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Rao S, Dimitropoulos G, Jardine R, Quickstad J, Satam L, Qureshi M, Bui T, Todorova AA, Tumaneng Y, Suthakaran A, Dalley K, Smith S, Patten SB. Primus Inter PARES: First among equals-practical strategies for young adult PAtient RESearch partners (PARES) by young adult PARES. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:45. [PMID: 38720386 PMCID: PMC11077772 DOI: 10.1186/s40900-024-00576-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/18/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND This manuscript is coauthored by 15 young adult Patient RESearch partners (PARES) with lived and living mental health experiences and three institutional researchers across Canada involved in a patient-oriented research (POR) study called the HEARTS Study: Helping Enable Access and Remove Barriers To Support for Young Adults with Mental Health-Related Disabilities. We share our reflections, experiences and lessons learned as we grapple with the field of POR for its lack of clarity, hierarchical structures, internalized ableism, and accessibility challenges, among others. To mitigate the difficulties of POR, we started by laying the groundwork for equality by embracing the principle of Primus Inter Pares: First Among Equals as the foundation of our approach. In this way, we began with what we know for certain: the inherent worth and dignity of young adults as equal partners, recognizing their expertise, worldviews, creativity, and capacity to contribute meaningfully and intentionally to the research that affects their lives and futures. MAIN BODY The manuscript underscores the need to reconceptualize meaningful engagement in POR, advocating a shift from traditional, biased paradigms that fail to address the complexities faced by young adults with mental illness. It introduces what we have termed Adaptive and Differential Engagement, underscoring the necessity of tailoring participation to individual preferences and circumstances alongside a Tripartite Compensation model that promotes fair and holistic remuneration in research collaborations. Then we discuss the approaches we have conceptualized, such as Equitable Dialogue, Trust Architecture, Community Continuum, Unity in Diversity, Shared Stewardship, and Agile Frameworks that collectively aim to overcome barriers like language intimidation, power imbalances, framework fatigue, consultation burnout, trust deficits, and systemic discrimination and exclusion. The manuscript does not seek to prescribe any universal or standardized solutions; in fact, it seeks the opposite. Instead, it offers a thoughtful and transparent contribution to the POR canon, providing resources for young adults eager to engage in research and institutional researchers aspiring to collaborate with them. CONCLUSION This manuscript is a product of our collective learning and critical self-evaluation. By integrating theoretical insights with practical strategies, we present a justice-oriented blueprint for an inclusive and egalitarian approach to POR. We advocate for applications of POR that are responsive to the individualized contexts of young adult PARES, ensuring their perspectives are central to the research with the resources to take the lead should they choose.
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Affiliation(s)
- Sandy Rao
- Faculty of Social Work, University of Calgary, Calgary, Canada.
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada.
| | - Gina Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, Canada
- Department of Psychiatry, University of Calgary, Calgary, Canada
- Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Canada
| | - Rae Jardine
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Julien Quickstad
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Laetitia Satam
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
- University of Alberta, Edmonton, AB, Canada
| | - Mohammad Qureshi
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Thyra Bui
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Antoaneta Alexandrova Todorova
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ysabelle Tumaneng
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Abitha Suthakaran
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Kaiden Dalley
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Stacie Smith
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
- Faculty of Education, Mount Saint Vincent University, Halifax, NS, Canada
| | - Scott B Patten
- Department of Psychiatry, University of Calgary, Calgary, Canada
- Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
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Renner HM, Rowland B, Hutchinson D, Toumbourou JW. The role of adolescent social inclusion in educational attainment among vulnerable youth. Child Adolesc Ment Health 2024; 29:161-169. [PMID: 38500401 PMCID: PMC11047753 DOI: 10.1111/camh.12709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Completing high school enables access to educational and employment opportunities associated with better physical and mental health and improved quality of life. Identifying modifiable factors that promote optimal educational trajectories for youth experiencing disadvantage is an important research focus. Social inclusion has been theorised to play a role in promoting better educational outcomes for this priority population, however limited research has examined this relationship. METHOD This study used three waves of data from the state-representative Australian arm of the International Youth Development Study (IYDS) (youngest cohort, N = 733; 54% female, 95% Australian born) to examine the extent to which vulnerability in primary school (Grade 5; Mage = 10.97, SD = 0.38) and social inclusion in mid-adolescence (Year 10; Mage = 15.50, SD = 0.53), were associated with school completion in young adulthood (post-secondary; Mage = 19.02, SD = 0.43). RESULTS Regression models identified an interaction between social inclusion and vulnerability (OR = 1.37, 95% CI [1.06, 1.77], p = .016), indicating that the association between vulnerability and school completion varied as a student's level of social inclusion increased. Higher social inclusion was beneficial for youth with lower levels of vulnerability but did not appear to influence school completion for the most vulnerable students. CONCLUSIONS For many young people, promoting social inclusion may support engagement in education and play a protective role. However, further research is needed to better understand the role of social inclusion for highly vulnerable youth, particularly the mechanisms via which social inclusion may have differential effects on school completion.
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Affiliation(s)
- Heidi M Renner
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Faculty of Health, Deakin University, Geelong, Vic., Australia
| | - Bosco Rowland
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Faculty of Health, Deakin University, Geelong, Vic., Australia
- Eastern Health Clinical School & Monash Addiction Research Centre, Monash University, Richmond, Vic., Australia
| | - Delyse Hutchinson
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Faculty of Health, Deakin University, Geelong, Vic., Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Vic., Australia
- Department of Paediatrics, Royal Children's Hospital, University of Melbourne, Melbourne, Vic., Australia
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - John W Toumbourou
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Faculty of Health, Deakin University, Geelong, Vic., Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Vic., Australia
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Mulvale G, Green J, Robert G, Larkin M, Vackerberg N, Kjellström S, Hossain P, Moll S, Lim E, Craythorne SL. Adopting, implementing and assimilating coproduced health and social care innovations involving structurally vulnerable populations: findings from a longitudinal, multiple case study design in Canada, Scotland and Sweden. Health Res Policy Syst 2024; 22:42. [PMID: 38566129 PMCID: PMC10988938 DOI: 10.1186/s12961-024-01130-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Innovations in coproduction are shaping public service reform in diverse contexts around the world. Although many innovations are local, others have expanded and evolved over time. We know very little, however, about the process of implementation and evolution of coproduction. The purpose of this study was to explore the adoption, implementation and assimilation of three approaches to the coproduction of public services with structurally vulnerable groups. METHODS We conducted a 4 year longitudinal multiple case study (2019-2023) of three coproduced public service innovations involving vulnerable populations: ESTHER in Jönköping Region, Sweden involving people with multiple complex needs (Case 1); Making Recovery Real in Dundee, Scotland with people who have serious mental illness (Case 2); and Learning Centres in Manitoba, Canada (Case 3), also involving people with serious mental illness. Data sources included 14 interviews with strategic decision-makers and a document analysis to understand the history and contextual factors relating to each case. Three frameworks informed the case study protocol, semi-structured interview guides, data extraction, deductive coding and analysis: the Consolidated Framework for Implementation Research, the Diffusion of Innovation model and Lozeau's Compatibility Gaps to understand assimilation. RESULTS The adoption of coproduction involving structurally vulnerable populations was a notable evolution of existing improvement efforts in Cases 1 and 3, while impetus by an external change agency, existing collaborative efforts among community organizations, and the opportunity to inform a new municipal mental health policy sparked adoption in Case 2. In all cases, coproduced innovation centred around a central philosophy that valued lived experience on an equal basis with professional knowledge in coproduction processes. This philosophical orientation offered flexibility and adaptability to local contexts, thereby facilitating implementation when compared with more defined programming. According to the informants, efforts to avoid co-optation risks were successful, resulting in the assimilation of new mindsets and coproduction processes, with examples of how this had led to transformative change. CONCLUSIONS In exploring innovations in coproduction with structurally vulnerable groups, our findings suggest several additional considerations when applying existing theoretical frameworks. These include the philosophical nature of the innovation, the need to study the evolution of the innovation itself as it emerges over time, greater attention to partnered processes as disruptors to existing power structures and an emphasis on driving transformational change in organizational cultures.
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Affiliation(s)
- Gillian Mulvale
- DeGroote School of Business, McMaster University, 4350 South Service Road, Suite 421, Burlington, ON, L7L 5R8, Canada.
| | - Jenn Green
- DeGroote School of Business, McMaster University, 4350 South Service Road, Suite 421, Burlington, ON, L7L 5R8, Canada
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
- The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Michael Larkin
- Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom
| | - Nicoline Vackerberg
- Region Jönköping County, Jönköping, Sweden
- The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Sofia Kjellström
- The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Puspita Hossain
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Sandra Moll
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Esther Lim
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- SingHealth Office of Regional Health, Singapore Health Services, Singapore, Singapore
| | - Shioma-Lei Craythorne
- Institute of Health and Neurodevelopment, Aston University, Birmingham, United Kingdom
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Ford A, De Togni G, Erikainen S, Filipe AM, Pickersgill M, Sturdy S, Swallow J, Young I. How and why to use 'vulnerability': an interdisciplinary analysis of disease risk, indeterminacy and normality. MEDICAL HUMANITIES 2024; 50:125-134. [PMID: 37696602 DOI: 10.1136/medhum-2023-012683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/13/2023]
Abstract
In recent years, 'vulnerability' has been getting more traction in theoretical, professional and popular spaces as an alternative or complement to the concept of risk. As a group of science and technology studies scholars with different disciplinary orientations yet a shared concern with biomedicine, self and society, we investigate how vulnerability has become a salient and even dominant idiom for discussing disease and disease risk. We argue that this is at least partly due to an inherent indeterminacy in what 'vulnerability' means and does, both within and across different discourses. Through a review of feminist and disability theory, and a discussion of how vulnerability and disease both get recruited into a binary conceptualisation of normal versus abnormal, we argue that vulnerability's indeterminacy is, in fact, its strength, and that it should be used differently than risk. Using COVID-19 management in the UK as an illustration of the current ambivalence and ambiguity in how vulnerability versus risk is applied, we suggest that instead of being codified or quantified, as it has started to be in some biomedical and public health applications, vulnerability and its remedies should be determined in conjunction with affected communities and in ways that are polyvalent, flexible and nuanced. The concept of vulnerability encapsulates an important precept: we must recognise inequality as undesirable while not attempting to 'solve' it in deterministic ways. Rather than becoming fixed into labels, unidirectional causalities or top-down universalising metrics, vulnerability could be used to insist on relational, context-specific understandings of disease and disease risk-in line with contemporary social justice movements that require non-hierarchical and non-universal approaches to problems and solutions.
