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Beck McGreevy P, Wood S, Thomson E, Burmeister C, Spence H, Pelletier J, Giesinger W, McDougall J, McLeod R, Hutchison A, Lock K, Norton A, Barker B, Urbanoski K, Slaunwhite A, Nosyk B, Pauly B. Doing community-based research during dual public health emergencies (COVID and overdose). Harm Reduct J 2023; 20:135. [PMID: 37715202 PMCID: PMC10504762 DOI: 10.1186/s12954-023-00852-4] [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: 02/07/2023] [Accepted: 08/20/2023] [Indexed: 09/17/2023] Open
Abstract
Meaningful engagement and partnerships with people who use drugs are essential to conducting research that is relevant and impactful in supporting desired outcomes of drug consumption as well as reducing drug-related harms of overdose and COVID-19. Community-based participatory research is a key strategy for engaging communities in research that directly affects their lives. While there are growing descriptions of community-based participatory research with people who use drugs and identification of key principles for conducting research, there is a gap in relation to models and frameworks to guide research partnerships with people who use drugs. The purpose of this paper is to provide a framework for research partnerships between people who use drugs and academic researchers, collaboratively developed and implemented as part of an evaluation of a provincial prescribed safer supply initiative introduced during dual public health emergencies (overdose and COVID-19) in British Columbia, Canada. The framework shifts from having researchers choose among multiple models (advisory, partnership and employment) to incorporating multiple roles within an overall community-based participatory research approach. Advocacy by and for drug users was identified as a key role and reason for engaging in research. Overall, both academic researchers and Peer Research Associates benefited within this collaborative partnerships approach. Each offered their expertise, creating opportunities for omni-directional learning and enhancing the research. The shift from fixed models to flexible roles allows for a range of involvement that accommodates varying time, energy and resources. Facilitators of involvement include development of trust and partnering with networks of people who use drugs, equitable pay, a graduate-level research assistant dedicated to ongoing orientation and communication, technical supports as well as fluidity in roles and opportunities. Key challenges included working in geographically dispersed locations, maintaining contact and connection over the course of the project and ensuring ongoing sustainable but flexible employment.
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Affiliation(s)
- Phoenix Beck McGreevy
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Shawn Wood
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Erica Thomson
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
- BCYADWS (BC Yukon Association of Drug War Survivors), Vancouver, Canada
| | - Charlene Burmeister
- PWLLE Stakeholder Engagement Lead, Professionals for Ethical Engagement of Peers (PEEP), BC Centre for Disease Control, Provincial Health Services Authority, Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
- CSUN (Coalition of Substance Users of the North), Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Heather Spence
- KANDU (Knowledging All Nations and Developing Unity), Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Josh Pelletier
- KANDU (Knowledging All Nations and Developing Unity), Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Willow Giesinger
- BCYADWS (BC Yukon Association of Drug War Survivors), Vancouver, Canada
| | - Jenny McDougall
- CSUN (Coalition of Substance Users of the North), Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Rebecca McLeod
- CSUN (Coalition of Substance Users of the North), Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Abby Hutchison
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Kurt Lock
- BCCDC (British Columbia Centre for Disease Control) Harm Reduction Program, 655 West 12Th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Alexa Norton
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
- First Nations Health Authority, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Brittany Barker
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
- First Nations Health Authority, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Karen Urbanoski
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
- School of Public Health and Social Policy, University of Victoria, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Amanda Slaunwhite
- BCCDC (British Columbia Centre for Disease Control) Harm Reduction Program, 655 West 12Th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Bohdan Nosyk
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Centre for Health Evaluation and Outcome Sciences, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Bernie Pauly
- Canadian Institute for Substance Use Research, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada.
- School of Nursing, University of Victoria, Box 1700 Stn CSC, Victoria, BC, Canada.
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Poliquin H, Perreault M, Villela Guilhon AC, Bertrand K. Improving Harm Reduction Services: A Qualitative Study on the Perspectives of Highly Marginalized Persons Who Inject Drugs in Montreal. JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426221123269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Harm reduction (HR) is an alternative to the moralization of drug use and a pragmatic public health approach aimed at minimizing harms associated with use. This study sought to gain the perspectives of persons who inject drugs (PWID) on the adequacy of services provided by HR organizations in Montreal. Twenty-two semi-structured interviews and two focus groups were conducted with 30 participants. Some of the key advantages of HR perceived by participants include access to injection equipment, psychosocial support, and reduced social isolation. However, many wanted more opportunities for social insertion and greater value to be placed on their knowledge and life experiences (e.g., experiential knowledge of the street scene, drug use, sex work, or homelessness). This study suggests that PWID who access HR services in Montreal are interested in paid work opportunities in environments that promote power sharing, and activities that are conducted and managed by and for them.
