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Gogoi M, Qureshi I, Chaloner J, Al-Oraibi A, Reilly H, Wobi F, Agbonmwandolor JO, Ekezie W, Hassan O, Lal Z, Kapilashrami A, Nellums L, Pareek M. Discrimination, disadvantage and disempowerment during COVID-19: a qualitative intrasectional analysis of the lived experiences of an ethnically diverse healthcare workforce in the United Kingdom. Int J Equity Health 2024; 23:105. [PMID: 38783292 PMCID: PMC11118759 DOI: 10.1186/s12939-024-02198-0] [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: 06/19/2023] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Healthcare workers (HCWs) in the United Kingdom (UK) have faced many challenges during the COVID-19 pandemic, some of these arising out of their social positions. Existing literature explicating these challenges (e.g., lack of appropriate PPE, redeployment, understaffing) have highlighted inequities in how these have been experienced by HCWs based on ethnicity, gender or, job role. In this paper, we move a step ahead and examine how the intersection of these social positions have impacted HCWs' experiences of challenges during the pandemic. METHODS We collected qualitative data, using interviews and focus groups, from 164 HCWs from different ethnicities, gender, job roles, migration statuses, and regions in the United Kingdom (UK) between December 2020 and July 2021. Interviews and focus groups were conducted online or by telephone, and recorded with participants' permission. Recordings were transcribed and a hybrid thematic analytical approach integrating inductive data-driven codes with deductive ones informed by an intersectional framework was adopted to analyse the transcripts. RESULTS Thematic analysis of transcripts identified disempowerment, disadvantage and, discrimination as the three main themes around which HCWs' experiences of challenges were centred, based on their intersecting identities (e.g., ethnicity gender, and/or migration status). Our analysis also acknowledges that disadvantages faced by HCWs were linked to systemic and structural factors at the micro, meso and macro ecosystemic levels. This merging of analysis which is grounded in intersectionality and considers the ecosystemic levels has been termed as 'intrasectionalism'. DISCUSSION Our research demonstrates how an intrasectional lens can help better understand how different forms of mutually reinforcing inequities exist at all levels within the healthcare workforce and how these impact HCWs from certain backgrounds who face greater disadvantage, discrimination and disempowerment, particularly during times of crisis like the COVID-19 pandemic.
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Affiliation(s)
- Mayuri Gogoi
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
| | - Irtiza Qureshi
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- The Nottingham Centre for Public Health and Epidemiology, University of Nottingham, Nottingham, UK
| | - Jonathan Chaloner
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Amani Al-Oraibi
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Holly Reilly
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
| | - Fatimah Wobi
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Joy Oghogho Agbonmwandolor
- David Evans Medical Research Centre, Nottingham University Hospital NHS Trust, City Hospital, Nottingham, UK
| | - Winifred Ekezie
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Centre for Ethnic Health Research, University of Leicester, Leicester, UK
| | - Osama Hassan
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Zainab Lal
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
| | - Anuj Kapilashrami
- School of Health and Social Care, University of Essex, Colchester, UK
- Centre for Global Health & Intersectional Equity Research, University of Essex, Colchester, UK
| | - Laura Nellums
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- College of Population Health, Health Sciences Centre, University of New Mexico, Albuquerque, NM, USA
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester, UK.
- Development Centre for Population Health, University of Leicester, Leicester, UK.
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
- NIHR Leicester BRC, Leicester, UK.
- NIHR ARC East Midlands, Leicester, UK.
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Sherman AD, Febres-Cordero S, Bonds Johnson K, Clark KD, Klepper M, Duroseau B, Lin Y, Zhang W, Coleman M, Prakash D, Daniel GA, Chand AT, Kalu U, Tarter R, Allgood S, Cohen S, Kelly U, Balthazar M. Intersectionality in nursing research: A scoping review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2023; 5:100155. [PMID: 37982092 PMCID: PMC10655863 DOI: 10.1016/j.ijnsa.2023.100155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 11/21/2023] Open
Abstract
Background An intersectional approach to health research provides an analytical foundation to explain the multidimensionality of health status, resource accessibility, privilege, oppression, and current and historical context. The use of intersectionality in health research has known limitations. Its use in health-related fields too often focuses on outcomes, such as health disparities, rather than processes, such as power structures and social determinants. Objective This scoping review serves to examine how intersectionality has been implemented by nurses in the peer-reviewed literature. We offer insight into how it may be incorporated to inform future nursing research and healthcare provision. Design & Methods Systematic searches of PubMed (n = 257), SCOPUS (n = 807), EMBASE (n = 396), CINAHL (n = 224), and Health Source: Nursing and Academics (n = 491), published since the seminal publication on intersectionality (1989 - 2023), identified 131 research articles that met inclusion and exclusion criteria. Data extraction and synthesis were used to describe the breadth and depth of the literature specific to the application of intersectionality in nursing research. Results The included studies used intersectionality to examine the intersections of numerous identities, such as race, gender, and immigration status. However, most studies were descriptive/observational in nature, underreported their methods, and conducted deficit-based research instead of strength-based inquiries. Of note, the vast majority of included articles were published within the last five years. Conclusions Future researchers using intersectionality as a framework can improve their approach by reporting clear definitions and operationalization of intersectionality. Observational science dominated the included studies; future research should focus on intervention development and evaluation using an intersectional lens. Lastly, caution should be placed on research that focuses solely on deficits among marginalized communities, which places scientists at risk of perpetuating stereotypes or enhancing already-existing stigmas.