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Affiliation(s)
- Andrea Ford
- Centre for Biomedicine Self and Society, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Giulia De Togni
- Centre for Biomedicine Self and Society, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Sonja Erikainen
- Department of Sociology, University of Aberdeen, Aberdeen, UK
| | | | - Martyn Pickersgill
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Steve Sturdy
- School of Social and Political Science, The University of Edinburgh College of Humanities and Social Science, Edinburgh, UK
| | - Julia Swallow
- Centre for Biomedicine Self and Society, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Ingrid Young
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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Guilamo-Ramos V, Johnson C, Thimm-Kaiser M, Benzekri A. Nurse-led approaches to address social determinants of health and advance health equity: A new framework and its implications. Nurs Outlook 2023; 71:101996. [PMID: 37349232 DOI: 10.1016/j.outlook.2023.101996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND The U.S. health care system is burdened by inefficiencies, longstanding health inequities, and unstainable costs. Within the nursing profession and the broader health care sector, there is growing recognition of the need for a paradigm shift that addresses persistent structural problems and advances health equity. PURPOSE Despite evidence of the importance of the social determinants of health (SDOH) in shaping inequitable health outcomes, practical tools for applying SDOH theory in the development of effective nurse-led programs to mitigate harmful SDOH remain scarce. METHODS We synthesize extant SDOH literature into a heuristic framework for conceptualizing core SDOH mechanisms, constructs, and principles. FINDINGS To illustrate how nurse scientists can use the framework to guide the development of programs for SDOH mitigation, we outline a three-step exemplar application to the U.S. Latino HIV epidemic. DISCUSSION Our framework can inform a paradigm shift toward nurse-led, multi-level SDOH mitigation across practice, education, and research.
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Affiliation(s)
- Vincent Guilamo-Ramos
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC; School of Medicine, Department of Family Medicine and Community Health, Department of Infectious Diseases, Duke University, Durham, NC; Presidential Advisory Council on HIV/AIDS, US Department of Health and Human Services, Washington, DC.
| | - Celia Johnson
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC
| | - Marco Thimm-Kaiser
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC
| | - Adam Benzekri
- Center for Latino Adolescent and Family Health, Duke University, Durham, NC; School of Nursing, Duke University, Durham, NC
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Bowleg L. The white racial frame of public health discourses about racialized health differences and "disparities": what it reveals about power and how it thwarts health equity. Front Public Health 2023; 11:1187307. [PMID: 37822536 PMCID: PMC10562601 DOI: 10.3389/fpubh.2023.1187307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023] Open
Abstract
Although several public health scholars have advocated for more clarity about concepts such as health disparities and health equity, attention to the framing of public health discourses about racialized health differences and "disparities" in the U.S., and what it reveals about power and the potential for achieving health equity, is surprisingly rare. Sociologist Joe Feagin, in his book, The White Racial Frame: Centuries of Racial Framing and Counter-Framing coined the term white racial frame to describe the predominantly white racialized worldview of majority white and white-oriented decisionmakers in everyday and institutional operations. Informed by insights from critical race theories about the white racial frame, white epistemological ignorance, and colorblind racism; critical perspectives on social class; Black feminist perspectives; framing; and critical discourse analysis, in this perspective I discuss: (1) the power of language and discourses; (2) the white racial frame of three common public health discourses - health disparities, "race," and social determinants of health (SDOH); (3) the costs and consequences of the white racial frame for advancing health equity; and (4) the need for more counter and critical theoretical frames to inform discourses, and in turn research and political advocacy to advance health equity in the U.S.
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Affiliation(s)
- Lisa Bowleg
- Department of Psychological and Brain Sciences, The George Washington University, Washington, DC, United States
- The Intersectionality Training Institute, Philadelphia, PA, United States
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Trentin M, Rubini E, Bahattab A, Loddo M, Della Corte F, Ragazzoni L, Valente M. Vulnerability of migrant women during disasters: a scoping review of the literature. Int J Equity Health 2023; 22:135. [PMID: 37481546 PMCID: PMC10362632 DOI: 10.1186/s12939-023-01951-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 07/06/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND Disasters have an unequal impact on the population because of differences in conditions of vulnerability, exposure, and capacity. Migrants and women are among the groups that are at greater risk for and disproportionately affected by disasters. However, despite the large body of evidence that analyzes their vulnerability separately, disaster research that targets migrant women is scant. The aim of this scoping review was to analyze the published scientific literature concerning the vulnerability of migrant women and the consequent negative impact they experience during disasters. METHODS A literature search was conducted on December 15th, 2021 on Pubmed, Scopus, and Web of Science databases. No time filter was applied to the search. Information regarding the article's main characteristics and design, migrant women and their migration experience, as well as about the type of disaster was collected. The factors responsible for the vulnerability of migrant women and the negative outcomes experienced during a disaster were extracted and inductively clustered in main themes reflecting several vulnerability pathways. The review followed the Joanna Briggs Institute methodology for scoping reviews and relied on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). RESULTS After full text review, 14 articles met the inclusion criteria. All of them adopted a qualitative methodology and focused on COVID-19. The pandemic negatively affected migrant women, by triggering numerous drivers that increased their level of exposure and vulnerability. Overall, six vulnerability factors have been identified: legal status, poverty conditions, pre-existing health conditions, limited agency, gender inequality and language and cultural barriers. These resulted in nine impacts: worsening of mental health status, poor access to care, worsening of physical health conditions, fraud, exacerbation of poverty, gender-based violence, jeopardization of educational path, and unfulfillment of their religious needs. CONCLUSIONS This review provided an analysis of the vulnerability factors of migrant women and the pathways leading to negative outcomes during a disaster. Overall, the COVID-19 pandemic demonstrated that health equity is a goal that is still far to reach. The post-pandemic era should constitute the momentum for thoroughly addressing the social determinants of health that systematically marginalize the most vulnerable groups.
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Affiliation(s)
- Monica Trentin
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, 28100, Novara, Italy.
| | - Elena Rubini
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, 28100, Novara, Italy
| | - Awsan Bahattab
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, 28100, Novara, Italy
| | | | - Francesco Della Corte
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, 28100, Novara, Italy
| | - Luca Ragazzoni
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, 28100, Novara, Italy
| | - Martina Valente
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, 28100, Novara, Italy
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Pakhomova TE, Nicholson V, Fischer M, Ferguson J, Moore DM, Salters K, Lester RT, Kremer H, Dawydiuk N, Barrios R, Parashar S. Exploring Primary Healthcare Experiences and Interest in Mobile Technology Engagement Amongst an Urban Population Experiencing Barriers to Care. QUALITATIVE HEALTH RESEARCH 2023:10497323231167829. [PMID: 37225177 DOI: 10.1177/10497323231167829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Mobile phone-based engagement approaches provide potential platforms for improving access to primary healthcare (PHC) services for underserved populations. We held two focus groups (February 2020) with residents (n = 25) from a low-income urban neighbourhood (downtown Vancouver, Canada), to assess recent healthcare experiences and elicit interest in mobile phone-based healthcare engagement for underserved residents. Note-based analysis, guided by interpretative description, was used to explore emerging themes. Engagement in PHC was complicated by multiple, intersecting personal-level and socio-structural factors, and experiences of stigma and discrimination from care providers. Perceived inadequacy of PHC services and pervasive discrimination reported by participants indicate a significant and ongoing need to improve client-provider relationships to address unmet health needs. Mobile phone-based engagement was endorsed, highlighting phone ownership and client-provider text-messaging, facilitated by non-clinical staff such as peers, as helpful to strengthening retention and facilitating care team connection. Concerns raised included reliability, cost, and technology and language accessibility.
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Affiliation(s)
- Tatiana E Pakhomova
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Valerie Nicholson
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Matthew Fischer
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Joanna Ferguson
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada
| | - Kate Salters
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Richard T Lester
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Hayden Kremer
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Nicole Dawydiuk
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health, Vancouver, BC, Canada
| | - Surita Parashar
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada
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Shahid S, Hogeveen S, Sky P, Chandra S, Budhwani S, de Silva R, Bhatia RS, Seto E, Shaw J. Health equity related challenges and experiences during the rapid implementation of virtual care during COVID-19: a multiple case study. Int J Equity Health 2023; 22:44. [PMID: 36906566 PMCID: PMC10007658 DOI: 10.1186/s12939-023-01849-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/18/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Virtual care quickly became of crucial importance to health systems around the world during the COVID-19 pandemic. Despite the potential of virtual care to enhance access for some communities, the scale and pace at which services were virtualized did not leave many organizations with sufficient time and resources to ensure optimal and equitable delivery of care for everyone. The objective of this paper is to outline the experiences of health care organizations rapidly implementing virtual care during the first wave of the COVID-19 pandemic and examine whether and how health equity was considered. METHODS We used an exploratory, multiple case study approach involving four health and social service organizations providing virtual care services to structurally marginalized communities in the province of Ontario, Canada. We conducted semi-structured qualitative interviews with providers, managers, and patients to understand the challenges experienced by organizations and the strategies put in place to support health equity during the rapid virtualization of care. Thirty-eight interviews were thematically analyzed using rapid analytic techniques. RESULTS Organizations experienced challenges related to infrastructure availability, digital health literacy, culturally appropriate approaches, capacity for health equity, and virtual care suitability. Strategies to support health equity included the provision of blended models of care, creation of volunteer and staff support teams, participation in community engagement and outreach, and securement of infrastructure for clients. We put our findings into the context of an existing framework conceptualizing access to health care and expand on what this means for equitable access to virtual care for structurally marginalized communities. CONCLUSION This paper highlights the need to pay greater attention to the role of health equity in virtual care delivery and situate that conversation around existing inequitable structures in the health care system that are perpetuated when delivering care virtually. An equitable and sustainable approach to virtual care delivery will require applying an intersectionality lens on the strategies and solutions needed to address existing inequities in the system.
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Affiliation(s)
- Simone Shahid
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada.
| | - Sophie Hogeveen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Philina Sky
- Waasegiizhig Nanaandawe'iyewigamig, PO Box 320, Keewatin, ON, P0X 1C0, Canada
| | - Shivani Chandra
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada
| | - Suman Budhwani
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada
| | - Ryan de Silva
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada
| | - R Sacha Bhatia
- Peter Munk Cardiac Centre, University Health Network, 585 University Ave, Toronto, ON, M5G 2N2, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 55 College St, Toronto, ON, M5T 3M6, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 55 College St, Toronto, ON, M5T 3M6, Canada.,Centre for Digital Therapeutics, Techna Institute, University Health Network, 90 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - James Shaw
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada.,Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada
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Maddox R, Drummond A, Kennedy M, Martinez SA, Waa A, Nez Henderson P, Clark H, Upton P, Lee JP, Hardy BJ, Tautolo ES, Bradbrook S, Calma T, Whop LJ. Ethical publishing in 'Indigenous' contexts. Tob Control 2023:tc-2022-057702. [PMID: 36781227 DOI: 10.1136/tc-2022-057702] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/27/2023] [Indexed: 02/15/2023]
Abstract
Ethical publishing practices are vital to tobacco control research practice, particularly research involving Indigenous (Indigenous peoples: For the purposes of this Special Communication, we use the term Indigenous people(s) to include self-identified individuals and communities who frequently have historical continuity with precolonial/presettler societies; are strongly linked to the land on which they or their societies reside; and often maintain their own distinct language(s), belief and social-political systems, economies and sciences. The authors humbly acknowledge, respect and value that Indigenous peoples are diverse and constitute many nations, cultures and language groups. Many Indigenous peoples also exist as governments in treaty relations with settler-colonial societies, and all Indigenous peoples have inherent rights under international law. The language and terminology used should reflect the local context(s) and could include, but are not limited to, terms such as Aboriginal, Bagumani, Cherokee, First Peoples, First Nations, Inuit, Iwaidja, Kungarakan, Lakota, Māori, Mѐtis, American Indian, Navajo, Wagadagam, Wiradjuri, Yurok, etc) people. These practices can minimise, correct and address biases that tend to privilege Euro-Western perspectives. Ethical publishing practices can minimise and address harms, such as appropriation and misuse of knowledges; strengthen mechanisms of accountability to Indigenous peoples and communities; ensure that tobacco control research is beneficial and meaningful to Indigenous peoples and communities; and support Indigenous agency, sovereignty and self-determination. To ensure ethical practice in tobacco control, the research methodology and methods must incorporate tangible mechanisms to include and engage those Indigenous peoples that the research concerns, affects and impacts.Tobacco Control is currently missing an ethical research and evaluation publishing protocol to help uphold ethical practice. The supporters of this Special Communication call on Tobacco Control to adopt publication practice that explicitly upholds ethical research and evaluation practices, particularly in Indigenous contexts. We encourage researchers, editors, peer reviewers, funding bodies and those publishing in Tobacco Control to reflect on their conduct and decision-making when working, developing and undertaking research and evaluation of relevance to Indigenous peoples.Tobacco Control and other publishers, funding bodies, institutions and research teams have a fundamental role in ensuring that the right peoples are doing the right work in the right way. We call for Tobacco Control to recognise, value and support ethical principles, processes and practices that underpin high-quality, culturally safe and priority-driven research, evaluation and science that will move us to a future that is commercial tobacco and nicotine free.
