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Coe JL, Morgan MH, Rehberg K, Kranzler EC, Ingersoll R, Namrow N, Huber-Krum S. Evaluating the implementation of family-centered substance use treatment for pregnant and postpartum people: A mixed-methods study. J Subst Use Addict Treat 2024:209409. [PMID: 38768816 DOI: 10.1016/j.josat.2024.209409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 05/02/2024] [Accepted: 05/14/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Family-centered substance use treatment (FCSUT) approaches for pregnant and postpartum people have the potential to prevent intergenerational transmission of adverse childhood experiences (ACEs). Guided by two theoretical frameworks drawn from implementation science (the Consolidated Framework for Implementation Research [CFIR] and the Reach, Effectiveness, Adoption, Implementation and Maintenance [RE-AIM] framework), this study used a mixed methods approach to answer: (1) What is the extent to which FCSUT approaches are offered for pregnant and postpartum people seeking substance use disorder (SUD) treatment? and (2) How are FCSUT approaches for pregnant and postpartum people implemented? METHODS This study utilized a sequential mixed methods design that began with quantitative data collection followed by qualitative data collection. The quantitative component consisted of service provision surveys of facilities that provided FCSUT to pregnant and postpartum people (n = 118). The qualitative component consisted of semi-structured in-depth interviews with administrators and providers working at FCSUT facilities (n = 26) and pregnant and postpartum people who were currently receiving or had previously received services in the last two years from FCSUT facilities (n = 27). The qualitative findings were used to deepen understanding of the quantitative findings. RESULTS Findings from the quantitative survey of treatment facilities' FCSUT provision revealed that while most facilities offered services related to substance use treatment, behavioral health, and parenting skills development or parent training, a smaller proportion offered services related to prenatal and postpartum health, sexual and reproductive health, and family-related services. Qualitative in-depth interviews with program administrators and providers and pregnant and postpartum people who had participated in FCSUT programs revealed major themes around expanding reach of facilities by maintaining participants' familial connections, resources for implementation and maintenance of FCSUT, the importance of program adaptation, and gaps in service delivery. CONCLUSIONS Results indicated there is a wide range of FCSUT services offered at treatment facilities across the United States. Furthermore, while many pregnant and postpartum people expressed positive experiences with FCSUT, there are some areas that should be considered for future progress to be made.
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Affiliation(s)
- Jesse L Coe
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary Harbert Morgan
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | | | | | | | - Sarah Huber-Krum
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA; Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Luna E, Springer A, Herrera D, Garcia ME, Brown L, Kelder SH. Identifying Factors That Influence Physical Activity and Healthy Aging Among Older Latino Adults. Health Educ Behav 2024:10901981241228221. [PMID: 38328931 DOI: 10.1177/10901981241228221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND For older Latinos, some benefits of leisure-time physical activity (LTPA) include enhanced cognitive functioning, decreased loneliness, and reduced premature mortality. Despite LTPA benefits, adults ≥50 years are one of the most inactive age groups in the United States. METHODS This qualitative study aimed to add to the limited evidence of LTPA in older Latino adults by exploring the barriers and facilitators for fitness class uptake and park use. Guided by a Social-Ecological Model of Health and Social Determinants of Health theoretical and a phenomenological research design, qualitative research data were collected via 27 personal interviews with Latino adults using a semistructured interview guide. Participants were recruited using purposive sampling strategies in collaboration with community partners. Bicultural data collectors conducted the semistructured interviews over Zoom. Thematic analysis was performed using Dedoose, following an inductive and deductive approach. RESULTS The main barriers to fitness class attendance and park use were family and/or work commitments, perceived safety, and perceived discrimination. Conversely, the critical facilitators for participation were socialization into a group, social connectedness with group members, fitness instructor characteristics, and exercise history. CONCLUSIONS Findings from this study hold important implications for the design of fitness programming and park-based recreation, including the need to increase the cultural diversity of recreation staff and culturally relevant programming. Future research is needed on time poverty related to family/work commitments and whether discriminatory practices at fitness centers, like ageism and race/ethnicity, influence physical activity behavior.
