Access to healthcare in superdiverse neighbourhoods

Knowledge-seeking and knowledge sharing of health services across social networks and communities: a scoping review

INTRODUCTION

Lay people's knowledge influences healthcare service utilisation, but the literature on people's knowledge-seeking and sharing about different healthcare services across social networks is patchy and not well integrated. This scoping review was undertaken to map how different studies report healthcare service -related (healthcare) knowledge-seeking or sharing in social circles and to identify evidence gaps for further research.

METHOD

Levac's enhanced scoping review framework was adapted to develop a comprehensive electronic search strategy. Four electronic databases-Medline, Web of Science, PsychINFO, and CINAHL were searched as well as Grey literature. Five per cent of all titles and abstracts screened were screened by a blinded second reviewer. After full-text screening, data were extracted and summarised.

RESULTS

The review included 14 quantitative, 23 qualitative, 2 mixed-method studies, one literature review and one report [N = 41]. Theories included within studies ranged from the socio-ecological model to bricolage. The concept of healthcare-related knowledge was generally ill defined and usually positioned within the concept of health literacy more generally. Lay people's healthcare knowledge was not generally considered as a distinct entity in a holistic sense, with only two studies identified which investigated healthcare knowledge exclusively at inter-personal (meso) levels. However, included studies showed that people's healthcare knowledge in everyday life is co-constructed when they engage in inter-personal interactions with informal social network ties. People tend to acquire healthcare knowledge from others who share similar lived experiences of using healthcare services, which binds the knowledge seekers through homophily. Due to the social responsibility to help others being ingrained within the community, people (predominantly women), support each other, providing emotional and instrumental support in addition to essential healthcare information. This then builds holistic healthcare literacy, which people conventionally do not gain solely from the knowledge transmitted by healthcare professionals.

CONCLUSION

People in diverse community settings acquired, co-constructed, transmitted, or suppressed knowledge about various healthcare services with the support of informal networks, mostly family and friends, combined with mass media sources. Therefore, people's healthcare knowledge is not an individual asset but a shared resource among their social circles. It is multi-faceted and acquired from diverse sources available in the local and online communities and not limited only to individually held lay accounts of using healthcare services.

Evaluation study of the urban governance of the COVID-19 crisis in the city of Antwerp

BACKGROUND

The COVID-19 pandemic has demanded crisis management at all governance levels. While most research has focused on responses of national governments, city-level governance had significant potential to develop tailored approaches. This study explored how the local COVID-19 response was organised and adapted to the specific city population and context in the City of Antwerp, Belgium.

METHODS

A case study using semi-structured interviews was set up with 20 key informants with a central role in the coordination and implementation of the city-level COVID-19 response in Antwerp. Thematic analysis of transcripts was guided by an adapted version of the OECD risk management cycle.

RESULTS

Respondents' accounts provide a granular understanding of pandemic preparedness, crisis management, and response and adaptation to the COVID-19 crisis in a mid-size European city. Its size was large enough to have a strong capacity within its government bodies, to utilise the expertise of strong partners in the area and to mobilise a critical mass for action, yet small enough to quickly establish connections and trust. In addition to a universal approach, they developed tailored responses to specific neighbourhoods and groups. Well-established community and organisational ties enhanced the effectiveness of grassroots initiatives. The perceived feeling of joint action contributed to a strong collective agency, but respondents noted the need for a system for monitoring and learning.

CONCLUSIONS

Local governments are important to develop tailored strategies and organise a locally relevant crisis response in cities. They need expertise and agency, with enough flexibility to experiment. To harness promising practices and avoid repeating errors in future crises, it is crucial to develop a system that better evaluates and monitors local responses, before, during and after crises.

Differences in STI/HIV Burden and Sexual Health Care-Seeking Behavior Among First- and Second-Generation Migrant and Western-Born Male Sex Workers Who Have Sex With Men in the Netherlands: A Retrospective Cohort Study

BACKGROUND

Globally, migrant sex workers have a higher burden of sexually transmitted infections (STI)/human immunodeficiency virus (HIV). This large study aimed to assess demographics, STI/HIV burden, and sexual health care-seeking behavior of first-generation migrant and second-generation migrant male sex workers who have sex with men (MSW-MSM) versus Western-born MSW-MSM.