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Affiliation(s)
- Raglan Maddox
- Bagumani (Modewa) Clan, Milne Bay, Papua New Guinea
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ali Drummond
- Meriam and Wuthathi, Torres Strait, Queensland, Australia
- Congress of Aboriginal and Torres Strait Islander Nurses and Midwives, Canberra, Australian Capital Territory, Australia
| | - Michelle Kennedy
- Wiradjuri, New South Wales, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, The University of Newcastle College of Health, Medicine and Wellbeing, Callaghan, New South Wales, Australia
- College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Sydney A Martinez
- Cherokee Nation Citizen, Tahlequah, Oklahoma, USA
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Andrew Waa
- Ngāti Hine/Ngāpuhi, Wellington, New Zealand
- Eru Pomare Māori Health Research Unit, University of Otago, Wellington, New Zealand
| | - Patricia Nez Henderson
- Navajo Nation (Diné), South Dakota, South Dakota, USA
- Black Hills Center for American Indian Health, Rapid City, South Dakota, USA
| | - Hershel Clark
- Navajo Nation (Diné), South Dakota, South Dakota, USA
- Black Hills Center for American Indian Health, Rapid City, South Dakota, USA
| | - Penney Upton
- University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Juliet P Lee
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California, USA
| | - Billie-Jo Hardy
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, Waakebiness-Bryce Institute for Indigenous Health, University of Toronto, Toronto, Ontario, Canada
- Well Living House, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - El-Shadan Tautolo
- Samoa/Ngāti Tapuniu, Auckland, New Zealand
- Pacific Health Research Centre, Auckland University of Technology, Auckland, New Zealand
| | - Shane Bradbrook
- Ngāi Tāmanuhiri, Rongowhakaata, Ngāti Kahungunu, Aotearoa, New Zealand
| | - Tom Calma
- Elder from the Kungarakan tribal group and a member of the Iwaidja tribal group, Northern Territory, Northern Territory, Australia
- Indigenous tobacco control advocate, Canberra, Australian Capital Territory, Australia
| | - Lisa J Whop
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
- Wagadagam, Gumulgal, Torres Strait, Queensland, Australia
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11
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Baker SR, Heaton LJ, McGrath C. Evolution and development of methodologies in social and behavioural science research in relation to oral health. Community Dent Oral Epidemiol 2023; 51:46-57. [PMID: 36756884 DOI: 10.1111/cdoe.12821] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/08/2022] [Accepted: 11/15/2022] [Indexed: 02/10/2023]
Abstract
The aim of this introductory paper is to provide an overview of key methodological developments in social and behavioural research in oral health. In the first section, we provide a brief historical perspective on research in the field. In the second section, we outline key methodological issues and introduce the seven papers in the theme. Conceptual models can contextualize research findings and address the 'why' and 'how' instead of 'what' and 'how many'. Many models exist, albeit they need to be evaluated (and adapted) for use in oral health research and in specific settings. The increasing availability of big data can facilitate this with data linkage. Through data linkage, it is possible to explore and understand in a broader capacity the array of factors that influence oral health outcomes and how oral health can influences other factors. With advances in statistical approaches, it is feasible to consider casual inferences and to quantify these effects. There is a need for not only individual efforts to embrace causal inference research but also systematic and structural changes in the field to yield substantial results. The value of qualitative research in co-producing knowledge with and from human participants in addressing 'the how' and 'the why' factors is also key. There have been calls to employ more sophisticated qualitative methods together with mixed methods approaches as ways of helping to address the complex or Wicked Problems in population oral health. In the final section, we outline possible future methodological directions in social and behavioural oral health research including participatory approaches and the development of core outcome sets. Our overriding goal in the paper is to facilitate a critical debate in relation to methodological issues which can be used to improve understanding and generate knowledge in population oral health and that this, in turn, will help inform oral health policy and practices.
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Affiliation(s)
- Sarah R Baker
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Lisa J Heaton
- CareQuest Institute for Oral Health, Boston, Massachusetts, USA.,Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, USA
| | - Colman McGrath
- Applied Oral Sciences & Community Dental Care, The University of Hong Kong, Hong Kong, Hong Kong
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12
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Macdonald ME. The Necessity of qualitative research for advancing oral health. Community Dent Oral Epidemiol 2023; 51:67-70. [PMID: 36749669 DOI: 10.1111/cdoe.12787] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 02/08/2023]
Abstract
Researchers are engaged with producing knowledge. Through this knowledge production, they make claims about the world. For applied health researchers, our knowledge production is both a scientific as well as a moral activity. Increasingly, oral health researchers are turning to qualitative research, a research approach that takes science and morality seriously. Qualitative research pushes researchers to think about the different worlds in which people live and work, and endeavours to generate data that reflect those worlds. This paper argues that humans are complex, and that qualitative approaches are necessary for understanding how we are all deeply embedded in historical, social, cultural and political contexts, and why this matters when thinking about oral health. This paper also dispels myths about the limitations of qualitative research and proposes future directions to improve the sophistication of qualitative oral health sciences.
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Affiliation(s)
- Mary Ellen Macdonald
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montréal, Québec, Canada.,Institute of Health Sciences Education, McGill University, Montréal, Québec, Canada
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13
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Antabe R, McIntosh M, Lawson E, Husbands W, Wong JPH, Arku G, Luginaah I. Black heterosexual men's resilience in times of HIV adversity: findings from the "weSpeak" study. BMC Public Health 2023; 23:182. [PMID: 36707783 PMCID: PMC9880929 DOI: 10.1186/s12889-023-15103-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/13/2023] [Accepted: 01/20/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND In Canada, heterosexual African, Caribbean and Black (ACB) men tend to suffer a disproportionate burden of HIV. Consequently, studies have examined the underlying contributors to this disparity through the nexus of behavioral and structural factors. While findings from these studies have been helpful, their use of deficit and risk models only furthers our knowledge of why ACB men are more vulnerable to HIV infection. Thus far, there is a dearth of knowledge on how heterosexual ACB men mobilize protective assets to promote their resilience against HIV infection. METHODS As part of a larger Ontario-based project called weSpeak, this study examined how ACB men acquire protective assets to build their resilience to reduce their HIV vulnerability. We analyzed three focus group discussions (n = 17) and 13 in-depth interviews conducted with ACB men using NVivo and a mixed inductive-deductive thematic analyses approach. RESULTS The findings show that ACB men mostly relied on personal coping strategies, including sexual abstinence, to build resilience against HIV. Interpersonal resources such as family, friends, and religious communities also played an important role in constructing ACB men's resilience. ACB men bemoaned their lack of access to essential institutional resources, such as health services, that are important in managing HIV adversity. CONCLUSION Based on these findings, there is an urgent need for HIV policy stakeholders, including service providers, to engage the ACB community in the design of intervention programs. Additionally, addressing the socioeconomic disadvantages faced by ACB communities will increase the capacity of ACB men to develop resilience against HIV.
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Affiliation(s)
- Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, 1265 Military Trail, M1C 1A4, Toronto, ON, Canada.
| | - Martin McIntosh
- Regional HIV/AIDS Connections (RHAC), 30-186 King Street, N6A 1C7 London, ON Canada
| | - Erica Lawson
- grid.39381.300000 0004 1936 8884Department of Gender, Sexuality, and Women’s Studies, Western University, 1151 Richmond Street, Lawson Hall Room, 3260, N6A 5B8 London, ON Canada
| | - Winston Husbands
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7 Toronto, ON Canada
| | - Josephine Pui-Hing Wong
- Daphne Cockwell School of Nursing, Faculty of Community Services, Toronto Metropolitan University, Podium Building, Room POD-481, 350 Victoria St, M5B 2K3 Toronto, ON Canada
| | - Godwin Arku
- grid.39381.300000 0004 1936 8884Department of Geography and Environment, Social Science Centre, Western University, 1151 Richmond St, N6A 5C2 London, ON Canada
| | - Isaac Luginaah
- grid.39381.300000 0004 1936 8884Department of Geography and Environment, Social Science Centre, Western University, 1151 Richmond St, N6A 5C2 London, ON Canada
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14
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Cleveland Sa L, Frydenlund E. The shortfalls of vulnerability indexes for public health decision-making in the face of emergent crises: the case of COVID-19 vaccine uptake in Virginia. Front Public Health 2023; 11:1042570. [PMID: 37206864 PMCID: PMC10188971 DOI: 10.3389/fpubh.2023.1042570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 03/31/2023] [Indexed: 05/21/2023] Open
Abstract
Equitable and effective vaccine uptake is a key issue in addressing COVID-19. To achieve this, we must comprehensively characterize the context-specific socio-behavioral and structural determinants of vaccine uptake. However, to quickly focus public health interventions, state agencies and planners often rely on already existing indexes of "vulnerability." Many such "vulnerability indexes" exist and become benchmarks for targeting interventions in wide ranging scenarios, but they vary considerably in the factors and themes that they cover. Some are even uncritical of the use of the word "vulnerable," which should take on different meanings in different contexts. The objective of this study is to compare four vulnerability indexes produced by private, federal, and state institutions to assess the application of these measures to the needs of the COVID-19 pandemic and other emergent crises. We focus on federal, state, and private industries' vulnerability indexes for the Commonwealth of Virginia. Qualitative comparison is done by considering each index's methodologies to see how and why they defined and measured "vulnerability." We also quantitatively compare them using percent agreement and illustrate the overlaps in localities identified as among the most vulnerable on a choropleth map. Finally, we provide a short case study that explores vaccine uptake in the six localities that were identified by at least three indexes as most vulnerable, and six localities with very low vaccine coverage that were identified by two or fewer indexes as highly vulnerable. By comparing the methodologies and index (dis)agreements, we discuss the appropriateness of using pre-existing vulnerability indexes as a public health decision-making tool for emergent crises, using COVID-19 vaccine uptake as a case study. The inconsistencies reflected by these indexes show both the need for context-specific and time-sensitive data collection in public health and policy response, and a critical critique of measured "vulnerability."