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Affiliation(s)
- Elena Luna
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA
| | - Andrew Springer
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA
- Michael & Susan Dell Center for Healthy Living, Austin, TX, USA
| | - Denise Herrera
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA
| | - Maria Elena Garcia
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA
| | - Louis Brown
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), El Paso, TX, USA
| | - Steven H Kelder
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, USA
- Michael & Susan Dell Center for Healthy Living, Austin, TX, USA
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Milionis C, Toska A. Conscientious objection to caring for transgender people: An ethical right or a discriminatory attitude? Int J Nurs Pract 2023; 29:e13180. [PMID: 37435639 DOI: 10.1111/ijn.13180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND In modern society, health professionals are often asked to use their technical skills to serve purposes other than treating illnesses. In such cases, some clinicians may express ethical reluctance to fulfill their patients' preferences. Conscientious objection in health care is the refusal by providers to perform a legally valid and scientifically approved clinical intervention because of moral concerns. Although health services and staff are obliged to respect gender identity and prohibit discrimination, some clinicians may exempt themselves from caring for transgender people, citing ethical reasons. The decision of health professionals to object to medical activities related to transgender care may collide with the interests of trans people and further marginalizes the already underprivileged gender-diverse population. AIM This discussion paper analyses the concept of 'conscientious objection' and its application in health care settings in relation to transgender-related care. FINDINGS AND CONCLUSION In general, the right of health professionals to abstain from contested duties on moral grounds must be protected. However, claims to conscience cannot be accepted within centers specialized in gender transitioning and for services unrelated to gender affirmation such as routine and urgent care. Personal responsibility and discretion on the part of clinicians is the most appropriate way to compromise between protecting the moral integrity of health professionals and shielding trans persons' access to care. Guidance is proffered on how to resolve the apparent impasse emerging from the denial of various types of health services to transgender people.
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Affiliation(s)
- Charalampos Milionis
- Department of Endocrinology, Diabetes and Metabolism, 'Elena Venizelou' General Hospital, Athens, Greece
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Bayram T, Sakarya S. Oppression and internalized oppression as an emerging theme in accessing healthcare: findings from a qualitative study assessing first-language related barriers among the Kurds in Turkey. Int J Equity Health 2023; 22:6. [PMID: 36611171 PMCID: PMC9824985 DOI: 10.1186/s12939-022-01824-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/01/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Language has been well documented to be a key determinant of accessing healthcare. Most of the literature about language barrier in accessing healthcare is in the context of miscommunication. However, it is critical to consider the historical and political contexts and power dynamics underlying actions. The literature in this matter is short. In this paper we aimed to find out how first-language affects access to healthcare for people who do not speak the official language, with a particular focus on language oppression. METHODS We conducted this qualitative study based on patient-reported experiences of the Kurds in Turkey, which is a century-long oppressed population. We conducted 12 in-depth interviews (all ethnically Kurdish, non-Turkish speaking) in Şırnak, Turkey, in 2018-2019 using maximum variation strategy. We used Levesque's 'Patient-Centred Access to Healthcare' framework which addresses individual and structural dimensions to access. RESULTS We found that Kurds who do not speak the official language face multiple first-language related barriers in accessing healthcare. Poor access to health information, poor patient-provider relationship, delay in seeking health care, dependence on others in accessing healthcare, low adherence to treatments, dissatisfaction with services, and inability to follow health rights were main issues. As an unusual outcome, we discovered that the barrier processes in accessing healthcare are particularly complicated in the context of oppression and its internalization. Internalized oppression, as we found in our study, impairs access to healthcare with creating a sense of reluctance to seek healthcare, and impairs their individual and collective agency to struggle for change. CONCLUSIONS A human-rights-based top-down policy shift, and a bottom-up community empowerment approach is needed. At the system level, official recognition of oppressed populations, acknowledgement of the determinants of their health; and incorporating their language in official capacities (particularly education and healthcare) is crucial. Interventions should include raising awareness among relevant professions and stakeholders that internalized oppression is an issue in accessing healthcare to be considered. Given that internalized oppression can be in other forms than language or ethnicity, future research aimed at examining other aspects of access to healthcare should pay a special attention to internalized oppression.