METHODS

Coded STI clinic consultations (n = 6970) from 3116 individual MSW-MSM attending any Dutch STI clinic between 2016 and 2021 were included. First-generation migrant: born outside of northern/central/southern/western Europe/North America/Oceania. Second-generation migrant: ≥1parent born outside of northern/central/southern/western Europe/North America/Oceania. Multivariable logistic regression analysis assessed associations between MSW-MSM groups and STI in first consultation in the data. A Cox proportional hazard regression compared the incidence of a first repeat consultation between migration groups, stratified by STI in first consultation. All analyses were adjusted for age and urbanity of STI clinic region.

RESULTS

First-generation migrant MSW-MSM (n = 1085) were mostly born in Latin America (50%), whereas second-generation migrant MSW-MSM (n = 368) mostly originated from North Africa (30.4%). The proportion of STI diagnoses differed (33.2%, 29.3%, 23.3%; P < 0.001) between the first-generation migrant, second-generation migrant, and Western-born MSW-MSM. First-generation migrant MSW-MSM versus Western-born had an adjusted odds ratio of 1.6 (95% confidence interval, 1.3-1.9) of STI diagnosis in the first consultation. First-generation migrant MSW-MSM versus Western-born had an adjusted hazard ratio of 1.5 (95% confidence interval, 1.3-1.8) of having a first repeat consultation at any time, when stratified for no STI in the first consultation.

CONCLUSIONS

The STI/HIV burden is high among all 3 MSW-MSM groups. First-generation migrants have higher odds of STI, but retention in care seems similar. Results highlight the importance of low-threshold STI testing and care for (migrant) MSW-MSM.

The influence of community health on hospitals attainment of Magnet designation: Implications for policy and practice

AIMS

To determine if there is an association between better County Health Rankings and the increased odds of a hospital gaining Magnet designation in subsequent years (2014-2019) compared with counties with lower rankings.

BACKGROUND

The Magnet hospital model is recognized to have a great effect on nurses, patients and organizational outcomes. Although Magnet hospital designation is a well-established structural marker for nursing excellence, the effect of County Health Rankings and subsequent hospital achievement of Magnet status is unknown.

DESIGN

A descriptive, cross-sectional quantitative approach was adopted for this study.

METHODS

Data were derived from 2010 to 2019 U.S. County Health Rankings, American Hospital Association, and American Nursing Credentialing Center databases. Logistic regression models were utilized to determine associations between county rankings for health behaviours, clinical care, social and economic factors, physical environment and counties with a new Magnet hospital after 2014.

RESULTS

Counties with the worst rankings for clinical care and socio-economic status had reduced odds of obtaining a Magnet hospital designation compared with best-ranking counties. While middle-ranking counties for the physical environment ranking had increased odds of having Magnet designation compared with best-ranking counties. Additionally, having an increased percent of government non-federal hospital or a higher percentage of critical access hospitals in the county reduced the odds of having a Magnet-designated facility after 2014.

CONCLUSION

The findings underscore the important associations between Magnet-designated facilities' location and the health of its surrounding counties. This study is the first to examine the relationship between County Health Rankings and a hospital's likelihood of obtaining Magnet status and points to the need for future research to explore outcomes of care previously identified as improved in Magnet-designated hospitals.

IMPLICATIONS

Recognizing the benefits of Magnet facilities, it is important for health care leaders and policy makers to seek opportunities to promote centres of excellence in higher need communities through policy and financial intervention.

Consultation rate and chlamydia positivity among ethnic minority clients at STI clinics in the Netherlands

Objectives

Although ethnic minority clients (EMs) from STI endemic countries have a higher risk for STI, little is known about their STI clinic consultation rate proportionality. The aim of this study was to assess consultation and chlamydia positivity rates among different EMs visiting STI clinics in the Netherlands.