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Affiliation(s)
- Lydia Cleveland Sa
- Storymodelers Lab, Graduate Program in International Studies, Virginia Modeling, Analysis, and Simulation Center, Old Dominion University, Norfolk, VA, United States
- *Correspondence: Lydia Cleveland Sa,
| | - Erika Frydenlund
- Storymodelers Lab, Virginia Modeling Analysis and Simulation Center, Old Dominion University, Suffolk, VA, United States
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15
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Macdonald ME, Muirhead V, Doughty J, Freeman R. Critically engaging vulnerability: Rethinking oral health with vulnerabilized populations. Community Dent Oral Epidemiol 2022; 50:469-475. [PMID: 34751455 DOI: 10.1111/cdoe.12703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/08/2021] [Accepted: 10/08/2021] [Indexed: 01/27/2023]
Abstract
This paper is the third in a series of narrative reviews challenging core concepts in oral health research and practice. Our series started with a framework for Inclusion Oral Health. Our second review explored one component of this framework, looking at how intersectionality adds important complexity to oral public health. This current manuscript drills into a second component of Inclusion Oral Health, exploring how labels can lead to 'othering' thereby misrepresenting populations and (re)producing harms. Specifically, we address a common oral public health label: vulnerable populations. This term is commonly used descriptively: an adjective (vulnerable) is used to modify a noun (population). What this descriptor conceals is the 'how,' 'why,' and 'therefore' that leads to and from vulnerability: How and why is a population made vulnerable; to what are they vulnerable; what makes them 'at risk,' and to what are they 'at risk'? In concealing these questions, we argue our conventional approach unwittingly does harm. Vulnerability is a term that implies a population has inherent characteristics that make them vulnerable; further, it casts populations as discrete, homogenous entities, thereby misrepresenting the complexities that people live. In so doing, this label can eclipse the strengths, agency and power of individuals and populations to care for themselves and each other. Regarding oral public health, the convention of vulnerability averts our research gaze away from social processes that produce vulnerability to instead focus on the downstream product, the vulnerable population. This paper theorizes vulnerability for oral public health, critically engaging its production and reproduction. Drawing from critical public health literature and disability studies, we advance a critique of vulnerability to make explicit hidden assumptions and their harmful outcomes. We propose solutions for research and practice, including co-engagement and co-production with peoples who have been vulnerabilized. In so doing, this paper moves forward the potential for oral public health to advance research and practice that engages complexity in our work with vulnerabilized populations.
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Affiliation(s)
- Mary Ellen Macdonald
- Faculty of Dentistry, and Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Vanessa Muirhead
- Centre for Dental Public Health and Primary Care, Institute of Dentistry, Barts and The London, School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Janine Doughty
- Pathway Homelessness and Inclusion Oral Health Fellow, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ruth Freeman
- Dental Health Services Research Unit, School of Dentistry, University of Dundee, Dundee, UK
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16
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Boucher LM, Dodd Z, Young S, Shahid A, Bayoumi A, Firestone M, Kendall CE. "They have their security, we have our community": Mutual support among people experiencing homelessness in encampments in Toronto during the COVID-19 pandemic. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100163. [PMID: 36060310 PMCID: PMC9425704 DOI: 10.1016/j.ssmqr.2022.100163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 01/12/2023]
Abstract
Unaffordable housing is a growing crisis in Canada, exacerbated by the COVID-19 pandemic, yet perspectives of people living outdoors in encampments have primarily gone unheard. We conducted qualitative interviews with encampment residents to explore how mutual support occurred within the social context of encampments. We found that mutually supportive interactions helped residents meet basic survival needs, as well as health and social needs, and reduced common health and safety risks related to homelessness. The homelessness sector should acknowledge that encampment residents form their own positive communities, and ensure policies and services do not isolate people from these beneficial social connections.
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Affiliation(s)
- Lisa M. Boucher
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada,C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St, Annex E, Ottawa, ON, K1N 5C8, Canada,Corresponding author. School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Zoë Dodd
- South Riverdale Community Health Centre, 955 Queen St E, Toronto, ON, M4M 3P3, Canada,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, 36 Queen St E, Toronto, ON, M5B 1W8, Canada
| | - Samantha Young
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada,Division of General Internal Medicine, St. Michael's Hospital, Unity Health Toronto, 36 Queen St E, Toronto, ON, M5B 1W8, Canada
| | - Abeera Shahid
- University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Ahmed Bayoumi
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, 36 Queen St E, Toronto, ON, M5B 1W8, Canada
| | - Michelle Firestone
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, 36 Queen St E, Toronto, ON, M5B 1W8, Canada
| | - Claire E. Kendall
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada,C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St, Annex E, Ottawa, ON, K1N 5C8, Canada,Department of Family Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
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17
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Molenaar J, Van Praag L. Migrants as 'vulnerable groups' in the COVID-19 pandemic: A critical discourse analysis of a taken-for-granted label in academic literature. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100076. [PMID: 35529889 PMCID: PMC9052635 DOI: 10.1016/j.ssmqr.2022.100076] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 01/12/2023]
Abstract
The COVID-19 pandemic affects different people unequally, and migrants are frequently among the groups considered particularly vulnerable. However, conceptualizations of 'vulnerability' are often ambiguous and poorly defined. Using critical discourse analysis methods, this article analyses the academic use of the term 'vulnerable' applied to migrants in the context of the COVID-19 pandemic across public health and social science disciplines. Our findings indicate that the concept of vulnerability is frequently applied to migrants in the COVID-19 context as a descriptor with seemingly taken-for-granted applicability. Migrants are considered vulnerable for a wide variety of reasons, most commonly relating to exposure to and risk of contracting COVID-19; poverty or low socio-economic status; precarity; access to healthcare; discrimination; and language barriers. Drivers of migrants' vulnerability were frequently construed as immutable societal characteristics. Additionally, our analysis revealed widespread generalization in the use of the notion of vulnerability, with limited consideration of the heterogeneity among and between diverse groups of migrants. Conceptualizations of migrants' vulnerability in the COVID-19 pandemic were sometimes used to advance seemingly contradictory policy implications or conclusions, and migrants' own views and lived experiences were often marginalized or excluded within these discourses. Our analysis highlights that although some definable groups of people are certainly more likely to suffer harm in crisis situations like the COVID-19 pandemic, the use of 'vulnerable' as a fixed descriptor has potentially negative implications. As an alternative, we suggest thinking about vulnerability as the dynamic outcome of a process of 'vulnerabilisation' shaped by social order and power relations.
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18
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Clark EC, Cranston E, Polin T, Ndumbe-Eyoh S, MacDonald D, Betker C, Dobbins M. Structural interventions that affect racial inequities and their impact on population health outcomes: a systematic review. BMC Public Health 2022; 22:2162. [PMCID: PMC9685079 DOI: 10.1186/s12889-022-14603-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/11/2022] [Indexed: 11/25/2022] Open
Abstract
AbstractStructural racism is the historical and ongoing reinforcement of racism within society due to discriminatory systems and inequitable distribution of key resources. Racism, embedded within institutional structures, processes and values, perpetuates historical injustices and restricts access to structural factors that directly impact health, such as housing, education and employment. Due to the complex and pervasive nature of structural racism, interventions that act at the structural level, rather than the individual level, are necessary to improve racial health equity. This systematic review was conducted to evaluate the effects of structural-level interventions on determinants of health and health outcomes for racialized populations. A total of 29 articles are included in this review, analyzing interventions such as supplemental income programs, minimum wage policies, nutrition safeguard programs, immigration-related policies, and reproductive and family-based policies. Most studies were quasi-experimental or natural experiments. Findings of studies were largely mixed, although there were clear benefits to policies that improve socioeconomic status and opportunities, and demonstrable harms from policies that restrict access to abortion or immigration. Overall, research on the effects of structural-level interventions to address health inequities is lacking, and the evidence base would benefit from well-designed studies on upstream policy interventions that affect the structural determinants of health and health inequities and improve daily living conditions.
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19
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Vecchio G, Tiznado-Aitken I, Castillo B, Steiniger S. Fair transport policies for older people: accessibility and affordability of public transport in Santiago, Chile. TRANSPORTATION 2022:1-27. [PMID: 36407886 PMCID: PMC9643989 DOI: 10.1007/s11116-022-10346-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
In this paper, we test how different public transport policy scenarios score in terms of fairness for a specific population group, considering a more complex representation of mobility-related inequalities and the policy implications of transport justice. To do so, we assess potential accessibility to public transport in Santiago de Chile under different policy scenarios, focusing on older people as a group whose demographic and socioeconomic conditions can determine different forms of disadvantage. We compare alternative accessibility policies based on the expansion of the Metro infrastructure network or on reduced public transport fares, considering the interaction between the spatial availability and the affordability of public transport. Results show that subsidized fares for public transport services are more beneficial to expand the accessibility of older people, especially those with lower incomes, while the expansion of the Metro network benefits mainly middle- and high-income older people. The proposed analysis is a first step towards a more detailed, place-based reading of mobility-related inequalities, aimed at assessing alternative policy measures.
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Affiliation(s)
- Giovanni Vecchio
- Instituto de Estudios Urbanos y Territoriales, Pontificia Universidad Católica de Chile, Santiago, Chile
- Centro de Desarrollo Urbano Sustentable - Cedeus, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Bryan Castillo
- Centro de Desarrollo Urbano Sustentable - Cedeus, Pontificia Universidad Católica de Chile, Santiago, Chile
- Partners for Action (P4A), University of Waterloo, Waterloo, Canada
| | - Stefan Steiniger
- Centro de Desarrollo Urbano Sustentable - Cedeus, Pontificia Universidad Católica de Chile, Santiago, Chile
- Escuela de Ingeniería de Construcción y Transporte, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
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20
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It is a relay not a sprint! Evolving co-design in a digital and virtual environment: neighbourhood services for elders. GLOBAL PUBLIC POLICY AND GOVERNANCE 2022. [PMCID: PMC9632595 DOI: 10.1007/s43508-022-00053-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is an emerging body of research on the co-design of public services, including co-design with vulnerable adults. However, what has been less explored has been the impact of digital technology and virtual environments upon the co-design process in this context. This paper analyses the contingencies of virtual co-design through a case study of a project to develop supportive local communities for vulnerable elderly people. This project was initially planned to use traditional co-design methods within a face-to-face environment, in the context of the local public service ecosystem. The CoVid-19 pandemic made this impossible. Consequently, an innovative approach to co-design was developed that shifted the process from a face-to-face to a virtual environment. This exploratory paper reports and evaluates this approach and its implications for the future of the theory and practice of the co-design of public services for vulnerable adults. Theoretically the paper evolves a model of co-design in a virtual space that is embedded within a public service ecosystem framework of value creation. At a practice level, the paper provides insight into the strategic and operational management of co-creation in a virtual space. It evolves the ‘Relay’ model of asynchronous co-creation across time and considers it key contingencies.