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Affiliation(s)
- Tevfik Bayram
- grid.14848.310000 0001 2292 3357School of Public Health, University of Montreal, 7101 Park Ave, Montreal, QC H3N 1X9 Canada
| | - Sibel Sakarya
- grid.15876.3d0000000106887552Department of Public Health, School of Medicine, Koç University, Topkapı, Koç Üniversitesi Hastanesi, Davutpaşa Cd. No:4, Zeytinburnu, 34010 Istanbul, Turkey
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Diouf NT, Musabyimana A, Blanchette V, Lépine J, Guay-Bélanger S, Tremblay MC, Dogba MJ, Légaré F. Effectiveness of Shared Decision-making Training Programs for Health Care Professionals Using Reflexivity Strategies: Secondary Analysis of a Systematic Review. JMIR Med Educ 2022; 8:e42033. [PMID: 36318726 PMCID: PMC9773026 DOI: 10.2196/42033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/05/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Shared decision-making (SDM) leads to better health care processes through collaboration between health care professionals and patients. Training is recognized as a promising intervention to foster SDM by health care professionals. However, the most effective training type is still unclear. Reflexivity is an exercise that leads health care professionals to question their own values to better consider patient values and support patients while least influencing their decisions. Training that uses reflexivity strategies could motivate them to engage in SDM and be more open to diversity. OBJECTIVE In this secondary analysis of a 2018 Cochrane review of interventions for improving SDM by health care professionals, we aimed to identify SDM training programs that included reflexivity strategies and were assessed as effective. In addition, we aimed to explore whether further factors can be associated with or enhance their effectiveness. METHODS From the Cochrane review, we first extracted training programs targeting health care professionals. Second, we developed a grid to help identify training programs that used reflexivity strategies. Third, those identified were further categorized according to the type of strategy used. At each step, we identified the proportion of programs that were classified as effective by the Cochrane review (2018) so that we could compare their effectiveness. In addition, we wanted to see whether effectiveness was similar between programs using peer-to-peer group learning and those with an interprofessional orientation. Finally, the Cochrane review selected programs that were evaluated using patient-reported or observer-reported outcome measurements. We examined which of these measurements was most often used in effective training programs. RESULTS Of the 31 training programs extracted, 24 (77%) were interactive, among which 10 (42%) were considered effective. Of these 31 programs, 7 (23%) were unidirectional, among which 1 (14%) was considered effective. Of the 24 interactive programs, 7 (29%) included reflexivity strategies. Of the 7 training programs with reflexivity strategies, 5 (71%) used a peer-to-peer group learning strategy, among which 3 (60%) were effective; the other 2 (29%) used a self-appraisal individual learning strategy, neither of which was effective. Of the 31 training programs extracted, 5 (16%) programs had an interprofessional orientation, among which 3 (60%) were effective; the remaining 26 (84%) of the 31 programs were without interprofessional orientation, among which 8 (31%) were effective. Finally, 12 (39%) of 31 programs used observer-based measurements, among which more than half (7/12, 58%) were effective. CONCLUSIONS Our study is the first to evaluate the effectiveness of SDM training programs that include reflexivity strategies. Its conclusions open avenues for enriching future SDM training programs with reflexivity strategies. The grid developed to identify training programs that used reflexivity strategies, when further tested and validated, can guide future assessments of reflexivity components in SDM training.