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Affiliation(s)
- Athena D. F. Sherman
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Sarah Febres-Cordero
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Kalisha Bonds Johnson
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Kristen D. Clark
- Department of Nursing, University of New Hampshire, Durham, NH, USA
| | | | | | - Yufen Lin
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Wenhui Zhang
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Mercy Coleman
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Diane Prakash
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Gaea A. Daniel
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Arzina Tabassum Chand
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Ugo Kalu
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Robin Tarter
- Oregon Health and Science University, Portland, OR, USA
| | | | - Sydney Cohen
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Ursula Kelly
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
- Atlanta VA Health Care System, Atlanta, Georgia, USA
| | - Monique Balthazar
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
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Kapilashrami A, Aziz R. Pandemic preparedness with 20/20 vision: Applying an intersectional equity lens to health workforce planning. Int J Health Plann Manage 2023; 38:1117-1126. [PMID: 37421639 DOI: 10.1002/hpm.3677] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/25/2023] [Accepted: 06/22/2023] [Indexed: 07/10/2023] Open
Abstract
Human resource for health (HRH) is considered critical for achieving Universal Health Coverage, and the crisis surrounding HRH is now established as a global emergency. Their vital role has been central in the pandemic response. Yet, the discussions and deliberations on the recent pandemic treaty circumscribe HRH discussions to their capacities and protection, and address discrimination mainly in relation to gender. While this paper endorses the case for prioritisation of HRH in global pandemic preparedness planning, it re-frames the HRH crisis in relation to the institutional and structural factors driving HRH shortage, maldistribution and skills-needs misalignment. We critique the supply-and-demand framing of HRH crisis as one that obliviates the systematic inequalities within health systems that underpin health workforce motivations, distribution, satisfaction and performance. We propose an intersectional equity lens to redefine the HRH challenges, understand their underlying drivers and accordingly integrate in the global pandemic preparedness plans.
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Affiliation(s)
- Anuj Kapilashrami
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Roomi Aziz
- School of Health and Social Care, University of Essex, Colchester, UK
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Carazo S, Villeneuve J, Laliberté D, Longtin Y, Talbot D, Martin R, Denis G, Ducharme F, Paquet-Bolduc B, Anctil G, Hegg-Deloye S, De Serres G. Risk and protective factors for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection among healthcare workers: A test-negative case-control study in Québec, Canada. Infect Control Hosp Epidemiol 2023; 44:1121-1130. [PMID: 36082690 PMCID: PMC9530374 DOI: 10.1017/ice.2022.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/23/2022] [Accepted: 08/28/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES In Québec, Canada, we evaluated the risk of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection associated with (1) the demographic and employment characteristics among healthcare workers (HCWs) and (2) the workplace and household exposures and the infection prevention and control (IPC) measures among patient-facing HCWs. DESIGN Test-negative case-control study. SETTING Provincial health system. PARTICIPANTS HCWs with PCR-confirmed coronavirus disease 2019 (COVID-19) diagnosed between November 15, 2020, and May 29, 2021 (ie, cases), were compared to HCWs with compatible symptoms who tested negative during the same period (ie, controls). METHODS Adjusted odds ratios (aORs) of infection were estimated using regression logistic models evaluating demographic and employment characteristics (all 4,919 cases and 4,803 controls) or household and workplace exposures and IPC measures (2,046 patient-facing cases and 1,362 controls). RESULTS COVID-19 risk was associated with working as housekeeping staff (aOR, 3.6), as a patient-support assistant (aOR, 1.9), and as nursing staff (aOR, 1.4), compared to administrative staff. Other risk factors included being unexperienced (aOR, 1.5) and working in private seniors' homes (aOR, 2.1) or long-term care facilities (aOR, 1.5), compared to acute-care hospitals. Among patient-facing HCWs, exposure to a household contact was reported by 9% of cases and was associated with the highest risk of infection (aOR, 7.8). Most infections were likely attributable to more frequent exposure to infected patients (aOR, 2.7) and coworkers (aOR, 2.2). Wearing an N95 respirator during contacts with COVID-19 patients (aOR, 0.7) and vaccination (aOR, 0.2) were the measures associated with risk reduction. CONCLUSION In the context of the everchanging SARS-CoV-2 virus with increasing transmissibility, measures to ensure HCW protection, including vaccination and respiratory protection, and patient safety will require ongoing evaluation.