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21
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Chung A, Zorbas C, Peeters A, Backholer K, Browne J. A Critical Analysis of Representations of Inequalities in Childhood Obesity in Australian Health Policy Documents. Int J Health Policy Manag 2022; 11:1767-1779. [PMID: 34380204 PMCID: PMC9808209 DOI: 10.34172/ijhpm.2021.82] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/10/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In Australia, childhood obesity follows a socioeconomic gradient whereby children with lower socioeconomic position are disproportionately burdened. To reduce these inequalities in childhood obesity requires a multi-component policy-driven response. Action to address health issues is underpinned by the ways in which they are represented as 'problems' in public policy. This study critically examines representations of inequalities in childhood obesity within Australian health policy documents published between 2000-2019. METHODS Australia's federal, state and territory government health department websites were searched for health policy documents including healthy weight, obesity, healthy eating, food and nutrition strategies; child and youth health strategies; and broader health and wellbeing, prevention and health promotion policies that proposed objectives or strategies for childhood obesity prevention. Thematic analysis of eligible documents was guided by a theoretical framework informed by problematization theory, ecological systems theory, and theoretical principles for equity in health policy. RESULTS Eighteen policy documents were eligible for inclusion. The dominant representation of inequalities in childhood obesity was one of individual responsibility. The social determinants of inequalities in childhood obesity were acknowledged, yet policy actions predominantly focused on individual determinants. Equity was positioned as a principle of policy documents but was seldom mentioned in policy actions. CONCLUSION Current representations of inequalities in childhood obesity in Australian health policy documents do not adequately address the underlying causes of health inequities. In order to reduce inequalities in childhood obesity future policies will need greater focus on health equity and the social determinants of health (SDoH).
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Affiliation(s)
- Alexandra Chung
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Christina Zorbas
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Anna Peeters
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Kathryn Backholer
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Jennifer Browne
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
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22
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Nunn JS, Shafee T, Chang S, Stephens R, Elliott J, Oliver S, John D, Smith M, Orr N, Preston J, Borthwick J, van Vlijmen T, Ansell J, Houyez F, de Sousa MSA, Plotz RD, Oliver JL, Golumbic Y, Macniven R, Wines S, Borda A, da Silva Hyldmo H, Hsing PY, Denis L, Thompson C. Standardised data on initiatives-STARDIT: Beta version. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:31. [PMID: 35854364 PMCID: PMC9294764 DOI: 10.1186/s40900-022-00363-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE There is currently no standardised way to share information across disciplines about initiatives, including fields such as health, environment, basic science, manufacturing, media and international development. All problems, including complex global problems such as air pollution and pandemics require reliable data sharing between disciplines in order to respond effectively. Current reporting methods also lack information about the ways in which different people and organisations are involved in initiatives, making it difficult to collate and appraise data about the most effective ways to involve different people. The objective of STARDIT (Standardised Data on Initiatives) is to address current limitations and inconsistencies in sharing data about initiatives. The STARDIT system features standardised data reporting about initiatives, including who has been involved, what tasks they did, and any impacts observed. STARDIT was created to help everyone in the world find and understand information about collective human actions, which are referred to as 'initiatives'. STARDIT enables multiple categories of data to be reported in a standardised way across disciplines, facilitating appraisal of initiatives and aiding synthesis of evidence for the most effective ways for people to be involved in initiatives. This article outlines progress to date on STARDIT; current usage; information about submitting reports; planned next steps and how anyone can become involved. METHOD STARDIT development is guided by participatory action research paradigms, and has been co-created with people from multiple disciplines and countries. Co-authors include cancer patients, people affected by rare diseases, health researchers, environmental researchers, economists, librarians and academic publishers. The co-authors also worked with Indigenous peoples from multiple countries and in partnership with an organisation working with Indigenous Australians. RESULTS AND DISCUSSION Over 100 people from multiple disciplines and countries have been involved in co-designing STARDIT since 2019. STARDIT is the first open access web-based data-sharing system which standardises the way that information about initiatives is reported across diverse fields and disciplines, including information about which tasks were done by which stakeholders. STARDIT is designed to work with existing data standards. STARDIT data will be released into the public domain (CC0) and integrated into Wikidata; it works across multiple languages and is both human and machine readable. Reports can be updated throughout the lifetime of an initiative, from planning to evaluation, allowing anyone to be involved in reporting impacts and outcomes. STARDIT is the first system that enables sharing of standardised data about initiatives across disciplines. A working Beta version was publicly released in February 2021 (ScienceforAll.World/STARDIT). Subsequently, STARDIT reports have been created for peer-reviewed research in multiple journals and multiple research projects, demonstrating the usability. In addition, organisations including Cochrane and Australian Genomics have created prospective reports outlining planned initiatives. CONCLUSIONS STARDIT can help create high-quality standardised information on initiatives trying to solve complex multidisciplinary global problems.
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Affiliation(s)
- Jack S Nunn
- Director of Science for All (Education Charity Registered in Australia), Melbourne, Australia.
- School of Public Health, La Trobe University, Melbourne, VIC, Australia.
| | - Thomas Shafee
- School of Life Sciences, La Trobe University, Melbourne, VIC, Australia
| | | | - Richard Stephens
- Patient Advocate, Co-Editor-in-Chief, 'Research Involvement and Engagement', London, UK
| | - Jim Elliott
- Public Involvement Lead at Health Research Authority (England), London, UK
| | - Sandy Oliver
- Professor of Public Policy at UCL Social Research Institute, London, UK
- University of Johannesburg, Johannesburg, South Africa
| | - Denny John
- Adjunct Professor, Ramaiah University of Applied Sciences, Bengaluru, India
- Chair, Campbell and Cochrane Economic Methods Group, London, UK
| | | | - Neil Orr
- Department of Linguistics, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
- Poche Centre Indigenous Health, The University of Sydney, Sydney, Australia
| | - Jennifer Preston
- National Institute for Health and Care Research, Alder Hey Clinical Research Facility, Liverpool, UK
| | | | | | - James Ansell
- Consumers Health Forum of Australia, Deakin, Australia
| | | | - Maria Sharmila Alina de Sousa
- Independent Impact Intelligence Design & Strategy Consultant, Research Impact Academy Brazil Ambassador, Sao Paulo, Brazil
| | - Roan D Plotz
- Applied Ecology and Environmental Change Research Group, Institute for Sustainable Industries and Liveable Cities, Victoria University, Melbourne, Australia
| | | | | | - Rona Macniven
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Sydney, 2052, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, 2109, Australia
| | | | - Ann Borda
- University of Melbourne, Melbourne, Australia
- University College London, London, UK
| | - Håkon da Silva Hyldmo
- Department of Geography, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pen-Yuan Hsing
- University of Bath, Bath, UK
- MammalWeb Project, London, UK
| | - Lena Denis
- Johns Hopkins University, Baltimore, USA
| | - Carolyn Thompson
- University College London, London, UK
- Institute of Zoology, Zoological Society of London, London, UK
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23
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van der Meer L, Barsties LS, Daalderop LA, Waelput AJM, Steegers EAP, Bertens LCM. Social determinants of vulnerability in the population of reproductive age: a systematic review. BMC Public Health 2022; 22:1252. [PMID: 35751043 PMCID: PMC9233331 DOI: 10.1186/s12889-022-13651-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background The health of an (unborn) child is largely determined by the health and social determinants of its parents. The extent to which social determinants of parents or prospective parents affect their own health depends partly on their coping or resilience abilities. Inadequate abilities allow negative effects of unfavourable social determinants to prevail, rendering them vulnerable to adverse health outcomes. Addressing these determinants in the reproductive-aged population is therefore a key approach in improving the health of the future generation. This systematic review aims to synthesise evidence on social determinants of vulnerability, i.e., inadequate coping or low resilience, in the general population of reproductive age. Methods The databases EMBASE, Medline, PsycINFO, CINAHL, Google Scholar, Web of Science, and Cochrane Library, were systematically searched from database inception to December 2th 2021. Observational studies examining social determinants and demographics in relation to vulnerability among the general population of reproductive age (men and women aged 18-40 years), conducted in a high-income country in Europe or North America, Australia or New Zealand were eligible for inclusion. Relevant data was extracted from each included article and findings were presented in a narrative and tabulated manner. Results We identified 40,028 unique articles, of which 78 were full text reviewed. Twenty-five studies were included, of which 21 had a cross-sectional study design (84%). Coping was the most frequently assessed outcome measure (n = 17, 68%). Thirty social determinants were identified. Overall, a younger age, lower socioeconomic attainment, lack of connection with the social environment, and adverse life events were associated with inadequate coping or low resilience. Conclusions This review shows that certain social determinants are associated with vulnerability in reproductive-aged individuals. Knowing which factors make people more or less vulnerable carries health-related implications. More high-quality research is needed to obtain substantial evidence on the strength of the effect of these social conditions in this stage of life. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13651-6.
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Affiliation(s)
- Lindsey van der Meer
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands.
| | - Lisa S Barsties
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands.,DRIFT - Dutch Research Institute for Transitions, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Leonie A Daalderop
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands.,DRIFT - Dutch Research Institute for Transitions, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Adja J M Waelput
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Loes C M Bertens
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
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24
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Everhart AR, Ferguson L, Wilson JP. Construction and validation of a spatial database of providers of transgender hormone therapy in the US. Soc Sci Med 2022; 303:115014. [PMID: 35594740 DOI: 10.1016/j.socscimed.2022.115014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/04/2022] [Accepted: 05/04/2022] [Indexed: 11/26/2022]
Abstract
What little data on transgender healthcare is available often focuses on transgender people's negative experiences in accessing healthcare. However, no research has been conducted that illustrates where gender-affirming hormone therapy, one part of transgender-specific medical care, is available. Without these data, large scale research to discern patterns of availability of and access to gender-affirming medical care is nearly impossible. Community-based organizations, and even trans individuals themselves have constructed repositories and databases of healthcare providers to inform other care seekers where they can access transition-related care providers, but their data are often incomplete, and usually formatted to be user-facing rather than streamlined for research purposes. To fill this gap, this article outlines the methodology for the construction of a spatial database of providers of gender-affirming hormone therapy for transgender people in the US, which is available on GitHub, created from existing community-based resources and the accompanying verification process. The completeness of the database is tested via comparison to data from the US Transgender Survey in which respondents reported travel distance to access transgender-specific care providers. The database accounted for all but 7.5% of respondents who may have accessed unknown facilities based on self-reported travel distance. Results indicate that existing methodologies for database construction regarding healthcare providers are difficult to apply when working with transgender-specific medical care and that tests for replicability and validation often take for granted the wide availability of relevant data and information. While the database unto itself can only demonstrate where care is available, it will enable future research into why these geographic patterns in care availability exist. Finally, the methodology can be replicated to produce databases for other kinds of specialized or politicized medical care such as abortion, gender-affirming surgery, or HIV treatment.
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Affiliation(s)
- Avery R Everhart
- University of Southern California, Dornsife College of Letters, Arts, and Sciences, Spatial Sciences Institute, 3616 Trousdale Parkway, AHF B55, Los Angeles, CA, 90089, USA; Center for Applied Transgender Studies, Chicago, IL, USA.
| | - Laura Ferguson
- University of Southern California, Keck School of Medicine, Institute on Inequalities in Global Health, 2001 N Soto St, Los Angeles, CA, 90032, USA.
| | - John P Wilson
- University of Southern California, Dornsife College of Letters, Arts, and Sciences, Spatial Sciences Institute, 3616 Trousdale Parkway, AHF B55, Los Angeles, CA, 90089, USA.
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25
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Substance and Behavioral Addictions, and Their Consequences among Vulnerable Populations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106163. [PMID: 35627700 PMCID: PMC9141345 DOI: 10.3390/ijerph19106163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 02/01/2023]
Abstract
"Vulnerable populations" in health behavior research, practice and policy is generally used to refer to groups that, due to their life circumstances, may require extra consideration, reasonable accommodation, and legitimized protection [...].