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Affiliation(s)
- Ndeye Thiab Diouf
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Community Health, Faculty of Nursing and Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Angèle Musabyimana
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Community Health, Faculty of Nursing and Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Virginie Blanchette
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Human Kinetic and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Johanie Lépine
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Sabrina Guay-Bélanger
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Marie-Claude Tremblay
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Office of Education and Continuing Professional Education, Université Laval, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Maman Joyce Dogba
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Office of Education and Continuing Professional Education, Université Laval, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - France Légaré
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1), Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
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Hickman AC, Johnson RL, Lawler SP. Health-promoting pedagogy: Using reflexivity to support learning and action in planetary health education. Health Promot J Austr 2022; 33 Suppl 1:22-26. [PMID: 35922693 PMCID: PMC9826018 DOI: 10.1002/hpja.648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/15/2022] [Accepted: 08/01/2022] [Indexed: 01/11/2023] Open
Abstract
ISSUE ADDRESSED International competencies for health promotion education require ethical practice that is supported by reflexive health promotion practitioners, yet professional bodies do not codify how health promotion curriculum should support students' skill development in reflexive practice. METHODS Reflexivity in teaching and learning was scaffolded through short, progressive reflective blogs assessments, supportive feedback/feedforward mechanisms, and nested assessment design. RESULTS Student feedback is offered to demonstrate the impact of reflexive pedagogy in health promotion education. CONCLUSION Reflexivity in teaching and learning supports students in learning the role of health promotion in planetary health and developing skills in planetary health advocacy. SO WHAT Explicitly teaching the practice and process of critical reflexivity can help students develop personal insight, support professional practice, and promote positive change in the health of people and our planet.
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Ridde V, Carillon S, Desgrées du Loû A, Sombié I. Analyzing implementation of public health interventions : a need for rigor, and the challenges of stakeholder involvement. Rev Epidemiol Sante Publique 2022; 71:101376. [PMID: 35835715 DOI: 10.1016/j.respe.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES This article shows how conceptual models can help to develop and evaluate public health interventions. It also reports on the challenges of getting stakeholders involved. METHOD The analysis is based on the reflexive approach applied by the authors during their participation in two public health intervention research (PHIR) projects, in France and in Burkina Faso. RESULTS In Paris, PHIR aimed to enable sub-Saharan immigrants to appropriate the existing means of prevention and sexual health care and to strengthen their empowerment in view of preserving their health. Evaluation was carried out using mixed methods. The intervention process theory is based on Ninacs' conceptual model of individual empowerment. The Consolidated Framework For Implementation Research (CFIR) was mobilized a posteriori to analyze the process. PHIR stemmed from collaboration between a research team and two associations. The different stakeholders were involved in the evaluation process, as were, at certain times, persons in highly precarious situations. In Ouagadougou, a community-based dengue vector control intervention was deployed to address an essential but neglected need. As regards evaluation, we opted for a holistic, mixed method approach (effectiveness and process). The contents of the intervention were determined based on tacit knowledge, a community preference survey and solid evidence. The theoretical framework of the intervention consisted in an eco-biological model of vector control. The implementation analysis combined an internal assessment of implementation fidelity with an external CFIR process analysis. All stakeholders were involved in the evaluation process. DISCUSSION Analysis confirmed not only the value of process evaluations in PHIR, but also the primordial importance of a rigorous approach. Stakeholder involvement is a major challenge to be addressed early in the planning of RISPs; with this in mind, effective and ethically sound assessment mechanisms need to be drawn up. Interdisciplinary evaluative approaches should be preferred, and the use of justified, relevant, and flexible frameworks is highly recommended. CONCLUSION Lessons learned for those wishing to engage in the process evaluation of a public health intervention are hereby presented.
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Affiliation(s)
- V Ridde
- Centre population et développement (Ceped), Institut de recherche pour le développement (IRD) et Université Paris Cité, Inserm ERL 1244, 45 rue des Saints-Pères, 75006 Paris, France.
| | - S Carillon
- Centre population et développement (Ceped), Institut de recherche pour le développement (IRD) et Université Paris Cité, Inserm ERL 1244, 45 rue des Saints-Pères, 75006 Paris, France
| | - A Desgrées du Loû
- Centre population et développement (Ceped), Institut de recherche pour le développement (IRD) et Université Paris Cité, Inserm ERL 1244, 45 rue des Saints-Pères, 75006 Paris, France
| | - I Sombié
- Institut des Sciences des Sociétés (INSS), Centre National de la Recherche Scientifique et Technologique (CNRST), 03 BP 7047, Avenue du Capitaine Thomas Sankara, Ouagadougou, Burkina Faso
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Díaz Rios LK, Stage VC, Leak TM, Taylor CA, Reicks M. Collecting, Using, and Reporting Race and Ethnicity Information: Implications for Research in Nutrition Education, Practice, and Policy to Promote Health Equity. J Nutr Educ Behav 2022; 54:582-593. [PMID: 35351358 DOI: 10.1016/j.jneb.2022.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
This report will describe approaches for collecting, analyzing, and reporting race and ethnicity information in nutrition education and behavior research, practice, and policy to advance health equity. Race and ethnicity information is used to describe study participants and compare nutrition and health-related outcomes. Depending on the study design, race and ethnicity categories are often defined by the research question or other standardized approaches. Participant self-reported data are more acceptable than researcher adjudicated identification data, which can add bias and/or error. Valid methods to collect, use, and report race and ethnicity information are foundational to publication quality, findings of value, contribution to the knowledge base, and health equity.