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Affiliation(s)
- Sara Carazo
- Institut national de santé Publique du Québec, Québec, Québec, Canada
| | - Jasmin Villeneuve
- Institut national de santé Publique du Québec, Québec, Québec, Canada
| | - Denis Laliberté
- Direction de la santé publique de la Capitale-Nationale, CIUSSS de la Capitale-Nationale, Québec, Québec, Canada
- Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Yves Longtin
- Infection Prevention and Control Unit, Jewish General Hospital, Montreal, Québec, Canada
- McGill University Faculty of Medicine, Montreal, Québec, Canada
| | - Denis Talbot
- Faculty of Medicine, Laval University, Québec, Québec, Canada
- Centre de recherche du CHU de Québec—Université Laval, Québec, Québec, Canada
| | - Richard Martin
- Institut national de santé Publique du Québec, Québec, Québec, Canada
| | - Geoffroy Denis
- McGill University Faculty of Medicine, Montreal, Québec, Canada
- CIUSSS Centre Sud de Montréal, Montreal, Québec, Canada
| | - Francine Ducharme
- Faculté des sciences infirmières, Université de Montréal, Montreal, Québec, Canada
- Centre de recherche de l’Institut de gériatrie de Montréal, Montreal, Québec, Canada
| | - Bianka Paquet-Bolduc
- Infection Prevention and Control Unit, Institut Universitaire en cardiologie et pneumologie de Québec, Québec, Québec, Canada
| | - Geneviève Anctil
- Institut national de santé Publique du Québec, Québec, Québec, Canada
| | | | - Gaston De Serres
- Institut national de santé Publique du Québec, Québec, Québec, Canada
- Faculty of Medicine, Laval University, Québec, Québec, Canada
- Centre de recherche du CHU de Québec—Université Laval, Québec, Québec, Canada
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Nwaru C, Li H, Bonander C, Santosa A, Franzén S, Rosvall M, Nyberg F. Occupational role and COVID-19 among foreign-born healthcare workers in Sweden: a registry-based study. Eur J Public Health 2023; 33:202-208. [PMID: 36762873 PMCID: PMC10066486 DOI: 10.1093/eurpub/ckad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Many studies report that foreign-born healthcare workers (HCWs) in high-income countries have an elevated risk of COVID-19. However, research has not yet specifically evaluated the distribution of COVID-19 among foreign-born workers in different healthcare work groups. We examined the risk of COVID-19 infection and hospitalization among foreign-born HCWs in different occupational roles in Sweden. METHODS We linked occupational data (2019) of 783 950 employed foreign-born workers (20-65 years) to COVID-19 data registered between 1 January 2020 and 30 September 2021. We used Cox proportional hazards regression to estimate the hazard ratio (HR) with 95% confidence intervals (95% CIs) of COVID-19 infection and hospitalization in eight healthcare occupational groups vs. non-HCWs and assessed whether region of birth modified the association between healthcare occupations and COVID-19. RESULTS All HCWs had a higher risk of COVID-19 outcomes than non-HCWs, but the risk differed by occupational role. Hospital-based assistant nurses had the highest risk (infection: HR 1.78; 95% CI 1.72-1.85; hospitalization: HR 1.79; 95% CI 1.52-2.11); allied HCWs had the lowest risk (infection: HR 1.22; 95% CI 1.10-1.35; hospitalization: HR 0.98; 95% CI 0.59-1.63). The relative hazard of the outcomes varied across foreign-born workers from different regions. For example, the relative risk of COVID-19 infection associated with being a physician compared to a non-HCW was 31% higher for African-born than European-born workers. CONCLUSIONS The risk of COVID-19 among foreign-born HCWs differed by occupational role and immigrant background. Public health efforts that target occupational exposures as well as incorporate culturally responsive measures may help reduce COVID-19 risk among foreign-born HCWs.
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Affiliation(s)
- Chioma Nwaru
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Huiqi Li
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Bonander
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ailiana Santosa
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Franzén
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Rosvall
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Social Medicine, Regionhälsan, Region Västra Götaland, Gothenburg, Sweden
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Brathwaite B. Call it by its name: racism and the need to be anti-racist in British nursing. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:962-963. [PMID: 36227789 DOI: 10.12968/bjon.2022.31.18.962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Speed E, Carter S, Green J. Pandemics, infection control and social justice: challenges for policy evaluation. CRITICAL PUBLIC HEALTH 2022. [DOI: 10.1080/09581596.2022.2029195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Ewen Speed
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Simon Carter
- Department of Sociology, Walton Hall, Milton Keynes, the Open University, UK
| | - Judith Green
- Wellcome Centre for Cultures & Environments of Health, University of Exeter, Exeter, UK
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