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26
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Reflecting on the Value of Community Researchers in Criminal Justice Research Projects. SOCIAL SCIENCES-BASEL 2022. [DOI: 10.3390/socsci11040166] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
While the importance of community researchers has long been acknowledged in disability studies, inclusive research practices such as these are less common in research about another marginalised group: people who are in prison or have spent time in prison. Over the past decade in Australia, the number and rate of people imprisoned has risen rapidly, and recidivism rates remain high, indicating a need for improved services. In this article, we draw on methodological reflections from two case studies on research with marginalised communities, one in disability studies and one in post-prison research. We apply insights from disability research to argue the importance of incorporating community researchers in qualitative research projects seeking to explore the experiences of people involved with the criminal justice system, such as people who have been released from prison.
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27
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Klass P, Ratner AJ. "The Sombre Aspect of the Entire Landscape" - Epidemiology and the Faroe Islands. N Engl J Med 2022; 386:1202-1205. [PMID: 35333484 DOI: 10.1056/nejmp2120194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Perri Klass
- From the Arthur L. Carter Journalism Institute, New York University (P.K.), and the Departments of Pediatrics (P.K., A.J.R.) and Microbiology (A.J.R.) and the Division of Pediatric Infectious Diseases (A.J.R.), NYU Grossman School of Medicine - both in New York
| | - Adam J Ratner
- From the Arthur L. Carter Journalism Institute, New York University (P.K.), and the Departments of Pediatrics (P.K., A.J.R.) and Microbiology (A.J.R.) and the Division of Pediatric Infectious Diseases (A.J.R.), NYU Grossman School of Medicine - both in New York
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28
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Maddox R, Bovill M, Waa A, Gifford H, Tautolo ES, Nez Henderson P, Martinez S, Clark H, Bradbrook S, Calma T. Reflections on Indigenous commercial tobacco control: 'The dolphins will always take us home'. Tob Control 2022; 31:348-351. [PMID: 35241610 DOI: 10.1136/tobaccocontrol-2021-056571] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Raglan Maddox
- Modewa Clan, Milne Bay, Papua New Guinea
- Aboriginal and Torres Strait Islander Health Group, National Centre for Epidemiology and Public Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Michelle Bovill
- Wiradjuri, New South Wales, New South Wales, Australia
- School of Health and Medicine, Hunter Medical Research Institute, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Andrew Waa
- Ngāti Hine/Ngāpuhi, Aotearoa, New Zealand
- Eru Pomare Māori Health Research Unit, University of Otago, Wellington, New Zealand
| | - Heather Gifford
- Ngāti Hauiti, Aotearoa, New Zealand
- Research for Māori Health and Development, Whakauae Research Services, Whanganui, New Zealand
| | - El-Shadan Tautolo
- Samoa/Ngāti Tapuniu, Samoa, Samoa
- AUT Pacific Health Research Centre, Auckland University of Technology, Auckland, New Zealand
| | - Patricia Nez Henderson
- Navajo Nation (Diné), Turtle Island, Arizona, USA
- Black Hills Center for American Indian Health, Rapid City, South Dakota, USA
| | - Sydney Martinez
- Cherokee Nation Citizen, Tahlequah, Oklahoma, USA
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Hershel Clark
- Navajo Nation (Diné), Turtle Island, Arizona, USA
- Black Hills Center for American Indian Health, Rapid City, South Dakota, USA
| | - Shane Bradbrook
- Ngāi Tāmanuhiri, Rongowhakaata, Ngāti Kahungunu, Aotearoa, New Zealand
| | - Tom Calma
- Elder from the Kungarakan tribal group and a member of the Iwaidja tribal group, Northern Territory, South Australia, Australia
- Office of the National Coordinator, Tackling Indigenous Smoking, Canberra, Australian Capital Territory, Australia
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29
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Govindasamy LS, Carlin E. Anti-racism in the emergency department: Past time to tackle racism in our health systems. Emerg Med Australas 2021; 34:108-111. [PMID: 34962088 DOI: 10.1111/1742-6723.13918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Laksmi Sakura Govindasamy
- Emergency Department, Austin Health, Melbourne, Victoria, Australia.,School of Business, Law and Entrepreneurship, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Emma Carlin
- Emergency Department, Wellington Regional Hospital, Wellington, New Zealand.,Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
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30
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Salamanca-Buentello F, Cheng DK, Sabioni P, Majid U, Upshur R, Sud A. Mal/adaptations: A qualitative evidence synthesis of opioid agonist therapy during major disruptions. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 101:103556. [PMID: 34902805 DOI: 10.1016/j.drugpo.2021.103556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/12/2021] [Accepted: 11/25/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Opioid agonist therapy (OAT) has been severely disrupted by the COVID-19 pandemic. The risks of opioid withdrawal, overdose, and diversion have increased, so there is an urgent need to adapt OAT to best support people who use drugs (PWUD). This review examines the views and experiences of PWUD, health care providers, and health system administrators on OAT during major disruptions to medical care to inform appropriate health system responses during the current pandemic and beyond. METHODS We conducted a systematic review and qualitative evidence synthesis. We searched three comprehensive datasets for qualitative and mixed-methods studies that examined OAT in the context of major disruptions such as natural disasters, and analyzed included studies using thematic analysis and the constant comparative method. We used conceptual frameworks of health systems resilience and adaptive systems to interpret our findings. RESULTS We included 10 studies published between 2002 and 2020 that examined OAT in the context of hurricanes, earthquakes, and terrorist attacks. We organized our results into three themes: uncertainty, inconsistency, and vulnerability; regulatory inflexibility; and lack of coordination. The highly regulated but poorly coordinated systems of OAT provision lacked flexibility to adapt to major disruptions, thereby manufacturing vulnerability for both PWUD and health workers. CONCLUSIONS OAT programs must be resilient and adaptable to face major disruptions while maintaining quality care. Our findings provide guidance to develop and implement innovative strategies that increase the adaptive potential of OAT programs while focusing on the needs of PWUD.
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Affiliation(s)
- Fabio Salamanca-Buentello
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada
| | - Darren K Cheng
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada
| | - Pamela Sabioni
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada
| | - Umair Majid
- Institute for Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada
| | - Ross Upshur
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada; Division of Clinical Public Health, Dalla Lana Faculty of Public Health, 155 College Street, Toronto, Ontario M5G 1L4, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada
| | - Abhimanyu Sud
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, Ontario M4M 2B5, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada.
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31
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Thurber KA, Barrett EM, Agostino J, Chamberlain C, Ward J, Wade V, Belfrage M, Maddox R, Peiris D, Walker J, Baffour B, Wenitong M, Law C, Senior T, Priest N, Freeman K, Schramm T. Risk of severe illness from COVID-19 among Aboriginal and Torres Strait Islander adults: the construct of 'vulnerable populations' obscures the root causes of health inequities. Aust N Z J Public Health 2021; 45:658-663. [PMID: 34550638 PMCID: PMC8652479 DOI: 10.1111/1753-6405.13172] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/01/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To quantify the prevalence of known health-related risk factors for severe COVID-19 illness among Aboriginal and Torres Strait Islander adults, and their relationship with social determinants. METHODS Weighted cross-sectional analysis of the 2018-19 National Aboriginal and Torres Strait Islander Health Survey; Odds Ratios for cumulative risk count category (0, 1, or ≥2 health-related risk factors) by social factors calculated using ordered logistic regression. RESULTS Of the adult population, 42.9%(95%CI:40.6,45.2) had none of the examined health-related risk factors; 38.9%(36.6,41.1) had 1, and 18.2%(16.7,19.7) had ≥2. Adults experiencing relative advantage across social indicators had significantly lower cumulative risk counts, with 30-70% lower odds of being in a higher risk category. CONCLUSIONS Aboriginal and Torres Strait Islander peoples must continue to be recognised as a priority population in all stages of pandemic preparedness and response as they have disproportionate exposure to social factors associated with risk of severe COVID-19 illness. Indigeneity itself is not a 'risk' factor and must be viewed in the wider context of inequities that impact health Implications for public health: Multi-sectoral responses are required to improve health during and after the COVID-19 pandemic that: enable self-determination; improve incomes, safety, food security and culturally-safe healthcare; and address discrimination and trauma.
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Affiliation(s)
- Katherine A Thurber
- National Centre for Epidemiology and Population Health, Australian National University, Acton Australian Capital Territory
| | - Eden M Barrett
- National Centre for Epidemiology and Population Health, Australian National University, Acton Australian Capital Territory
| | - Jason Agostino
- National Centre for Epidemiology and Population Health, Australian National University, Acton Australian Capital Territory.,National Aboriginal Community Controlled Health Organisation, Canberra, Australian Capital Territory
| | | | - James Ward
- UQ Poche Centre for Indigenous Health, The University of Queensland, St Lucia, Queensland
| | - Vicki Wade
- Menzies School of Health Research, Royal Darwin Hospital Campus, Tiwi, Northern Territory
| | - Mary Belfrage
- The Royal Australian College of General Practitioners Ltd, East Melbourne, Victoria
| | - Raglan Maddox
- National Centre for Epidemiology and Population Health, Australian National University, Acton Australian Capital Territory
| | - David Peiris
- The George Institute for Global Health, UNSW Sydney, New South Wales
| | - Jennie Walker
- National Centre for Epidemiology and Population Health, Australian National University, Acton Australian Capital Territory
| | - Bernard Baffour
- School of Demography, College of Arts and Social Sciences, The Australian National University, Australian Capital Territory
| | - Mark Wenitong
- Apunipima Cape York Health Council, Bungalow, Queensland
| | - Charlee Law
- National Centre for Epidemiology and Population Health, Australian National University, Acton Australian Capital Territory.,Hunter New England Local Health District Population Health, Wallsend, New South Wales
| | - Timothy Senior
- The Royal Australian College of General Practitioners Ltd, East Melbourne, Victoria
| | - Naomi Priest
- Centre for Social Research and Methods, College of Arts and Social Sciences, Australian National University, Acton, Australian Capital Territory.,Population Health, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria
| | - Kate Freeman
- The Royal Australian College of General Practitioners Ltd, East Melbourne, Victoria
| | - Tanya Schramm
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania
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32
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Protudjer JLP, Greenhawt M, Abrams EM. Race and Ethnicity and Food Allergy: Remaining Challenges. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3859-3861. [PMID: 34749943 DOI: 10.1016/j.jaip.2021.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/31/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Jennifer L P Protudjer
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Man, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Man, Canada
| | - Matthew Greenhawt
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Man, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Man, Canada; Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC, Canada.