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Affiliation(s)
- Hélène Poliquin
- Institut national de santé publique du Québec, Montréal, QC, Canada
| | - Michel Perreault
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Ana C. Villela Guilhon
- Department of Community Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
| | - Karine Bertrand
- Department of Community Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
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Pauly B, Sullivan G, Inglis D, Cameron F, Phillips J, Rosen C, Bullock B, Cartwright J, Hainstock T, Trytten C, Urbanoski K. Applicability of a national strategy for patient-oriented research to people who use(d) substances: a Canadian experience. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:22. [PMID: 35610726 PMCID: PMC9127478 DOI: 10.1186/s40900-022-00351-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 04/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Europe and North America are in the grips of a devastating overdose crisis. People who use substances often feel unsafe to access healthcare due to fears of stigma, blame, judgement, poor treatment, or other repercussions. As a result, they often avoid, delay, or leave care, resulting in premature death and missed opportunities for care. Internationally, there have been concerted efforts to move towards patient-engaged research to enhance the quality of health care systems and services. In Canada, the Canadian Institutes of Health Research (CIHR) Strategy for Patient-Oriented Research (SPOR) initiative promotes engagement of patients as active partners in health care research. As part of a community based patient oriented research project, we critically analyze the SPOR framework to provide insights into what constitutes safer research with people who use(d) substances. METHODS We undertook a two-stage process that began with a review of community based research principles and the SPOR framework. At the second stage, we undertook a qualitative descriptive study employing focus groups to generate description of the adequacy and appropriateness of the SPOR framework for guiding research with people who use(d) substances on four key dimensions (patient engagement, guiding principles, core areas of engagement and benefits). The data were analyzed using qualitative content analysis to identify key issues and insights. RESULTS While the SPOR framework includes a range of patient roles, principles and areas for engagement, there are issues and gaps related to essential elements of safe patient-oriented research for people who use substances. These include an individualized focus on patients as partners, lack of recognition of community benefits, power imbalances and distrust due to systemic stigma, engagement as one way capacity building and learning, and lack of accountability for taking action on research findings. CONCLUSIONS Given the extent of stigma in health care and the ongoing illicit drug policy crisis, strategies for enhancing equitable Patient-Oriented Research (POR) include shifting language from patient partners to community researchers, recognizing power inequities and adding trust and equity as core POR principles including pay equity. Employing community based participatory research as a POR methodology allows the lead researchers to fully engage community throughout the research process, enhances community benefits and accountability for action.
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Affiliation(s)
- Bernadette Pauly
- University of Victoria School of Nursing, Canadian Institute for Substance Use Research, Victoria, Canada.
| | - Ginger Sullivan
- University of Victoria School of Nursing, Canadian Institute for Substance Use Research, Victoria, Canada
| | - Dakota Inglis
- University of Victoria, Canadian Institute for Substance Use Research, Victoria, Canada
| | | | | | - Conor Rosen
- Umbrella Society for Addictions and Mental Health, Victoria, Canada
| | - Bill Bullock
- Victoria Division of Family Practice, Victoria, Canada
| | - Jennifer Cartwright
- BC Support Unit, Advancing Patient Oriented Research, Vancouver Island Regional Centre, Victoria, Canada
| | - Taylor Hainstock
- BC Support Unit, Advancing Patient Oriented Research, Vancouver Island Regional Centre, Victoria, Canada
| | | | - Karen Urbanoski
- University of Victoria, Canadian Institute for Substance Use Research, Victoria, Canada
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Foster R, Carver H, Wallace J, Dunedin A, Burridge S, Foley P, Pauly B, Parkes T. "PPI? That sounds like Payment Protection Insurance": Reflections and learning from a substance use and homelessness study Experts by Experience group. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:82. [PMID: 34801090 PMCID: PMC8605889 DOI: 10.1186/s40900-021-00324-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/03/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND Patient and Public Involvement in research is important for citizenship, accountability and transparency, and has the practical benefit of helping to ensure its quality and applicability. Involving members of the public in research is becoming increasingly commonplace, in the UK and internationally. It is essential that public involvement is inclusive of individuals and their diverse life experiences, including challenging experiences that may be associated with stigma and social exclusion. The involvement of people with lived/living experience of substance use and homelessness in research is increasing in response to increased recognition of the importance of inclusion and the benefits conferred to research. MAIN BODY In this commentary, we share our own experiences of being part of a Patient and Public Involvement group that was convened during a feasibility study of a peer-delivered harm reduction intervention. We are a diverse group but share experience of the field of substance use/homelessness, as people with lived/living experience, and as researchers and practitioners. We share our reflections and learning, as well as offer recommendations for researchers working in our field. Our group worked together to make a positive and deliberate contribution to the study. This did not happen by chance but required the development of mutual trust and respect, with each member having a commitment to support the group for its two-year duration. SHORT CONCLUSION It is important for researchers to appreciate that meaningful Patient and Public Involvement is very valuable but requires a commitment from all involved. Regarding our field of substance use and homelessness specifically, it is essential that people with these experiences have opportunities to contribute to research and can do so in a meaningful way. People with lived/living experience are able to bring to life the rich tapestry of others' experiences. However, the involvement must be neither tokenistic nor indifferent to the wider challenges common to these experiences.
