Community health equity research & policy最新文献

There is a pressing need for research that prioritizes the inclusion of diverse communities in the alcohol research field. A community-engaged approach can lead to more sustainable approaches, enhance buy-in, and lead to actions that are more equitable. The Community Engagement Studio (CES) model, which facilitates discussions between researchers, community engagement coordinators, and community experts, is one structured method to support conducting community-engaged research. In our creative alcohol study, we utilized Collaborative Filmmaking (CF) - a participatory, visual research method - to explore structural and neighborhood effects on alcohol use. We applied the CES model to enhance our study with community input prior to launch, which is particularly important when applying novel methodologies. The CES discussion illuminated several topics for the research team to consider regarding research study logistics (e.g., filmmaking prompts, recruitment, filmmaking support) and how to approach the research topic of alcohol use (e.g., trauma, sensitivity). This allowed the research team to make critical adjustments to their approach to ensure the tools, data collection techniques, and recruitment methods were appropriate. Input from community experts also uncovered important considerations related to trauma, ethics, and trust, which are vital for creative, participatory health research. Overall, the CES served as a valuable model for fostering community dialogue and can be used to enhance the impact of creative research.

BackgroundThe 'Guidelines on Midwifery Services Initiative, 2018' introduces the Nurse Practitioner in Midwifery (NPM) cadre to improve maternal mortality rates, quality of care, and reduce overmedicalisation in the Indian public health system. The paper examines how the NPM cadre is envisioned in the guidelines, positioned within the medical hierarchy, and aligned within the existing maternal health context. It also looks at how existing midwives and midwifery advocates perceive the changes introduced and the accompanying professionalisation process.MethodologyThe study employed two methods: (a) qualitative document analysis (QDA) of the midwifery guidelines and (b) semi-structured in-depth interviews with 14 nurse-midwifery leaders and advocates.FindingsThe QDA uncovers the underlying themes of task shifting and institutional deliveries as dominant, discussions on professional autonomy and primary health care receiving less importance and even less reflection on the history of midwifery in India. The interview findings highlight (a) tensions around carving out a separate profession, (b) the implications of midwifery at the primary healthcare level and (c) the need for an enabling environment for midwives. This paper reveals how the guidelines frame midwifery as a cost-effective, specialised nursing care within the institutional delivery framework and distanced from its traditional connotations.DiscussionIt elucidates tensions around autonomous midwifery involving professional boundaries, negotiations with medical professionals, institutional perceptions, and historical stereotypes. It builds on the broader literature on 'professions' in sociology by identifying aspects of 'professional boundary work' embedded in policy documents and experiences of participants - thereby unpacking the midwifery professionalisation process in the Indian context.

Objective: To describe the creation, deployment, and initial impact of a place-based, multi-level, multi-component initiative designed to prevent cardiovascular health disparities in high-risk neighborhoods in Indianapolis, Indiana. Methods: The Indianapolis Health Equity Access outReach & Treatment (iHEART) Collaborative uses a community-driven, place-based approach and leverages partnerships with local organizations, businesses, and residents to implement health screenings, educational outreach, and support for social determinants of health (SDOH). Results: From September 2022 - September 2024, iHEART conducted 4048 blood pressure screenings; 3135 in community settings. >38% of participants were identified as having Stage 1 hypertension or being at risk. 29% of 1219 individuals with elevated CVD risk were previously undiagnosed. 94.6% of 223 individuals referred for medical care completed follow-up care. Barbershop 2.0 screened 378 patrons, with 126 returning for additional screenings. >50% of these returning participants demonstrated improvements between their initial and follow-up screenings. The Convenient Home Evaluation for Cardiovascular Health and Individual Tracking (CHECK-IT) program enrolled 1105 patients; 63.9% achieved blood pressure control, or their last recorded blood pressure reading below 140/90 mmHg, by the end of the 4-month program. Conclusions: iHEART's approach highlights the potential benefits of combining health and SDOH interventions, offering a promising model for addressing health inequities.

Background: Despite the previous success of a universal health care system, Sri Lanka is facing novel challenges including non-communicable diseases such as diabetes and cancer, an aging population, and most recently, the COVID-19 pandemic. Previous pandemic and disaster responses worldwide have centered local community approaches as crucial for effective solutions. However, there is a gap in the literature surrounding the role of community organizations in Sri Lanka's public health response. Purpose: This study investigates the role of community-based responses during the COVID-19 pandemic in Sri Lanka through the perspective of public health professionals and nongovernmental organization (NGO) affiliates. Research Design: The study is based on qualitative interviews and the antecedent literature review, used to triangulate the collected qualitative data.Study Sample: Ten interviews were conducted to gain an understanding of the role of community organizations in Sri Lanka's COVID-19 pandemic response from both those who work within the public health sector as well as community organizations that assisted with public health efforts. Results: Findings demonstrate that community organizations aided in the COVID-19 response through various forms of hands-on support, most commonly including fundraising and the provision of resources, food, safety equipment, and educational materials. In addition, community organizations' were most successful in navigating the pandemic climate when they communicated closely with communities, engaged in ongoing collaboration with the government, and used innovative strategies. Conclusion: We see this work as exploratory and important for informing future research on the Sri Lankan public health context. Our findings suggest that community organizations should not be overlooked in global public health contexts as they are often well positioned to combat arising public health issues through their unique networks and potential for new and creative solutions.