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Bungay V, Guta A, Varcoe C, Slemon A, Manning E, Comber S, Perri M. Gaps in health research related to sex work: an analysis of Canadian health research funding. CRITICAL PUBLIC HEALTH 2021. [DOI: 10.1080/09581596.2021.1987385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Vicky Bungay
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, Ontario, Canada
| | - Colleen Varcoe
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allie Slemon
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eli Manning
- School of Social Work, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Scott Comber
- Rowe School of Business, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Melissa Perri
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Ferreira JBB, Santos LLD, Ribeiro LC, Rodrigues Fracon BR, Wong S. Vulnerability and Primary Health Care: An Integrative Literature Review. J Prim Care Community Health 2021; 12:21501327211049705. [PMID: 34654333 PMCID: PMC8521415 DOI: 10.1177/21501327211049705] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The objective was to analyze the evidence available in the scientific literature on the concept of vulnerability, in theoretical perspectives and its use, in Primary Health Care. An integrative literature review was carried out with the inclusion criteria: articles in English, full text, peerreviewed, related to vulnerability and primary health care, with the explicit concept of vulnerability, and published until July 31, 2020. The electronic databases accessed were by crossing the descriptors "vulnerability," "vulnerabilities," "primary health care," "primary healthcare," and "primary care." The final sample consisted of 19 articles. The thematic analysis produced 2 themes: "Theoretical foundations of the concept of vulnerability" and "The use of the concept of vulnerability in PHC." In the second theme, 2 sub-themes emerged: Evaluation of health policies, programs, and services and Classification of individuals, groups, and families. There was a plurality of theoretical foundations for the concept of vulnerability and a smaller scope of its use in Primary Health Care. It is expected that the study will subsidize public policymakers and health teams in the design of services and actions aimed at vulnerable populations and in situations of vulnerability.
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Affiliation(s)
| | | | | | | | - Sabrina Wong
- University of British Columbia, Vancouver, Canada
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35
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Logie CH. Sexual rights and sexual pleasure: Sustainable Development Goals and the omitted dimensions of the leave no one behind sexual health agenda. Glob Public Health 2021; 18:1953559. [PMID: 34278957 DOI: 10.1080/17441692.2021.1953559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This commentary explores the missing discourse of sexual rights and sexual pleasure in the Sustainable Development Goals (SDG) that purport to leave no one behind. The SDG propose a welcome focus on sexual health and human rights for all, expanding beyond the Millennium Development Goals. While promising in many ways for advancing global sexual and reproductive health, and reproductive rights, the omission of sexual rights is troubling. So too is the erasure of lesbian, gay, bisexual, transgender and queer (LGBTQ) persons, and sex workers, from the SDG discussions of social inequities. Illustrative examples are provided to demonstrate how a sexual rights focus could advance SDG 3 focused on healthy lives and well-being for all. First, sexual rights are presented as integral to realizing Target 3.3's focus on ending the HIV pandemic among LGBTQ persons and sex workers (and LGBTQ sex workers). Second, sexual pleasure is introduced as an integral component of sexual health and sexual rights that could facilitate the realization of Target 3.7's aim to provide universal access to sexual and reproductive health information and education. To truly leave no one behind and realize sexual health for all, the SDG need to begin from a foundation of sexual rights.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Centre for Gender & Sexual Health Equity, Vancouver, Canada
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Langer SL, Castro FG, Chen ACC, Davis KC, Joseph RP, Kim WS, Larkey L, Lee RE, Petrov ME, Reifsnider E, Youngstedt SD, Shaibi GQ. Recruitment and retention of underrepresented and vulnerable populations to research. Public Health Nurs 2021; 38:1102-1115. [PMID: 34240459 DOI: 10.1111/phn.12943] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022]
Abstract
Per principles outlined in the Belmont Report, research involving human subjects should minimize risks to participants and maximize benefits to participants and society. Recruitment of participants should be equitable. Once enrolled, participants have the right to withdraw at any point. Researchers must balance these principles with pressures to meet enrollment goals and, in the context of repeated-measures designs, retain participants across time. The purpose of this perspective is to describe the approach and corresponding activities for recruiting and retaining underrepresented and vulnerable populations that are the focus of a transdisciplinary academic research center. To this effort, we offer diverse disciplinary backgrounds, experience working with a wide range of populations (from infants to older adults and across multiple health conditions), and spanning a variety of research designs. Effective strategies offered include partnering with community entities, approaching potential participants where they are and at a time of readiness, using population-appropriate modes of communication and data collection, conducting study activities in familiar settings and at convenient times, maintaining frequent contact, and offering meaningful incentives. These strategies are consistent with population-specific reports found in the extant literature and underscore their cross-cutting nature, with adaptations based on participant and community partner needs and preferences.
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Affiliation(s)
- Shelby L Langer
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Felipe González Castro
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Angela Chia-Chen Chen
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Kelly Cue Davis
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Rodney P Joseph
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Wonsun Sunny Kim
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Linda Larkey
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Rebecca E Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Megan E Petrov
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Elizabeth Reifsnider
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Shawn D Youngstedt
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
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Cash-Gibson L, Pericàs JM, Martinez-Herrera E, Benach J. Health Inequalities in the Time of COVID-19: The Globally Reinforcing Need to Strengthen Health Inequalities Research Capacities. INTERNATIONAL JOURNAL OF HEALTH SERVICES : PLANNING, ADMINISTRATION, EVALUATION 2021; 51:300-304. [PMID: 33684016 PMCID: PMC8191151 DOI: 10.1177/0020731421993939] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The full impact of coronavirus disease 2019 (COVID-19) is yet to be well established; however, as the pandemic spreads, and early results emerge, unmet needs are being revealed, and pressing questions are being asked about who is most affected, how, where, and in what ways government responses might be exacerbating inequalities. A number of scholars have called for more in-depth critical research on COVID-19 and health inequalities to produce a strong empirical evidence based on these issues. There are also justifiable concerns about the scarcity of health-equity actions oriented analyses of the situation and calls for more empirical evidence on COVID-19 and health inequalities. A preliminary condition to establish this type of information is strong capacity to conduct health inequalities research. Worldwide, however, this type of capacity is limited, which, alongside other challenges, will likely hinder capacities of many countries to develop comprehensive equity-oriented COVID-19 analyses, and adequate responses to present and future crises. The current pandemic reinforces the pending need to invest in and strengthen these research capacities. These capacities must be supported by widespread recognition and concern, cognitive social capital, and greater commitment to coordinated, transparent action, and responsibility. Otherwise, we will remain inadequately prepared to respond and meet our society's unmet needs.
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Affiliation(s)
- Lucinda Cash-Gibson
- Research Group on Health Inequalities, Environment and Employment Conditions, Pompeu Fabra University, Barcelona, Spain
- Pompeu Fabra University Public Policy Center, Johns Hopkins University, Barcelona, Spain
| | - Juan M. Pericàs
- Research Group on Health Inequalities, Environment and Employment Conditions, Pompeu Fabra University, Barcelona, Spain
- Pompeu Fabra University Public Policy Center, Johns Hopkins University, Barcelona, Spain
- Hospital Clínic de Barcelona, Barcelona, Spain
- Institute for Research, Vall d’Hebron Hospital Universitari, Barcelona, Spain
| | - Eliana Martinez-Herrera
- Research Group on Health Inequalities, Environment and Employment Conditions, Pompeu Fabra University, Barcelona, Spain
- Research Group of Epidemiology, National School of Public Health “Héctor Abad Gómez”, University of Antioquia, Medellín, Colombia
| | - Joan Benach
- Research Group on Health Inequalities, Environment and Employment Conditions, Pompeu Fabra University, Barcelona, Spain
- Pompeu Fabra University Public Policy Center, Johns Hopkins University, Barcelona, Spain
- Transdisciplinary Research Group on Socioecological Transitions (GinTrans2), Universidad Autónoma de Madrid, Madrid, Spain
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Schaaf M, Kapilashrami A, George A, Amin A, Downe S, Boydell V, Samari G, Ruano AL, Nanda P, Khosla R. Unmasking power as foundational to research on sexual and reproductive health and rights. BMJ Glob Health 2021; 6:bmjgh-2021-005482. [PMID: 33832951 PMCID: PMC8039258 DOI: 10.1136/bmjgh-2021-005482] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/13/2021] [Accepted: 03/15/2021] [Indexed: 01/19/2023] Open
Affiliation(s)
- Marta Schaaf
- Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Anuj Kapilashrami
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Asha George
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, Western Province, South Africa
| | - Avni Amin
- Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, Preston, Lancashire, UK
| | - Victoria Boydell
- Global Health Centre, Geneva Graduate Institute, Geneva, Switzerland
| | - Goleen Samari
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Ana Lorena Ruano
- Centre for International Health, University of Bergen, Bergen, Norway.,Center for the Study of Equity and Governance in Health Systems (CEGSS), Guatemala City, Guatemala
| | - Priya Nanda
- Bill and Melinda Gates Foundation India, New Delhi, Delhi, India
| | - Rajat Khosla
- Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
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McLaren L, Masuda J, Smylie J, Zarowsky C. Unpacking vulnerability: towards language that advances understanding and resolution of social inequities in public health. Canadian Journal of Public Health 2021; 111:1-3. [PMID: 31994015 DOI: 10.17269/s41997-019-00288-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Janet Smylie
- University of Toronto and St. Michael's Hospital, Toronto, ON, Canada
| | - Christina Zarowsky
- Université de Montréal, Montréal, QC, Canada.,University of the Western Cape, Cape Town, South Africa
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Kamalakannan S, Bhattacharjya S, Bogdanova Y, Papadimitriou C, Arango-Lasprilla JC, Bentley J, Jesus TS. Health Risks and Consequences of a COVID-19 Infection for People with Disabilities: Scoping Review and Descriptive Thematic Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4348. [PMID: 33923986 PMCID: PMC8074171 DOI: 10.3390/ijerph18084348] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/08/2021] [Accepted: 04/16/2021] [Indexed: 12/11/2022]
Abstract
This study aims to synthesize the literature on any disproportionate health risks or consequences of a COVID-19 infection for people with disabilities. Scoping review with a descriptive thematic analysis was carried out. Up to mid-September 2020, seven scientific databases and three preprint servers were searched to identify empirical or perspective papers. Snowballing searches and expert' consultations also took place. Two independent reviewers were used for the screenings and data extractions. Of 1027 references, 58 were included, 15 of which were empirical articles. The thematic analysis showed that: (1) People with disabilities living in residential or long-term care facilities were more likely to have greater infection rates; (2) Intersecting mediators of greater infection risks were multiple (e.g., lack of accessible information); (3) People with disabilities often face greater health problems when infected; and (4) Unethical disadvantages in the rationing of lifesaving and critical care can be experienced by people with disabilities. Conclusions: Beyond any health-related vulnerabilities (e.g., comorbidity rates), multiple yet modifiable environmental factors can provide disproportionate health risks and consequences of a COVID-19 infection for people with disabilities. Public health and policy measures must prevent or reduce modifiable environmental risks.