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Affiliation(s)
- Rebecca Foster
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, 4S26 RG Bomont Building, University of Stirling, Stirling, FK9 4LA, UK
| | - Hannah Carver
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, 4S26 RG Bomont Building, University of Stirling, Stirling, FK9 4LA, UK.
| | - Jason Wallace
- The Scottish Drugs Forum, 91 Mitchell Street, Glasgow, UK
| | - Alex Dunedin
- The Ragged University, Online Forum, Edinburgh, UK
| | | | - Philip Foley
- Turning Point Scotland, 54 Govan Road, Glasgow, UK
| | - Bernie Pauly
- School of Nursing, University of Victoria, Victoria, Canada
| | - Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, 4S26 RG Bomont Building, University of Stirling, Stirling, FK9 4LA, UK
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Austin T, Boyd J. Having a voice and saving lives: a qualitative survey on employment impacts of people with lived experience of drug use working in harm reduction. Harm Reduct J 2021; 18:1. [PMID: 33407500 PMCID: PMC7789009 DOI: 10.1186/s12954-020-00453-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 12/07/2020] [Indexed: 11/14/2022] Open
Abstract
Background Ongoing legal and social discrimination, and stigmatization of people with lived experience of drug use (PWLE) continues to contribute to overdose-related deaths in Canada. The involvement of PWLE working in harm reduction services has proven effective in decreasing drug-related harms among PWLE; however, there exist unintended negative impacts. PWLE working in harm reduction services risk overextending themselves beyond employment parameters (e.g., emotional labor) with few systems in place (e.g., employment advocacy) for support. While meaningful participation of PWLE in harm reduction programs is critical to addressing the overdose crisis, their labor in Canada’s overdose response commands further investigation and recognition. This paper examines some of the benefits and negative aspects of working in harm reduction among PWLE. Methods Fifty qualitative surveys were completed by PWLE working in harm reduction services from across Canada at the National 2018 Stimulus conference held in Edmonton, Alberta. The surveys focused on the benefits and negatives of ‘peer’ employment and recommendations for organizational transformation through short answer written sections. Surveys were analyzed thematically using NVivo, informed by critical perspectives on substance use, with attention to key re-occurring themes on employment equity. Results While participants described multiple benefits of working in harm reduction services, such as the valuing of their expertise by fellow ‘peers,’ growing skill sets, countering stigma, and preventing overdose deaths, issues of workplace equity were significantly identified. Stigma, tokenism, workplace discrimination, including power and pay inequities, as well as lack of worker compensation and benefits were identified as key factors persisting in the everyday experiences of participants. Conclusion Continued exposure to stigma, workplace discrimination, and/or power imbalances, combined with the impact of high stakes employment (e.g., dealing with overdose deaths), can have significant consequences for PWLE working in harm reduction, including burn out. Policy recommendations include large-scale structural changes that address inequities of hierarchical ‘peer’ employment for PWLE, including increased leadership roles for diverse PWLE, pay equity and benefits, unionization, as well as more supportive working environments attentive to the intersecting social-structural factors (poverty, criminalization, racism, gendered violence) impacting the everyday lives of PWLE working in harm reduction.