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Affiliation(s)
- L Karina Díaz Rios
- Division of Agriculture and Natural Resources, University of California Merced, Merced, CA
| | - Virginia C Stage
- Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC
| | - Tashara M Leak
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | | | - Marla Reicks
- Department of Food Science and Nutrition, University of Minnesota, St Paul, MN.
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Champine RB, McCullough WR, El Reda DK. Critical Race Theory for Public Health Students to Recognize and Eliminate Structural Racism. Am J Public Health 2022; 112:850-852. [PMID: 35446604 DOI: 10.2105/ajph.2022.306846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Robey B Champine
- Robey B. Champine is with the Division of Public Health and the Department of Family Medicine in the College of Human Medicine at Michigan State University, Flint. Wayne R. McCullough is with the Division of Public Health and the Department of Family Medicine in the College of Human Medicine at Michigan State University, Flint. Darline K. El Reda is with the Division of Public Health in the College of Human Medicine at Michigan State University, Flint
| | - Wayne R McCullough
- Robey B. Champine is with the Division of Public Health and the Department of Family Medicine in the College of Human Medicine at Michigan State University, Flint. Wayne R. McCullough is with the Division of Public Health and the Department of Family Medicine in the College of Human Medicine at Michigan State University, Flint. Darline K. El Reda is with the Division of Public Health in the College of Human Medicine at Michigan State University, Flint
| | - Darline K El Reda
- Robey B. Champine is with the Division of Public Health and the Department of Family Medicine in the College of Human Medicine at Michigan State University, Flint. Wayne R. McCullough is with the Division of Public Health and the Department of Family Medicine in the College of Human Medicine at Michigan State University, Flint. Darline K. El Reda is with the Division of Public Health in the College of Human Medicine at Michigan State University, Flint
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Stennett J, Hou R, Traverson L, Ridde V, Zinszer K, Chabrol F. Lessons Learned From the Resilience of Chinese Hospitals to the COVID-19 Pandemic: Scoping Review. JMIRx Med 2022; 3:e31272. [PMID: 35435649 PMCID: PMC9004618 DOI: 10.2196/31272] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/05/2021] [Accepted: 12/06/2021] [Indexed: 01/17/2023]
Abstract
Background The SARS-CoV-2 pandemic has brought substantial strain on hospitals worldwide; however, although the success of China’s COVID-19 strategy has been attributed to the achievements of the government, public health officials, and the attitudes of the public, the resilience shown by China’s hospitals appears to have been a critical factor in their successful response to the pandemic. Objective This paper aims to determine the key findings, recommendations, and lessons learned in terms of hospital resilience during the pandemic; analyze the quality and limitations of research in this field at present; and contribute to the evaluation of the Chinese response to the COVID-19 outbreak, building on a growing literature on the role of hospital resilience in crisis situations. Methods We conducted a scoping review of evidence on the resilience of hospitals in China during the COVID-19 crisis in the first half of 2020. Two online databases (the China National Knowledge Infrastructure and World Health Organization databases) were used to identify papers meeting the eligibility criteria. After extracting the data, we present an information synthesis using a resilience framework. Articles were included in the review if they were peer-reviewed studies published between December 2019 and July 2020 in English or Chinese and included empirical results pertaining to the resilience of Chinese hospitals in the COVID-19 pandemic. Results From the publications meeting the criteria (n=59), we found that substantial research was rapidly produced in the first half of 2020 and described numerous strategies used to improve hospital resilience, particularly in three key areas: human resources; management and communication; and security, hygiene, and planning. Our search revealed a focus on interventions related to training, health care worker well-being, eHealth/telemedicine, and workplace organization, while other areas such as hospital financing, information systems, and health care infrastructure were less well represented in the literature. We also noted that the literature was dominated by descriptive case studies, often lacking consideration of methodological limitations, and that there was a lack of both highly focused research on specific interventions and holistic research that attempted to unite the topics within a resilience framework. Conclusions We identified a number of lessons learned regarding how China’s hospitals have demonstrated resilience when confronted with the SARS-CoV-2 pandemic. Strategies involving interprovincial reinforcements, online platforms and technological interventions, and meticulous personal protective equipment use and disinfection, combined with the creation of new interdisciplinary teams and management strategies, reflect a proactive hospital response to the pandemic, with high levels of redundancy. Research on Chinese hospitals would benefit from a greater range of analyses to draw more nuanced and contextualized lessons from the responses to the crisis.
