Community health equity research & policy最新文献

Social determinants of health, the effects of colonialism, and systemic injustices result in some groups being at disproportionately higher risk for developing type 2 diabetes (T2D). Many T2D prevention programs have not been designed to provide equitable and inclusive care to everyone. This paper presents an example of the steps taken in an evidence-based community T2D prevention program, Small Steps for Big Changes (SSBC), to improve equitable access and inclusivity based on input from a stakeholder advisory group and the ConNECT Framework. To improve reach to those most at risk for T2D, SSBC has changed both eligibility criteria and program delivery. To ensure that all testing is done in an inclusive manner, changes have been made to measurements, and to training for those delivering the program. This paper also provides actionable recommendations for other researchers to incorporate into their own health programs to promote inclusivity and ensure that they reach those most at risk of T2D.

The novel Coronavirus (COVID-19) is a highly contagious viral illness that has caused the most significant global health crisis in recent human history. Individuals experiencing homelessness represent one of the more vulnerable populations for COVID-19 infection and morbidity. Amongst individuals experiencing homelessness in Phoenix, a student-led interprofessional organization called Street Medicine Phoenix (SMP) sought to both reduce the risk of COVID-19 transmission and morbidity/mortality related to infection. Through collaborations with the Maricopa County Department of Public Health and various community organizations, SMP developed a format for street-based vaccination clinics. SMP deployed these clinics on numerous occasions to the streets directly surrounding the community homeless shelter, allowing SMP to vaccinate individuals directly in their encampments. Through SMP's efforts starting in February 2021, 400 individuals experiencing homelessness have received at least one COVID-19 vaccine. Challenges encountered included low health literacy, lack of established rapport and trust, low vaccine confidence, difficulty verifying patients' vaccination status, difficulty obtaining sufficient information from patients to create a record in the Arizona State Immunization Information System (ASIIS), monitoring patients post-vaccination, transporting vaccine supplies from encampment to encampment, and lack of patient awareness of the mobile vaccine clinic services. Despite challenges, SMP's outreach efforts have demonstrated the feasibility and importance of mobile public health services to reach homeless encampments, particularly mobile vaccination clinics in response to disease outbreaks, and the necessity of strategic partnerships with community agencies to effectively meet the needs of underserved populations.

Local health departments (LHDs) play a leading role in eliminating health inequities as they proactively identify and address barriers to optimal health within the community they serve. This study evaluated a Midwestern County LHD's commitment, collaborations, and capacity to advance health equity in their organization. A total of 81 employees completed the online survey (response rate = 51%) and 12 among randomly selected employees completed the qualitative interviews (31.5%). More than 75% of participants reported that all departments had explicit work plans and 50% had a strong capacity to address social determinants of health. Almost 50% of the participants reported strong internal collaboration, but less than 25% indicated that no external partners were involved during the program planning process. Finally, a few participants identified the need for increased diversity in leadership and expressed the importance of quality training and feedback.

Background: Equity-deserving groups face well-known health disparities that are exacerbated by rural residence. Health technologies have shown promise in reducing disparities among these groups, but there has been no comprehensive evidence synthesis of outcomes.

Purpose: The purpose of this systematic review was to examine the patient, healthcare, and economic outcomes of health technology applications with rural living equity-deserving groups.

Research design: The databases searched included Medline and Embase. Articles were assessed for bias using the McGill mixed methods appraisal tool.

Analysis: Data were synthesized narratively using a convergent integrated approach for qualitative and quantitative findings.

Results: This evidence synthesis includes papers (n = 21) that reported on health technologies targeting rural equity-deserving groups. Overall, patient outcomes - knowledge, self-efficacy, weight loss, and clinical indicators - improved. Healthcare access improved with greater convenience, flexibility, time and travel savings, though travel was still occasionally necessary. All studies reported satisfaction with health technologies. Technology challenges reported related to connectivity and infrastructure issues influencing appointment quality and modality options. While some studies reported additional costs, overall, studies indicated cost savings for patients.

Conclusions: There is a paucity of research on health technologies targeting rural equity-deserving groups, and the available research has primarily focused on women. While current evidence was primarily of high quality, research is needed inclusive of equity-deserving groups and interventions co-designed with users that integrate culturally sensitive approaches. Review registered with Prospero ID = CRD42021285994.

The primary objective of this research was to describe the prevalence of violence against older adults according to sexual orientation as documented in the Notifiable Diseases Information System (SINAN) in Brazil. SINAN is a national database that compiles violence-related notifications reported by healthcare services. This ecological study analyzed aggregated data at the population level, focusing on violence notifications involving individuals aged 50 and above from 2017 to 2021. The data underwent descriptive and bivariate statistical analyses, adhering to a significance level of 5%. The completeness percentage of the sexual orientation variable ranged from 70% to 72%. Our analysis detected noteworthy disparities in the distribution of violence notifications based on sexual orientation. Specifically, lesbians had the highest incidence rates of physical violence compared to heterosexual and bisexual women. In a broader context, women demonstrated a higher susceptibility to psychological violence, with bisexual women experiencing a notably elevated prevalence (41.67%). Reports of physical and psychological violence differed based on contextual variables, such as race, education level, and geographic region. We hereby conclude that the disparities found in violence notifications underscore a troubling situation faced by older adults within the LGB community, with a particular emphasis on the challenges encountered by bisexual individuals. Improving cultural competence in health systems is essential to enhancing data collection and understanding the complexities of violence against this population.

