Public perspectives on health improvement within a remote-rural island community

Causes, Solutions and Health Inequalities: Comparing Perspectives of Professional Stakeholders and Community Participants Experiencing Low Income and Poor Health in London

BACKGROUND

Engaging with the public can influence policy decisions, particularly towards more radical policy change. While established research exists exploring public perceptions on causes of health inequalities, much less exists on how to tackle health inequalities in the UK. Despite an emphasis on 'lived experience', currently no study has focused on how individuals with very poor health conceive of both causes of, and solutions to, health inequalities.

METHODS

Q methodology was used to identify and describe the shared perspectives that exist on causes of, and solutions to, health inequalities experienced in low-income communities. Community participants living with low-incomes and poor health (n = 20) and professional stakeholders (n = 20) from London rank ordered 34 'Causes' and 39 'Solutions' statements onto quasi-normal shaped grids according to their point of view. Factor analysis defined factors for both 'Causes' and 'Solutions'.

RESULTS

Analysis produced three-factor solutions for both the 'Causes' and 'Solutions'. 'Causes' are (i) 'Systemic inequality and poverty', (ii) 'Ignored and marginalised communities', (iii) 'Precariousness, chronic stress and hopelessness'. 'Solutions' are (i) 'Meeting basic needs and providing opportunities to thrive', (ii) 'Empowering individuals to take control', (iii) 'Supporting healthy choices'. No professional stakeholders aligned with 'Ignored and marginalised communities' while at least one community participant or professional stakeholder aligned with all other factors.

CONCLUSION

Results support the view that the public has a relatively sophisticated understanding of causes of health inequalities and help challenge assumptions held by policy actors that lay members of the public do not recognise and understand more upstream ways to respond to health inequalities.

PATIENT OR PUBLIC CONTRIBUTION

The public contributed to the design of the Q study. Surveys and interviews with community participants informed the development of the statement set and the statement set was also piloted with community participants and finalised based on feedback.

From polarity to plurality: Perceptions of COVID-19 and policy measures in England and Scotland

AIM

The aim of this study was to uncover perspectives on the COVID-19 pandemic and the responses implemented by the UK and Scottish Governments to help control the spread of infection. Such understanding could help to inform future responses to pandemics at individual, community and national levels.

METHOD

Q methodology was used to elicit perspectives from people in England and Scotland with different experiences of the pandemic including public health officials, key workers, those on furlough, those who were unvaccinated or vaccinated to different levels, those who were 'shielding' because they were at higher risk and people with different scientific expertise. Participants rank-ordered phrases about different aspects of COVID-19 according to their viewpoint. Factor analysis was then conducted in conjunction with interview material from the same respondents.

RESULTS

A four-factor solution was statistically supported and was interpretable alongside the qualitative accounts of participants loading on these factors. These four perspectives are titled Dangerous and Unaccountable Leadership, Fear and Anger at Policy and Public responses, Governing Through a Crisis and Injustices Exposed.

CONCLUSION

The four perspectives demonstrate plurality and nuance in views on COVID-19 and the associated policies and restrictions, going beyond a binary narrative that has been apparent in popular and social media. The four perspectives include some areas of common ground, as well as disagreement. We argue that understanding the detail of different perspectives might be used to build cohesion around policy initiatives in future.

PATIENT OR PUBLIC CONTRIBUTION

The development of the statement set, which is rank-ordered by participants in a Q study, and factor interpretations were informed by views of the general public. The statement set was initially developed using existing publicly available material based on members of the general public experiencing the pandemic first hand. It was then piloted with members of the public experiencing different challenges as a result of COVID-19 and the subsequent lockdown and updated based on feedback. Finally, interpretations of the identified factors were presented publicly and edited according to their feedback.