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Affiliation(s)
- Jack Stennett
- Centre Population et Développement Institut de Recherche pour le Développement Université de Paris Paris France
| | - Renyou Hou
- Centre Population et Développement Institut de Recherche pour le Développement Université de Paris Paris France
| | - Lola Traverson
- Centre Population et Développement Institut de Recherche pour le Développement Université de Paris Paris France
| | - Valéry Ridde
- Centre Population et Développement Institut de Recherche pour le Développement Université de Paris Paris France
| | - Kate Zinszer
- Centre de Recherche en Santé Publique Université de Montréal Montréal, QC Canada
| | - Fanny Chabrol
- Centre Population et Développement Institut de Recherche pour le Développement Université de Paris Paris France
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Ridde V, Faye A. Challenges in Implementing the National Health Response to COVID-19 in Senegal. Glob Implement Res Appl 2022; 2:219-233. [PMID: 35967834 PMCID: PMC9361250 DOI: 10.1007/s43477-022-00053-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/26/2022] [Indexed: 04/27/2023]
Abstract
UNLABELLED Since the beginning of the COVID-19 pandemic in Africa, many epidemiological or anthropological studies have been published. However, few studies have yet been conducted to understand the implementation of State interventions to fight the COVID-19 pandemic. In Senegal, the national response plan was planned before the country experienced its first official case of COVID-19 on 2 March 2020. This qualitative study, conducted in March and April 2021, based on 189 interviews, aims to understand how the national response has been implemented in several regions of Senegal. Implementation of the response to the pandemic was favoured by good preparation, capacity to adapt, responsiveness of health actors, and commitment for both the political and religious authorities. The implementation response was confronted by several constraining factors such as the coercive approach, the challenges of coordinating actors, and the lack of intersectoral response. The central level has sometimes used reflexivity processes to adapt its response, but it has remained highly politicized, centralized, directive, and with little involvement of civil society. In Senegal, the response to the pandemic has been implemented in a relatively political and directive, even coercive manner, without necessarily considering prior knowledge and the need to adapt it to local contexts and to involve civil society and community actors in the process. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43477-022-00053-4.
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Affiliation(s)
- Valéry Ridde
- Institute of Health and Development (ISED), Cheikh Anta Diop University, Dakar, Senegal
- Université Paris Cité, IRD, Inserm, Ceped, 75006 Paris, France
| | - Adama Faye
- Institute of Health and Development (ISED), Cheikh Anta Diop University, Dakar, Senegal
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Schuitmaker-warnaar TJ, Gunn CJ, Regeer BJ, Broerse JEW. Institutionalizing Reflexivity for Sustainability: Two Cases in Health Care. Sustainability 2021; 13:11712. [DOI: 10.3390/su132111712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Unsustainability in health care comprises diminishing returns and misalignment between the health care regime and the needs of the population. To deal with complex sustainability problems, niche solutions can be collaboratively designed and implemented through reflexive methods. For second-order sustainability, however, the institutionalization of the reflexive element itself is also needed. This paper aims to provide insight into the possibilities of embedding reflexivity into institutions to support second-order sustainability by reporting on two consecutive participatory research programs that sought to address unsustainability in terms of misalignment and diminishing returns. The first case study reflexively monitored the system’s innovation toward an integrated perinatal care system. Reflection within the project and implementation was supported successfully, but for stronger embedding and institutionalization, greater alignment of the reflexive practices with regime standards was needed. Building on these lessons, the second case study, which was part of the IMI-PARADIGM consortium, collaboratively built a structured tool to monitor and evaluate “the return on engagement” in medicine development. To institutionalize reflexivity, the creation of “reflexive standards” together with regime actors appears to be most promising. Broader and deeper institutionalization of reflexive standards can be attained by building enforcement structures for reflexive standards in the collaborative process as part of the reflexive methodologies for addressing complex sustainability problems.
