sustainability and well-being of communities.

Food insecurity, depression, and HIV stigma adversely affect people with HIV and women face heightened vulnerability. Limited evidence exists regarding the factors associated with HIV internalized and experienced stigmas and depression for people with HIV and food insecurity in the Dominican Republic (DR). Using an HIV clinic-based sample of people with food insecurity in the DR (n = 115), we found that depressive symptoms and internalized and experienced stigmas were highly prevalent. A cross-sectional, multivariate linear regression analysis found that women, Haitians, and those with a detectable viral load had higher internalized stigma; those reporting intimate partner violence had higher internalized and experienced stigmas, while those reporting stronger social support had lower stigma scores for both types; finally, those with an undetectable viral load, better physical health, and better antiretroviral therapy adherence had reduced depression symptom severity. Targeting inequities related to gender, nationality and/or ethnicity, and HIV disease progression may mitigate internalized HIV stigma, and addressing the correlates of HIV stigmas and depression may improve HIV outcomes.

BackgroundThe integration of artificial intelligence (AI) and robotics into disability care presents transformative opportunities while simultaneously raising pressing ethical concerns. Issues related to autonomy, human dignity, and equitable access require careful consideration, particularly as these technologies reshape the dynamics of care delivery and clinical relationships. PurposeDrawing on an interdisciplinary approach that synthesizes insights from bioethical literature, illustrative case studies, and expert perspectives from healthcare, law, and technology, this reflection examines the ethical landscape of AI-supported rehabilitation and assistance. Particular attention is given to risks such as algorithmic bias, over-reliance on automation, and the potential erosion of the human dimension in care. A biopsychosocial model serves as a guiding framework to analyze how technological systems intersect with the lived experiences of individuals with disabilities. Ethical tensions emerge around personalized care, transparency in decision-making, and the inclusivity of data and design processes.ConclusionsThe analysis emphasizes the need for governance models that embed ethical safeguards and promote fairness, while also encouraging participatory design involving patients, caregivers, and healthcare professionals. By situating technological developments within broader socio-political and clinical contexts, this reflection identifies pathways toward a more equitable and human-centered integration of AI. Recommendations include investment in inclusive datasets, the development of fairness-aware algorithms, and the establishment of regulatory mechanisms that align innovation with fundamental rights and principles of social justice in healthcare.

Human Papillomavirus (HPV) is the most common sexually transmitted infection worldwide. Specifically, HPV is responsible for a large proportion of anal, cervical, vaginal, vulvar, penile and oropharyngeal cancers, highlighting the importance of optimizing the prevention of this public health issue. To date, vaccination is the most effective method for preventing HPV-related infections and associated diseases; however, vaccine uptake remains well below national targets. In Canada, gender-neutral HPV vaccination is recommended for all individuals between nine and 26 years, but can also be administered to adults until the age of 45. Despite widespread adoption of publicly-funded school-based vaccination programs, some populations report disproportionately lower rates of HPV vaccine uptake, including young adults, transgender peoples and men who have sex with men (MSM), rendering them vulnerable to morbidity and mortality. Addressing HPV-related disparities requires a coordinated, multi-level call to action involving collaboration between academic and community partners to normalize inclusive, gender-neutral vaccination. This paper explores opportunities for optimizing HPV vaccine uptake in Canada by emphasizing the importance of healthcare provider recommendation, improved access to community-based vaccination services, and representation of diverse populations (e.g., young adults, transgender peoples, MSM) in the development and delivery of vaccine communication/messaging. The time is now to normalize inclusive HPV vaccination in order to mitigate the persistence of vaccine-related disparities and strive toward global initiatives of health equity.

BackgroundStreet medicine programs provide medical care to individuals experiencing homelessness through "street runs," in which healthcare providers meet unhoused patients on the street and offer them care in that environment. Approximately 50 medical student-run street medicine programs operate in the United States. Data on strategies to improve street medicine services are limited. This study aimed to assess the impact of using an itemized menu of available supplies and services to guide patient encounters on a street medicine program's distribution of resources and therefore the numbers of patient needs that were met.MethodsWe performed a pre-post assessment study in an established street medicine program providing care in an urban downtown setting. Data were collected on the number and type of resources utilized in four street runs pre- and four street runs post-itemized menu implementation. Volunteers assisted patients in navigating the menu. The difference between resource utilization pre-post was assessed using the Mann-Whitney U test.ResultsThere were 98 patient encounters during the four street runs in the pre-itemized menu phase and 81 encounters in the post-itemized menu phase. There was a significant increase in patients' uptake of comfort items (p < .001), as well as clinical (p < .001) and overall (p < .001) needs met. There was no distribution of 17 resources during the four street runs pre-itemized menu implementation, but these resources were requested and received by patients 71 times in the four street runs post-implementation.ConclusionsImplementing an itemized menu significantly improved the street medicine program's ability to meet unhoused patients' needs.