Perceived Challenges to Tribally Led Shellfish Toxin Testing in Southeast Alaska: Findings From Key Informant Interviews

Shellfish harvesting is central to coastal Alaska Native ways of life, and tribes in Southeast Alaska are committed to preserving sustainable and safe access to subsistence foods. However, consumption of non-commercially harvested shellfish puts Alaska Native communities at elevated risk of exposure to shellfish toxins. To address a lack of state or federal toxin testing for subsistence and recreational harvesting, tribes across Southeast Alaska have formed their own toxin testing and ocean monitoring program. In this study, we interviewed environmental managers responsible for tribes' testing and others with shellfish toxin expertise to report on perceptions of barriers to tribally led testing in Southeast Alaska. Tribal staff identified 40 prospective key informants to interview, including all environmental managers responsible for shellfish toxin testing at subsistence sites in Southeast Alaska. All 40 individuals were invited to participate in an interview and 27 individuals were interviewed. The most frequently discussed barriers to shellfish toxin testing in Southeast Alaska relate to logistical and staffing difficulties associated with communities' remote locations, inconsistent and inadequate funding and funding structures that increase staff burdens, risk communication challenges related to conveying exposure risks while supporting subsistence harvesting, and implications of climate change-related shifts in toxin exposures for risk perception and risk communication. Participants stressed the social origins of perceived barriers. Disinvestment may create and sustain barriers and be most severely felt in Native communities and remote places. Climate change impacts may interact with social and cultural factors to further complicate risk management.

Insisting on help, facing challenges, and maintaining balance: The lived experiences of caregivers raising a child with developmental delay in the remote islands of Kinmen

PURPOSE

To explore the lived experiences of the caregivers of children with developmental delay (DD) on the remote island of Kinmen, Taiwan.

DESIGN AND METHODS

This descriptive phenomenological study included 14 caregivers of 16 children with DD recruited from Kinmen, Taiwan. Data were collected from September 2020 to February 2021 with face-to-face semi-structured interviews, which were transcribed verbatim and analyzed using thematic analysis.

RESULTS

Twelve caregivers were mothers; there was one father and one grandmother. Their mean age was 37.93 ± 5.17 years. The mean age of the children was 3.90 ± 1.49 years; 11 were male (69%). As we began our study, the COVID-19 pandemic occurred, which influenced two of the three themes: (1) focusing on their child's delayed development, which involved seeking a diagnosis and blaming themselves; (2) facing barriers to caring a child with DD on a remote island, which included ostracization of their child and limited off-island medical resources, especially during COVID-19; and (3) maintaining a healthy life balance, which involved protecting their child from physical or spiritual harm, including exposure to COVID-19, and reflecting on their strengths.

CONCLUSIONS

Our findings highlight the challenges of caring for a child with DD in the Kinmen islands of Taiwan, and the impact of the COVID-19 pandemic.

PRACTICAL IMPLICATIONS

Healthcare professionals are encouraged to provide caregivers of children with DD living in remote, island communities an opportunity to share their caregiving experiences and provide strategies for obtaining medical care, which could help reduce caregiver burden.

Young people's perspectives on addressing UK health inequalities: utopian visions and preferences for action

INTRODUCTION

It is increasingly recognised by UK researchers and population health advocates that an important impetus to effective policy action to address health inequalities is activation of public dialogue about the social determinants of health and how inequalities might be addressed. The limited body of existing scholarship reaches varying conclusions on public preferences for responding to health inequalities but with consensus around the importance of tackling poverty. Young people's perspectives remain underexplored despite their increasingly visible role in activism across a range of policy issues and the potential impact of widening inequalities on their generation's health and wellbeing.

METHODS

Six groups of young people (39 in total) from two UK cities (Glasgow and Leeds) were engaged in online workshops to explore views on health inequalities and potential solutions. Inspired by calls to employ notions of utopia, artist-facilitators and researchers supported participants to explore the evidence, debating solutions and imagining a more desirable society, using visual and performance art. Drawing together data from discussions and creative outputs, we analysed participants' perspectives on addressing health inequalities across four domains: governance, environment, society/culture and economy.

FINDINGS

Proposals ranged from radical, whole-systems change to support for policies currently being considered by governments across the United Kingdom. The consensus was built around embracing more participatory, collaborative governance; prioritising sustainability and access to greenspace; promoting inclusivity and eliminating discrimination and improving the circumstances of those on the lowest incomes. Levels of acceptable income inequality, and how best to address income inequality were more contested. Individual-level interventions were rarely presented as viable options for addressing the social inequalities from which health differences emanate.