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Jones CM, Gautier L, Ridde V. A scoping review of theories and conceptual frameworks used to analyse health financing policy processes in sub-Saharan Africa. Health Policy Plan 2021; 36:1197-1214. [PMID: 34027987 DOI: 10.1093/heapol/czaa173] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2020] [Indexed: 11/15/2022] Open
Abstract
Health financing policies are critical policy instruments to achieve Universal Health Coverage, and they constitute a key area in policy analysis literature for the health policy and systems research (HPSR) field. Previous reviews have shown that analyses of policy change in low- and middle-income countries are under-theorised. This study aims to explore which theories and conceptual frameworks have been used in research on policy processes of health financing policy in sub-Saharan Africa and to identify challenges and lessons learned from their use. We conducted a scoping review of literature published in English and French between 2000 and 2017. We analysed 23 papers selected as studies of health financing policies in sub-Saharan African countries using policy process or health policy-related theory or conceptual framework ex ante. Theories and frameworks used alone were from political science (35%), economics (9%) and HPSR field (17%). Thirty-five per cent of authors adopted a 'do-it-yourself' (bricolage) approach combining theories and frameworks from within political science or between political science and HPSR. Kingdon's multiple streams theory (22%), Grindle and Thomas' arenas of conflict (26%) and Walt and Gilson's policy triangle (30%) were the most used. Authors select theories for their empirical relevance, methodological rational (e.g. comparison), availability of examples in literature, accessibility and consensus. Authors cite few operational and analytical challenges in using theory. The hybridisation, diversification and expansion of mid-range policy theories and conceptual frameworks used deductively in health financing policy reform research are issues for HPSR to consider. We make three recommendations for researchers in the HPSR field. Future research on health financing policy change processes in sub-Saharan Africa should include reflection on learning and challenges for using policy theories and frameworks in the context of HPSR.
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Affiliation(s)
- Catherine M Jones
- London School of Economics and Political Science, LSE Health, Houghton Street, London WC2A 2AE, UK
| | - Lara Gautier
- Département de Gestion, d'Évaluation et de Politique de Santé, École de Santé Publique de l'Université de Montréal, 7101 Avenue du Parc, Montréal, QC H3N 1X9, Canada.,Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 7101 avenue du Parc, Montréal, QC H3N 1X9, Canada
| | - Valéry Ridde
- Institut de Recherche pour le Développement, Centre Population et Développement - CEPED (IRD-Université de Paris), Université de Paris ERL INSERM SAGESUD, 45 rue des Saints-Peres, Paris 75006, France
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Ridde V, Ouedraogo S, Yaya S. Closing the diversity and inclusion gaps in francophone public health: a wake-up call. BMJ Glob Health 2021; 6:bmjgh-2021-005231. [PMID: 33622712 PMCID: PMC7907845 DOI: 10.1136/bmjgh-2021-005231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 02/02/2023] Open
Affiliation(s)
- Valery Ridde
- CEPED (IRD-Université Paris Descartes), Universités de Paris, INSERM, IRD, Paris, France .,ISED, UCAD, Dakar, Senegal
| | | | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada.,The George Institute for Global Health, Imperial College London, London, UK
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Turcotte-Tremblay AM, Gali Gali IA, Ridde V. The unintended consequences of COVID-19 mitigation measures matter: practical guidance for investigating them. BMC Med Res Methodol 2021; 21:28. [PMID: 33568054 PMCID: PMC7873511 DOI: 10.1186/s12874-020-01200-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/21/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND COVID-19 has led to the adoption of unprecedented mitigation measures which could trigger many unintended consequences. These unintended consequences can be far-reaching and just as important as the intended ones. The World Health Organization identified the assessment of unintended consequences of COVID-19 