Twenty years of existing medical literature speak to a global interest in interprofessional experiences and the role of community engagement in the formation of 21st century health professionals, with recent literature highlighting shortcomings in the ability to form satisfactory therapeutic alliances with patients of lower socioeconomic status. A paucity of literature regarding effective interventions to rectify these gaps in care remains. This manuscript reports the findings of a retrospective analysis of participant satisfaction with Programa Candeal, a previously un-evaluated interprofessional health education program at the Bahiana School of Medicine and Public Health in Salvador, Brazil, seeking to improve the capacity of health professional students to work successfully on interdisciplinary health care teams through hands-on experience interacting with disenfranchised populations outside of the traditional roles of provider and patient. Results of a mixed quantitative-qualitative survey reveal that Programa Candeal is successful in encouraging health professional students to practice community engagement, cultivates a literacy with the concept of multi professional teamwork, and promotes humanistic interactions with community members at some of the widest socioeconomic divides in Brazil. This manuscript also highlights the relative ease of implementing a semi-automated online evaluation protocol without undue administrative burden in a low-resource environment.

Global learning is the practice of adopting and adapting global ideas to local challenges. To advance the field of global learning, we performed a case study of five communities that had implemented global health models to advance health equity in a U.S. setting. Surveys were developed using a Consolidated Framework for Implementation Research (CFIR) framework, and each site completed surveys to characterize their global learning experience with respect to community context, the learning and implementation process, implementation science considerations, and health equity. The immense diversity of sites and their experiences underscored the heterogenous nature of global learning. Nonetheless, all cases highlighted core themes of addressing social determinants of health through strong community engagement. Cross-sector participation and implementation science evaluation were strategies applied by many but not all sites. We advocate for continued global learning that advances health equity and fosters equitable partnerships with mutual benefits to origination and destination sites.

Background: Some residents in predominantly Black communities face significant challenges in accessing healthy food. However, urban agriculture is a growing sector that aims to increase overall food production, access to affordable and nutritious produce, and potentially improve community food security.

Purpose: This study aimed to provide insight into barriers and strategies that urban agriculture growers and advocates identified for accessing urban agriculture markets in their communities.

Research design and study sample: We interviewed and conducted focus groups with 17 urban growers and local food advocates that work in predominantly Black communities in Chicago.

Data collection and/or analysis: Understanding the complexities of access to healthy food can be challenging; therefore, we used the concept of access - accessibility, availability, affordability, accommodation, and acceptability - to better understand these barriers.

Results: Key barriers were the lack of accessibility to traditional food retailers, high availability of processed foods, and cultural acceptability of urban-produced foods.

Conclusion: Building urban agriculture networks to support growers, connect with consumers, and emphasize political engagement can help to diversify and grow urban agriculture.

In this paper we develop and provide a novel account of the process through which the Accredited Social Health Activists (ASHAs), a cadre of seemingly powerless community health workers in India, are navigating a complex policy process to incrementally achieve their goals. ASHAs have been demanding better working conditions, better compensation, and regularisation as public service employees through protests and strikes and have managed to gain concessions from both the Central and various State governments. We observed two important aspects that emerged: (a) ASHAs achieved incremental increases in their wages despite being the lowest in the health system hierarchy, and, (b) major gains were made during the 2 years of the pandemic. We examine and analyse ASHAs' engagement and strategies used, both overt and covert, sometimes with the government, and the role of other actors in determining these policy outcomes. We do so by drawing on academic literature and news media reports; we trace the changes in ASHAs' wages by tying together key events, 'windows of opportunity', and actions of 'policy entrepreneurs' involved in the process.In doing so, we further develop and propose an extension to Kingdon's multiple streams policy framework through the addition of a 'narrative stream'.

Background: The study looks into the condition of elderly Covid-19 patients regarding the kind of attention they received during the pandemic given the scarcity of medical resouces in the countries mentioned in this investigation. In this case, we apply the bioethical principle of justice on the age-based criteria in determining which patient must receive treatment The argument is that the same is a form of discimination against the elderly.

Purpose: The purpose of this study is to emphasize that the age-based criteria in deciding whether to treat elderly Covid-19 patients or not is violative of the bioethical principle of justice since it discriminates against them.

Method: This study uses the interpretive method. The authors analyzed the literature and the arguments pertaining to the issue of ageism at the height of the Covid-19 Pandemic. We mentioned the countries where the issue of prioritization was a big concern. The qualitative analysis in this paper is meant to respond to such medical dilemma.

Analysis: In our analysis, we determined that when age is used as a criterion, it violates the bioethical principle of justice. The principle is meant to ensure that physicians are fair in dealing with patients. Using age in deciding whether a life is worth saving or not is a prejudice against old people who require care and attention.

Discussion: Medical doctors must treat patients equally and without bias. The challenge, however, is that due to the unprecedented nature of the pandemic, a triage is put in place to be able to manage the overwhelming influx of Covid-19 patients. Some age-based medical treatment criteria that recommend age-based cutoffs for specific treatments are morally untenable. This is because the same is bereft of any acceptable justification that warrants the judgment that the elderly must have less priority when medical resources are scarce.

Conclusion: In conclusion, doctors must not discriminate patients on the basis of age. All lives are equal in moral worth. We argue that governments must promulgate non-discriminatory policies when it comes to medical treatment during a global public health emergency.

This commentary makes the case for greater collaboration between public health professionals and integrative, complementary and traditional health practitioners (ICTHP). Previous partnerships have been successful, and more such collaborative work is needed to help overcome division, enhance the health workforce, and move all involved toward shared goals. ICTHP providers may be uniquely able to work across ideological differences and engage individuals and communities who are less trusting of public health, including those who are vaccine hesitant. Diverse partnerships can be difficult to maintain, but the application of equitable processes may aid their success. In the face of highly complex public health challenges, partnerships with ICTHP are critical.