This study examines the work of a collective of community-based Indigenous health rights activists in southern Peru who, at the height of the pandemic, designed, recorded, and disseminated seven Quechua language and culturally tailored Public Service Announcements for radio broadcast to provide information about COVID-19 vaccines. The activists took initiative amid a dysfunctional vaccine roll-out, when vaccination rates in their region were among the lowest in the country, and when mortality rates from COVID-19 were very high. The experiences of the activist collective, including their participatory, community-based approach and their connections with health workers, demonstrate the importance of pre-existing, strong, respectful relationships between communities and health systems in times of public health crisis. This is not an easy task given that relationships between communities and Peru's government-run health system are complex and shaped by dynamics of power, including colonial legacies and contemporary injustices. This case critically reflects on the notion of resilience and provides insights into the enduring struggles by Indigenous activists to decolonize and strengthen the public health system by pushing for forms of community participation based on substantive partnerships with community-based actors that genuinely integrate their knowledge and expertise.

Background: The nutritional health of tamariki (children) in Aotearoa New Zealand (NZ) is poor. Nourishing Hawke's Bay (NHB) began as an initiative to address this problem in low advantage regions of Hawke's Bay (HB) and evolved into the evaluation of Ka Ora. Ka Ako the free, healthy school lunch programme, and the scoping of wider improvements in the regional food ecosystem.

Purpose: The aim of this paper is to describe how NHB co-designed and evaluated food interventions incorporating systems thinking and mātauranga Māori (traditional knowledge), as lenses through which to view the initiative.

Study sample and research design: Cognitive mapping interviews (n = 11) with community health and education leaders identified six key co-design principles or Pou (metaphorical posts) for NHB.

Data collection: Further systems methods, such as group model building and system dynamics modelling, and mātauranga Māori methods, such as wānanga (Māori learning forums), involved the community in food systems mapping and intervention co-design and prioritisation.

Results: Three Pou, 'food security,' 'mātauranga Māori' and 'children's hauora' (wellbeing), set the research agenda for NHB. the other three Pou, 'work with community,' 'cohesion and integration' and 'start with schools,' determined the subsequent research processes. Along with standard population evaluation methods (including quantitative and qualitative assessments of changes in student health and wellbeing), a participatory Value for Investment (VFI) analysis assessed return on investment.

Conclusions: Combining systems thinking and mātauranga Māori is a novel, participatory approach co-creating pathways to improved nutrition and food security for tamariki and holds promise for wider food system changes in regional NZ.

Purpose: Racial disparities in homelessness are pervasive and necessitate sustained effort on improving racial equity in homeless services. This study used a community-engaged approach and qualitative methods to describe the role of informal organizations identified by Black adults with lived experience of homelessness as preferred locations for accessing services and to explore the values and beliefs of these informal organizations. The study included representatives (N = 19) of community organizations (N = 17) in one southern city. Most participants (n = 14, 73.6%) worked in paid positions and included executive directors as well as volunteers.

Findings: Thematic analysis identified three themes that characterized values and the ways in which these organizations interface with one another and with the formal homelessness response system (HRS): boots-on-the-ground, the homelessness response system is inequitable, and cautious collaboration. Findings reveal avenues through which local collaboration can be improved and potential policies to improve racial equity in homeless services.

Conclusions: Informal organizations fill critical gaps in services and can reach people experiencing homelessness who are unable or unwilling to access formal services. However, informal organizations often remain disconnected from the larger HRS which can exacerbate racial inequities. Community care hubs are a promising solution to incorporating smaller organizations and building a more integrated and equitable HRS.

Background: Socio-economically disadvantaged women have poor maternal health outcomes. Maternal health interventions often fail to reach those who need them most and may exacerbate inequalities. In Bauchi State, Nigeria, a recent cluster randomised controlled trial (CRCT) showed an impressive impact on maternal health outcomes of universal home visits to pregnant women and their spouses. The home visitors shared evidence about local risk factors actionable by households themselves and the program included specific efforts to ensure all households in the intervention areas received visits.

Purpose: To examine equity of the intervention implementation and its pro-equity impact.

Research design and study sample: The overall study was a CRCT in a stepped wedge design, examining outcomes among 15,912 pregnant women.

Analysis: We examined coverage of the home visits (three or more visits) and their impact on maternal health outcomes according to equity factors at community, household, and individual levels.

Results: Disadvantaged pregnant women (living in rural communities, from the poorest households, and without education) were as likely as those less disadvantaged to receive three or more visits. Improvements in maternal knowledge of danger signs and spousal communication, and reductions in heavy work, pregnancy complications, and post-natal sepsis were significantly greater among disadvantaged women according to the same equity factors.

Conclusions: The universal home visits had equitable coverage, reaching all pregnant women, including those who do not access facility-based services, and had an important pro-equity impact on maternal health.

Despite the safety and effectiveness of the COVID-19 vaccine, public hesitancy about receiving vaccination remains strong among disproportionately affected populations in the United States. To design more locally and culturally appropriate strategies, research is needed to explore the qualitative characteristics of vaccine hesitancy in these populations. Thus, we conducted in-depth interviews with 19 Indigenous and 20 rural participants and utilized a grounded theory approach to identify factors associated with their COVID-19 vaccine decision making. Wariness regarding safety of vaccines, resignation over the quality of available health care, and a historical mistrust of government-led interventions influenced vaccine rejection for indigenous participants. Rural participants remained divided on the perceived threat and consequences of COVID-19 and the efficacy and safety of the vaccines. The influence of friends and family members impacted vaccine hesitancy, as did discussions with healthcare providers when discussions were perceived to be respectful, sensitive, and non-judgmental.