CONCLUSION

Young people contributed wide-ranging and visionary solutions to debates around addressing the enduring existence of health inequalities in the United Kingdom. Their reflections signal support for 'upstream' systemic change to achieve reductions in social inequalities and the health differences that flow from these.

PUBLIC CONTRIBUTION

An advisory group of young people informed the development of project plans. Participants shaped the direction of the project in terms of substantive focus and were responsible for the generation of creative project outputs aimed at influencing policymakers.

Community stakeholder-driven technology solutions towards rural health equity: A concept mapping study in Western Canada

BACKGROUND

Technology holds great potential for promoting health equity for rural populations, who have more chronic illnesses than their urban counterparts but less access to services. Yet, more participatory research approaches are needed to gather community-driven health technology solutions. The purpose was to collaboratively identify and prioritize action strategies for using technology to promote rural health equity through community stakeholder engagement.

METHODS

Concept mapping, a quantitative statistical technique, embedded within a qualitative approach, was used to identify and integrate technological solutions towards rural health equity from community stakeholders in three steps: (1) idea generation; (2) sorting and rating feasibility/importance and (3) group interpretation. Purposeful recruitment strategies were used to recruit key stakeholders and organizational representatives from targeted rural communities.

RESULTS

Overall, 34 rural community stakeholders from western Canada (76% female, mean age = 55.4 years) participated in the concept mapping process. In Step 1, 84 ideas were generated that were reduced to a pool of 30. Multidimensional scaling and cluster analysis resulted in a six-cluster map representing how technological solutions can contribute toward rural health equity. The clusters of ideas included technological solutions and applications, but also ideas to make health care more accessible regardless of location, training and support in the use of technology, ensuring digital tools are simplified for ease of use, technologies to support collaboration among healthcare professionals and ideas for overcoming challenges to data sharing across health systems/networks. Each cluster included ideas that were rated as equally important and feasible. Key themes included organizational and individual-level solutions and connecting patients to newly developed technologies.

CONCLUSIONS

Overall, the grouping of solutions revealed that technological applications require not only access but also support and collaboration. Concept mapping is a tool that can engage rural community stakeholders in the identification of technological solutions for promoting rural health equity.

PATIENT OR PUBLIC CONTRIBUTION

Rural community stakeholders were involved in the generation and interpretation of technological solutions towards rural health equity in a three-step process: (1) individual brainstorming of ideas, (2) sorting and rating all ideas generated and (3) collective interpretation and group consensus on final results.

Public perspectives on health improvement within a remote-rural island community

Background

Rural health outcomes are often worse than their urban counterparts. While rural health theory recognizes the importance of the social determinants of health, there is a lack of insight into public perspectives for improving rural health beyond the provision of health‐care services. Gaining insight into perceived solutions, that include and go beyond health‐ care, can help to inform resource allocation decisions to improve rural health.

Objective

To identify and describe shared perspectives within a remote‐rural community on how to improve rural health.

Method

Using Q methodology, a set of 40 statements were developed representing different perceptions of how to improve rural health. Residents of one remote‐rural island community ranked this statement set according to their level of agreement. Card‐sorts were analysed using factor analysis to identify shared points of view and interpreted alongside post‐sort qualitative interviews.

Results

Sixty‐two respondents participated in the study. Four shared perspectives were identified, labelled: Local economic activity; Protect and care for the community; Redistribution of resources; and Investing in people. Factors converged on the need to relieve poverty and ensure access to amenities and services.

Discussion and conclusions

Factors represent different elements of a multifaceted theory of rural health, indicating that ‘lay’ respondents are capable of comprehending various approaches to health improvement and perspectives are not homogenous within rural communities. Respondents diverged on the role of individuals, the public sector and ‘empowered’ community‐based organizations in delivering these solutions, with implications for policy and practice.

Public Contribution

Members of the public were involved in the development and piloting of the statement set.