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Affiliation(s)
| | - Tamar Austin
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada. .,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Olding M, Boyd J, Kerr T, McNeil R. "And we just have to keep going": Task shifting and the production of burnout among overdose response workers with lived experience. Soc Sci Med 2021; 270:113631. [PMID: 33418149 DOI: 10.1016/j.socscimed.2020.113631] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 01/13/2023]
Abstract
Overdose response programs in North America increasingly employ task shifting-shifting overdose response tasks to less specialized workers-to increase effectiveness and promote involvement of people with lived/living experience of drug use (PWLE). In Canada, task shifting has occurred through community-driven implementation of overdose response programs staffed primarily by PWLE. The implications of this task shifting on workers' well-being and service delivery has received little scholarly consideration, despite reports of widespread burnout among frontline responders. This study examines experiences and drivers of burnout among PWLE working at low-barrier supervised consumption sites ("Overdose Prevention Sites" or OPSs) in Vancouver, Canada. Between December 2016 and March 2020, we conducted ethnographic fieldwork at four OPSs, including in-depth interviews with 23 overdose response workers, three site-based focus groups with 20 additional workers, and 150 h of naturalistic observation. Data were analyzed to explore how working conditions, labour arrangements, economic insecurity and social disadvantage shaped burnout. We found that overdose response workers commonly reported burnout, which they attributed to the precarious and demanding nature of their work. While casual positions offered low-barrier employment, PWLE often lacked the wages and benefits enjoyed by other frontline workers, with limited supports and opportunities for advancement. Due to their social position within drug-using networks, PWLE's work encompassed hidden care work that participants felt was constant and undervalued. The scarcity of permanent full-time positions, alongside barriers to transitioning into formal employment, prevented many PWLE from earning livable wages or taking time off to 'recharge.' This study highlights how the devaluing and casualization of overdose response labour, compounded by other dimensions of structural vulnerability, are central to burnout among overdose response workers with lived experience. Interventions to address burnout within this setting must extend beyond individual-level interventions (e.g. counselling, self-care) to also strengthen working conditions and economic security of PWLE.
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Affiliation(s)
- Michelle Olding
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, V6Z 1Y6, BC, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, V6Z 1Y6, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, V6Z 1Y6, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, V6Z 1Y6, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Yale School of Medicine, New Haven, CT, United States; Yale School of Public Health, New Haven, CT, United States; Department of Anthropology, Yale University, New Haven, CT, United States.
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Bayat AH, Mohammadi R, Moradi-Joo M, Bayani A, Ahounbar E, Higgs P, Hemmat M, Haghgoo A, Armoon B. HIV and drug related stigma and risk-taking behaviors among people who inject drugs: a systematic review and meta-analysis. J Addict Dis 2020; 38:71-83. [PMID: 32186479 DOI: 10.1080/10550887.2020.1718264] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The impact of HIV-related stigma on people living with HIV has been well documented, but there have been few studies examining how drug-related stigma impacts risk-taking in the lives of people who inject drugs (PWID). This meta-analysis aimed to determine HIV and drug-related stigma and the association it has with risk-taking behaviors among PWID. We searched PubMed, Science Direct, Web of Science, and Cochrane electronic databases independently in March 2019. After reviewing for any study duplicates the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes (PICO) criteria. We used fixed and random-effects meta-analysis models to estimate the pooled prevalence, pooled odds ratio (OR) and 95% confidence intervals. After a detailed assessment, a total of 14 studies containing 13,689 participants met the eligibility criteria. Among the potential risk factors: employment status, depression and sharing injecting paraphernalia had a significant relationship with HIV and drug stigma among PWIDs respectively (OR = 0.78, 95%CI = 0.62-0.98), (OR = 1.84, 95%CI = 1.45-2.33) and (OR = 2.20, 95%CI = 1.84-1.63). Illicit drug use related stigma was found to be associated with several concurrent effects. The impact of stigma should be considered in the development of drug use prevention strategies. Perceived stigma is correlated with numerous negative consequences in other populations including people living with HIV/AIDS. These data suggest this could also be generalized to people who inject drugs because it seems that individuals with internalized stigma experience drug dependence, reduced comfort in seeking help from services and higher rates of depression.
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Affiliation(s)
- Amir-Hossein Bayat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Rasool Mohammadi
- School of Public Health, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohammad Moradi-Joo
- National Center for Health Insurance Research, Iran Health Insurance Organization, Tehran, Iran
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elahe Ahounbar
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Morteza Hemmat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Amin Haghgoo
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran.,Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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