Community health equity research & policy最新文献

BackgroundThe St Louis Resiliency in Communities After Stress and Trauma (ReCAST) project promoted community well-being in a designated Promise Zone over a 5-year period. The primary goals of the ReCAST project are: (1) to build a foundation to promote well-being, resiliency, and community healing through service integration; (2) to improve access to trauma-informed community behavioral health resources and youth peer support; and (3) to create community change through community and youth engagement, leadership development, improved governance, and capacity building.PurposeTo examine ReCAST stakeholder perceptions of resilience and trauma in their communities using Concept Mapping (CM), a participatory mixed methodology.ApproachCM is an integrated approach that supports the structured conceptualization of ideas and applies multidimensional scaling and hierarchical cluster analysis to bring together and organize the ideas of a group to capture the perspectives of multiple stakeholders.Results33 stakeholders participated in the ReCAST program. The resilience concept map yielded five clusters: (1) Community Relationships (positive and productive), (2) Religious Organizations/Spirituality, (3) Interaction with Diverse Communities, (4) People in power to create change, and (5) Community gatherings and organizations. The trauma cluster map identified the following clusters: (1) Substandard Education, (2) Traumatic events/community violence, (3) Racial Trauma, and (4) Physical Degradation of neighborhoods.DiscussionBased on CM results, participants identified the need for local political officials to make a coordinated effort to address issues expressed in both maps and funding of local organizations to address issues related to trauma and resilience, especially youth organizations.

PurposeThe global refugee crisis includes Afghan refugees, driven by decades of conflict. Understanding the currently unidentified, unique challenges of this group upon resettlement in the United States is crucial for bettering health outcomes. This needs assessment identifies the challenges surrounding health experiences of resettled Afghan refugees in Houston, Texas.MethodsAdult Afghan refugees resettled in Houston, Texas were surveyed via a needs assessment adapted from validated health screeners (PRAPARE, the RHS15, and CoPaQ) with translator assistance. Health experiences across demographics, urgent needs, accessibility, and healthcare services were assessed.Results: 73 participants were surveyed (median age: 33 years, 74% female). Most had lived in the U.S. for 1-3 years, primarily spoke Dari, lacked English proficiency, were unemployed, and earned less than $20,000 annually. Top needs were employment, food, and transportation, and key accessibility issues included transportation, clothing, and learning English. Though many had health insurance, only some felt comfortable visiting a doctor alone and felt understood by their physician. About one-third rated their health as fair or poor. For medical visits, most relied on case managers and interpreters for navigating appointments, traveled by car, and had wait times under an hour. Social determinants like housing, childcare, and healthcare access showed significant variation.ConclusionFindings reveal key elements, including language, transportation, provider communication, that shape the health experiences of resettled Afghan refugees. These access contributors can inform more responsive healthcare systems. Given the urgency of our analysis, healthcare, governmental and community programs should pursue targeted approaches to meet this population's needs.

Introduction: Midlife women, aged 40-65 years, are an under-researched population with poor and inequitable access to Women's Health and Wellbeing Services (WHWS). This study, which was supported by a Patient and Public Involvement group, explored the enablers and barriers to WHWS, with a focus on sexual health and wellbeing services, cervical and breast screening, menopause care, contraception, and incontinence services.

Methods: Semi-structured focus groups and interviews were conducted with sixty self-identifying women and gender non-binary participants aged 40-65 years living in the South-East of England. Recruitment was focused in underserved geographic areas and in underserved groups. Framework Analysis, also using the Socioecological Model, through an intersectionality lens, was used to analyse the enablers and barriers to WHWS. A feminist pragmatist approach was employed to interlink the findings into suggestions to improve access. The study was reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Results: Three main themes emerged: the lack of prioritisation of midlife women; the widespread deficits in knowledge of the needs of midlife women; and the impact of stigma on access to care, particularly sexual health and genitourinary syndrome of menopause services. The intersectional disadvantage of belonging to underserved groups for example due to ethnicity, income, and disability, overlapped across the themes. Participants advocated for integrated, holistic, community-based, women-only services.

Conclusion: Further research, education, and policy investment is required to address the complex, and often highly sensitive nature of many health and wellbeing issues that face midlife women. These challenges are compounded by belonging to an underserved group.

BackgroundCommunity health workers (CHW) can perform unique functions to facilitate the implementation of evidence-based interventions for infection-related cancer prevention and control, and alleviate minoritized and immigration-related disparities.PurposeWe describe the implementation evaluation of three CHW-delivered infection-related cancer programs focused on Asian American (AA) communities in New York City: 1) a H. pylori treatment adherence program for Chinese and Korean Americans; 2) a HPV screening program for Muslim Americans; and 3) a hepatitis B screening, linkage to care, and treatment program for AA and other priority communities.MethodsWe conducted semi-structured key informant interviews with multi-level stakeholders from the programs.ResultsLessons learned include the importance of: 1) sustaining engagement and buy-in from implementation partners; 2) prioritizing recipient- and deliverer-centeredness; 3) fostering program flexibility to accommodate multiple implementation settings and to meet dynamic community resources and priorities; and 4) understanding interoperability between the CHW-delivered intervention and the inner setting for effective program implementation.ConclusionsThese findings can inform other efforts to implement CHW-delivered community-clinical cancer programs for AA and other underserved communities to advance health equity.