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Affiliation(s)
- Sureshkumar Kamalakannan
- Public Health Foundation of India (PHFI), South Asia Centre for Disability Inclusive Development and Research (SACDIR), Indian Institute of Public Health-Hyderabad (IIPH-H), Hyderabad 500 033, India;
| | - Sutanuka Bhattacharjya
- Department of Occupational Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA 30303, USA;
| | - Yelena Bogdanova
- Physical Medicine & Rehabilitation Service, VA Boston Healthcare System, Boston, MA 02130, USA;
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | - Christina Papadimitriou
- Departments of Interdisciplinary Health Sciences, School of Health Sciences, Oakland University, Rochester, MI 48309-4452, USA;
| | - Juan Carlos Arango-Lasprilla
- IKERBASQUE, Basque Foundation for Science, 48903 Bilbao, Spain;
- Biocruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain
- Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, 48903 Leioa, Spain
| | - Jacob Bentley
- Department of Clinical Psychology, Seattle Pacific University, Seattle, WA 98119, USA;
- Department of Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21205-2196, USA
| | - Tiago S. Jesus
- Global Health and Tropical Medicine (GHTM) & WHO Collaborating Centre for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, 1349-008 Lisbon, Portugal
- Department of Occupational Therapy, College of Health & Rehabilitation Sciences: Sargent College, Boston University, MA 02215, USA
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Filipe AM, Lloyd S, Larivée A. Troubling Neurobiological Vulnerability: Psychiatric Risk and the Adverse Milieu in Environmental Epigenetics Research. FRONTIERS IN SOCIOLOGY 2021; 6:635986. [PMID: 33912612 PMCID: PMC8072338 DOI: 10.3389/fsoc.2021.635986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
In post-genomic science, the development of etiological models of neurobiological vulnerability to psychiatric risk has expanded exponentially in recent decades, particularly since the neuromolecular and biosocial turns in basic research. Among this research is that of McGill Group for Suicide Studies (MGSS) whose work centers on the identification of major risk factors and epigenetic traits that help to identify a specific profile of vulnerability to psychiatric conditions (e.g., depression) and predict high-risk behaviors (e.g., suicidality). Although the MGSS has attracted attention for its environmental epigenetic models of suicide risk over the years and the translation of findings from rodent studies into human populations, its overall agenda includes multiple research axes, ranging from retrospective studies to clinical and epidemiological research. Common to these research axes is a concern with the long-term effects of adverse experiences on maladaptive trajectories and negative mental health outcomes. As these findings converge with post-genomic understandings of health and also translate into new orientations in global public health, our article queries the ways in which neurobiological vulnerability is traced, measured, and profiled in environmental epigenetics and in the MGSS research. Inspired by the philosophy of Georges Canguilhem and by literature from the social studies of risk and critical public health, we explore how the epigenetic models of neurobiological vulnerability tie into a particular way of thinking about the normal, the pathological, and the milieu in terms of risk. Through this exploration, we examine how early life adversity (ELA) and neurobiological vulnerability are localized and materialized in those emerging models while also considering their broader conceptual and translational implications in the contexts of mental health and global public health interventions. In particular, we consider how narratives of maladaptive trajectories and vulnerable selves who are at risk of harm might stand in as a "new pathological" with healthy trajectories and resilient selves being potentially equated with a "new normal" way of living in the face of adversity. By troubling neurobiological vulnerability as a universal biosocial condition, we suggest that an ecosocial perspective may help us to think differently about the dynamics of mental health and distress in the adverse milieu.
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Affiliation(s)
- Angela Marques Filipe
- Department of Sociology and Centre for Research on Children & Families, McGill University, Montréal, QC, Canada
- Centre for Biomedicine, Self & Society, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Stephanie Lloyd
- Department of Anthropology, Université Laval, Québec, QC, Canada
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Implementing Anti-Racism Interventions in Healthcare Settings: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062993. [PMID: 33803942 PMCID: PMC8000324 DOI: 10.3390/ijerph18062993] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 11/21/2022]
Abstract
Racism towards Black, Indigenous and people of colour continues to exist in the healthcare system. This leads to profound harm for people who use and work within these settings. This is a scoping review to identify anti-racism interventions in outpatient healthcare settings. Searching the peer-reviewed and grey literature, articles were screened for inclusion by at least two independent reviewers. Synthesizing the socio-ecological levels of interventions with inductively identifying themes, a conceptual model for implementing anti-racism interventions in healthcare settings is presented. In total, 37 peer-reviewed articles were included in the review, with 12 empirical studies and 25 theoretical or conceptual papers. Six grey literature documents were also included. Healthcare institutions need to incorporate an explicit, shared language of anti-racism. Anti-racism action should incorporate leadership buy-in and commitment with dedicated resources, support and funding; a multi-level approach beginning with policy and organizational interventions; transparent accountability mechanisms for sustainable change; long-term meaningful partnerships with Black, Indigenous, and people of colour (i.e., racialized communities); and ongoing, mandatory, tailored staff education and training. Decision-makers and staff in healthcare settings have a responsibility to take anti-racism action and may improve the success and sustainability of their efforts by incorporating the foundational principles and strategies identified in this paper.
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Kim JY, Han JO, Lee H. Recommendation for response to the COVID-19 pandemic: Korean context of "distancing in daily life," considering vulnerable population. Int J Equity Health 2020; 19:198. [PMID: 33158449 PMCID: PMC7646719 DOI: 10.1186/s12939-020-01309-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/22/2020] [Indexed: 11/25/2022] Open
Abstract
While the coronavirus disease 2019 (COVID-19) pandemic is an ongoing worldwide, including South Korea (hereinafter Korea), it is impossible to predict the duration of the pandemic. To stop the spread of COVID-19, “social distancing,” which included mandatory lockdown, and attention to personal hygiene are being adopted globally as non-pharmaceutical preventive strategies. In Korea, after maintaining strong social distancing rules for a while, the government transitioned to implementing “distancing in daily life” since May 6, 2020. The distancing in daily life was combined with infection prevention activities to stop the COVID-19 pandemic, while guaranteeing one’s daily life and economic activities. In this regard, the Ministry of Health and Welfare in Korea disclosed key rules for personal quarantine. The five key rules for individual infection control are as follows: to stay at home for 3–4 days if you feel unwell, keep a distance of two arms’ length from others, to wash your hands for 30 s and cough or sneeze into your sleeves, ventilate at least twice a day and disinfect regularly, and stay connected while physically distancing. However, for vulnerable populations, it is very difficult to follow such rules. Thus, we attempted to recommend how the society could support such vulnerable populations who may face difficulties in following these individual infection control rules. Through our recommendations for the weakest part of our society, we expect to strengthen the overall social structure.
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Affiliation(s)
- Ja Young Kim
- Gyeonggi Public Health Policy Institute, 7th Floor, 172, Dolma-ro, Seongnam-si, Gyeonggi-do, 13605, Republic of Korea
| | - Jin-Ok Han
- Gyeonggi Public Health Policy Institute, 7th Floor, 172, Dolma-ro, Seongnam-si, Gyeonggi-do, 13605, Republic of Korea
| | - Heeyoung Lee
- Gyeonggi Public Health Policy Institute, 7th Floor, 172, Dolma-ro, Seongnam-si, Gyeonggi-do, 13605, Republic of Korea. .,Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
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Hayes K, Poland B, Cole DC, Agic B. Psychosocial adaptation to climate change in High River, Alberta: implications for policy and practice. Canadian Journal of Public Health 2020; 111:880-889. [PMID: 32720216 DOI: 10.17269/s41997-020-00380-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/29/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Psychosocial adaptation to climate change-related events remains understudied. We sought to assess how the psychosocial consequences of a major event were addressed via public health responses (e.g., programs, policies, and practices) that aimed to enhance, protect, and promote mental health. METHODS We report on a study of health and social service responses to the long-term mental health impacts of the 2013 Southern Alberta flood, in High River, Alberta. Qualitative research methods included (i) telephone interviews (n = 14) with key informant health and social services leaders, (ii) four focus group sessions with front-line health and social services workers (n = 14), and (iii) semi-structured interviews with a sample of community members (n = 18) who experienced the flood. We conducted a descriptive thematic analysis, with a focus on participants' perceptions and experiences. RESULTS Findings of this study suggest (1) the long-term psychosocial impacts of extreme weather and climate change require sustained recovery interventions rooted in local knowledge and interdisciplinary action; (2) there are unintended consequences related to psychosocial interventions that can incite complex emotions and impact psychosocial recovery; and (3) perceptions of mental health care, among people exposed to climate-related trauma, can guide climate change and mental health response and recovery interventions. CONCLUSION Based on this initial exploration, policy and practice opportunities for public health to enhance psychosocial adaptation to our changing climate are highlighted.
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Affiliation(s)
- Katie Hayes
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Blake Poland
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Donald C Cole
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Branka Agic
- Dalla Lana School of Public Health, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Ontario, Canada
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Erdmann R, Morrin L, Harvey R, Joya L, Clifford A, Soroka S. Canadian Senior Renal Leaders Community of Practice: Vulnerable Populations With Chronic Kidney Disease-Evidence to Inform Policy. Can J Kidney Health Dis 2020; 7:2054358120930977. [PMID: 32782812 PMCID: PMC7383632 DOI: 10.1177/2054358120930977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/14/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose: Low socioeconomic status, race, ethnicity, and rural/remote populations are all associated with disparities in access, care, and outcomes for chronic kidney disease (CKD). There have been different interventions supported by Canadian renal programs to address these disparities. This article reviews the evidence for impact of strategies to reduce inequities experienced by vulnerable populations living with or at risk of CKD and to collate and share interprovincial targeted interventions through the newly formed “Canadian Senior Renal Leaders Community of Practice” focused on translating evidence into clinical practice and policy. Source of Information: A literature search of Medline, CINAHL, PubMed, and Google Scholar from 2008 to 2018 identified 13 reports of processes and interventions that have been implemented in Australia, Canada, and the United States to reduce inequities in CKD care and can be categorized into 3 broad areas: (1) early screening and prevention, (2) disease management and dialysis, and (3) pretransplant. Web sites from each Canadian jurisdiction and from Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) Network were used to assess the current state of Canadian initiatives. Methods: Reviews were completed to gather information on renal initiatives for vulnerable populations, including (1) identification of populations that experience disparities in access to care or in outcomes in the context of CKD prevention and treatment and (2) interventions that have been implemented to reduce disparities in access, care, and outcomes for vulnerable populations with CKD. A current state summary of Canadian initiatives related to vulnerable populations was conducted through a review of publicly available information, including a review of renal program Web sites and a review of current projects related to vulnerable populations that are part of Can-SOLVE CKD. Can-SOLVE CKD is a Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR-SPOR) funded research network to transform the care of people affected by kidney disease. Key Findings: Interventions to improve inequities in access to CKD screening, disease management, and care are successful when developed with community engagement, provided to the patient in their own environment, and tailored to specific populations. Many provincial renal programs have implemented initiatives to support vulnerable populations with or at risk of CKD. Current projects funded through CIHR SPOR focus on underserved populations and involve partnerships with Indigenous populations. Many renal programs in Canada had or were in the process of implementing interventions to support vulnerable populations with CKD; however, information about the initiatives were not readily available online despite a strong interest and opportunity to support interprovincial knowledge sharing. Despite this common interest, little information is systematically shared between Canadian jurisdictions to support interprovincial sharing to promote evidence-informed policy and program development. Efforts will be made through the newly formed Canadian Senior Renal Leaders Community of Practice to collaborate and share learnings to inform future program and policy development, implementation, and evaluation. Limitations: As this was not a systematic review, literature search only encompassed studies published in English between 2008 and 2018. It is possible that populations and interventions were overlooked during the search and through the screening process. Furthermore, the controversial definition of “vulnerable” and literature that only came from Canada, the United States, and Australia limits the generalizability of this review.
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Affiliation(s)
| | | | | | - Lisa Joya
- Cancer Care Ontario, Toronto, Canada
| | | | - Steven Soroka
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, Canada
- Steven Soroka, Nova Scotia Health Authority, 5880 Dickson Building, 5820 University Ave, Halifax, NS, Canada B3H 1V8.
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