Methods

We calculated consultation rates in EM groups by dividing the number of STI consultations by the total number of inhabitants in the region belonging to an EM, then compared the EM rates to native Dutch rates. Factors associated with chlamydia positivity were analysed using multivariate regression analysis.

Results

A total of 23,841 clients visiting an eastern Netherlands STI clinic between 2011 and 2013 were included in the analysis, of which 7% were EMs. The consultation rate of native Dutch clients was 22.5 per 1000, compared to 8.5 per 1000 among EMs. Consultation rates in all EMs were lower than in Dutch clients, except for Antillean or Aruban EMs and Latin American EMs.

The chlamydia positivity rate among all clients was 15.5%, and Antillean or Aruban ethnicity (27.1%) EMs had the highest rates. Multivariate analysis identified the following factors associated with chlamydia positivity: Eastern or Northern European EM, African EM, Antillean or Aruban EM, STI related symptoms, heterosexual preference, partner in a risk group, receiving a partner notification, and having had three or more partners in the past six months.

Conclusion

On a population level, most EMs visit STI clinics less often than native Dutch clients, but they have a higher rate of positive chlamydia diagnoses. STI clinics should increase outreach activities for EM clients because they are insufficiently reached by current practices, but contribute substantially to chlamydia incidence rates.

'If there were doctors who could understand our problems, I would already be better': dissatisfactory health care and marginalisation in superdiverse neighbourhoods

How people in community settings describe their experience of disappointing health care, and their responses to such dissatisfaction, sheds light on the role of marginalisation and underlines the need for radically responsive service provision. Making the case for studying unprompted accounts of dissatisfaction with healthcare provision, this is an original analysis of 71 semi-structured interviews with healthcare users in superdiverse neighbourhoods in four European cities. Healthcare users spontaneously express disappointment with services that dismiss their concerns and fail to attend to their priorities. Analysing characteristics of these healthcare users show that no single aspect of marginalisation shapes the expression of disappointment. In response to disappointing health care, users sought out alternative services and to persuade reluctant service providers, and they withdrew from services, in order to access more suitable health care and to achieve personal vindication. Promoting normative quality standards for diverse and diversifying populations that access care from a range of public and private service providers is in tension with prioritising services that are responsive to individual priorities. Without an effort towards radically responsive service provision, the ideal of universal access on the basis of need gives way to normative service provision.

Collaboration with community connectors to improve primary care access for hardly reached people: a case comparison of rural Ireland and Australia

BACKGROUND

This study presents a way for health services to improve service access for hardly reached people through an exploration of how staff can find and collaborate with citizens (referred to as connectors) who span socio-cultural boundaries in their community. The study explored the local socio-cultural contexts of connectors' boundary spanning activities and if they are health related; boundary spanning occurring between connectors and health professionals at the interface of health systems and community; and the opportunities and barriers to actively seeking out and collaborating with community connectors to access marginalised and hardly reached people.

METHODS

We conducted a qualitative case comparison from rural Ireland and Australia. Following purposive snow-ball sampling techniques to recruit participants, semi-structured interviews were conducted with 34 community informants, 21 healthcare staff and 32 connectors. Transcripts were coded and analysed using an inductive approach to ascertain categories and overall themes.

RESULTS

We found a diverse sample of connectors relating to heterogenous, small and locally distinct groups of hardly reached people. Overall 26 connectors were active at the interface between health services and the community, with variation in how this occurred between cases. The majority (21) described one or more health related activities with hardly reached people. All connectors expressed a willingness to develop a relationship with local health services on issues they identified as relevant. Barriers to collaborations between connectors and health services related to bureaucracy, workload, and burnout.

CONCLUSIONS

Collaborating with connectors has potential as one strategy to improve access to health services for hardly reached people. To enact this, health staff need to identify local socio-cultural boundaries and associated connectors, facilitate two-way connections at the boundary between health services and community and enable collaboration by attending to activities in the community, at the interface between health services and community, and within the health system.