ObjectivesHealth inequity is a significant and pressing concern in the United States, and multiple studies showed that immigrants are one of the groups with the poorest access to healthcare compared to native-born populations. This study focuses on developing an in-depth understanding of how immigration status impacts primary healthcare (PHC) access among African immigrant women, particularly Ethiopian immigrant women (EIW).DesignA cross-sectional qualitative design was used to examine how immigration status shaped the healthcare experiences of EIW. In-depth interviews were conducted with 21 EIW in-person and virtually. The interviews were audio recorded and transcribed verbatim. Data analysis followed an inductive thematic analysis using NVivo 12 software.ResultsFour major themes emerged from the analysis, demonstrating how immigration and immigration status shape EIW's healthcare access and experiences. These were: (1) Employment-based insurance, (2) Eligibility for primary healthcare services, (3) Work conditions and time, and (4) Fear of losing status and the unknown. Across all themes, participants' experiences were deeply gendered and tied to broader labor and sociocultural conditions, highlighting the vitality of immigration status in determining healthcare access.ConclusionThe findings demonstrated the crucial need to expand work authorization to all immigrant groups, streamline the application process, and extend document validity to mitigate healthcare access barriers and prevent immigrants from taking low-wage, unprotected, and hazardous jobs that heighten health risks. Expanding eligibility to different groups of immigrants for programs such as Medicaid and Children's Health Insurance Program, and providing clear, comprehensive healthcare information tailored for immigrant populations are recommended.

BackgroundCervical cancer disproportionally burdens Hispanic immigrant communities in the United States, despite its preventable nature and curability when detected early. These persistent disparities represent a "wicked problem," characterized by contested evidence, fragmented data, and a politicized health policy environment.MethodsThis study uses Tarrant County, Texas-a high-disparity urban region-as a case study to explore how multilevel governance structures shape immigrant health inequities. Drawing on the concept of wicked problems and the political determinants of health (PDoH) framework, we analyze archival data through a policy science lens to examine how electoral, legal, and institutional forces perpetuate barriers to life-saving care for immigrant women.ResultsFour key themes emerged from our analysis: (1) a reactive political environment that amplifies exclusion, (2) decision-making shaped by legal ambiguity, (3) passive enforcement of immigration policies through institutional design, and (4) blame-shifting between public and private healthcare systems. These dynamics collectively sustain health disparities by limiting access to preventive care and delaying treatment among immigrant populations.ConclusionFindings demonstrate that cervical cancer disparities are not solely the result of individual health behaviors but are produced and sustained by structural and political forces. Addressing these disparities requires interdisciplinary partnerships and place-based strategies that confront the institutional barriers embedded in local governance. We call for strategic alliances among researchers, community stakeholders, and policymakers to foster shared accountability and develop responsive, equity-driven policies for addressing cervical cancer and other preventable conditions in immigrant communities.

Access to healthy foods, especially for those who are living with diabetes and hypertension, is crucial in managing these chronic diseases. This study evaluates the implementation of a food pharmacy and food prescription program at a safety-net hospital that serves vulnerable populations. Patients who screen as food insecure using the USDA adult food security survey receive a referral from the physician to the food pharmacy program where a dietician reviews their dietary requirements based on their chronic disease and develops a diet plan. Patients then receive fresh produce, meats and other products every 2 weeks that meets their nutritional needs from the food pharmacy. Biometric data from the patient's most recent clinic visit at the time of enrollment was collected as the baseline measures including blood pressure, weight, and HbA1c (if diabetic). Additionally, biometric information was collected from the patient's medical records from regularly scheduled clinic visits at 6 month intervals. A total of 266 patients were enrolled in the program during the 13-month period that was studied (121 patients with 6-month data and 68 patients with 12-month data). The statistical analysis showed a significant improvement in diastolic blood pressure at 12 months and in weight at both the 6 months and 12 months timeframes when comparing to baseline biometrics.

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.

ContextPresenting the COVID-19 crisis as a pandemic misleadingly implies a certain homogeneity between the regions of the Globe in terms of their burden and reactions. However, from the outset of the crisis, countries presented different epidemiological realities and sometimes adopted divergent, even opposing measures. Curiously, the heterogeneity of responses persisted as scientific evidence accumulated about COVID-19 and the strategies for dealing with it.Case studyThis commentary aims to recount the specific experience of Burkina Faso, and how it reoriented its initial biomedical response into a multisectoral strategy. Burkina Faso set up a committee specifically to examine the effects not only of the pandemic, but also of the control measures. This committee was mandated to decompartmentalize the lens through which the COVID-19 was dealt with. It entered into dialogue with a level of stakeholders often overlooked during national health crisis: communities. As a member of this "National Committee for Crisis Management of the Pandemic", one of the co-authors contributed to its orientations and has witnessed first-hand some of the challenges it faced.RecommendationsThis experience suggests that the project of extricating the field of public health from medicine is advancing in Burkina Faso. In order to manage future crises more effectively and across different sectors, there is an urgent need to establish state structures and to strengthen public health systems. States need coordination units that have the legitimacy, authority and resources required to mobilize a variety of actors at the community, national and international levels.

BackgroundCommunity-based participatory research coproduces knowledge by emphasizing bidirectional exchanges between participants, communities, and researchers.Purpose, Research Design, and Study SampleWe highlight three studies in historically marginalized communities on separate continents (Richmond, CA, USA; Rio de Janeiro, Brazil; Marseille industrial zone, France) to exemplify how community-based participatory research improves research, offers tangible community benefits, and values residents more than traditional research methods.Data AnalysisWe provide insights into the process of conducting meaningful community-based participatory epidemiologic research.ResultsIn each of these communities, community-based participatory research led to high-quality research that helped inform context-appropriate policies and programs to improve health and advance health equity in these communities.ConclusionsWe recommend that researchers consistently engage with community members during all phases of research so that they can engage more participants, more deeply in the research process, build local capacity, improve data collection and data quality, as well as increase our understanding of research findings to inform future applied research and practice.