mitigation measures as a top priority. Thus far, however, their systematic assessment has been neglected due to the inattention of researchers as well as the lack of training and practical tools. MAIN TEXT Over six years our team has gained extensive experience conducting research on the unintended consequences of complex health interventions. Through a reflexive process, we developed insights that can be useful for researchers in this area. Our analysis is based on key literature and lessons learned reflexively in conducting multi-site and multi-method studies on unintended consequences. Here we present practical guidance for researchers wishing to assess the unintended consequences of COVID-19 mitigation measures. To ensure resource allocation, protocols should include research questions regarding unintended consequences at the outset. Social science theories and frameworks are available to help assess unintended consequences. To determine which changes are unintended, researchers must first understand the intervention theory. To facilitate data collection, researchers can begin by forecasting potential unintended consequences through literature reviews and discussions with stakeholders. Including desirable and neutral unintended consequences in the scope of study can help minimize the negative bias reported in the literature. Exploratory methods can be powerful tools to capture data on the unintended consequences that were unforeseen by researchers. We recommend researchers cast a wide net by inquiring about different aspects of the mitigation measures. Some unintended consequences may only be observable in subsequent years, so longitudinal approaches may be useful. An equity lens is necessary to assess how mitigation measures may unintentionally increase disparities. Finally, stakeholders can help validate the classification of consequences as intended or unintended. CONCLUSION Studying the unintended consequences of COVID-19 mitigation measures is not only possible but also necessary to assess their overall value. The practical guidance presented will help program planners and evaluators gain a more comprehensive understanding of unintended consequences to refine mitigation measures.
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Affiliation(s)
- Anne-Marie Turcotte-Tremblay
- School of Public Health, Université de Montréal, 7101 Avenue du Parc, Montreal, QC, H3N 1X9, Canada.
- Department and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Boston, MA, 02115, USA.
| | | | - Valéry Ridde
- IRD (French Institute for Research on Sustainable Development), CEPED, Université de Paris, 45 Rue des Saints-Pères, 75006, Paris, France
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Kasberg A, Müller P, Markert C, Bär G. [Categorizing methods used in participatory research]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 64:146-155. [PMID: 33373015 PMCID: PMC7843478 DOI: 10.1007/s00103-020-03267-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Abstract
Hintergrund In der Forschung gewinnen partizipative Ansätze an Bedeutung. Der Einsatz partizipativer Methoden erfolgt meist ohne eine methodologische Auseinandersetzung oder den Bezug auf eine gemeinsame Systematik. Ziel der Arbeit Auf der Grundlage eines Scoping-Reviews wird eine Systematisierung partizipativer Methoden vorgeschlagen. Damit wird ein Beitrag zum Diskurs über partizipative Methoden geleistet, die gesundheitliche Chancengleichheit fördern. Material und Methoden Nach einer Literaturrecherche wurden 44 Treffer eingeschlossen. Die Suche sowohl nach deutsch- als auch englischsprachiger Literatur basierte auf diversen Datenbanken (PubMed, PsycInfo, SocIndex, Livivo, Cochrane, Fachportal Pädagogik), einer Handsuche und einer Suche nach dem Schneeballprinzip. Ergebnisse und Diskussion Die Systematisierung kombiniert phasen- und formatbasierte Logiken. Als zentrale Prinzipien in den Definitionen einer partizipativen Methodologie und von partizipativen Methoden werden die Mehrdimensionalität und Phasenintegration berücksichtigt. Daraus abgeleitet werden die Hauptunterscheidung von prozessgestaltenden und forschenden Methoden. Schwerpunkte zeigen sich bei den Erhebungsmethoden und Reflexionsverfahren. Lücken im deutschsprachigen Raum sind bei Methoden gemeinsamer Entscheidungsfindungen, der Auswertung und Verwendung erkennbar. Fazit Die Ergebnisse helfen bei der Einordnung verschiedener Ansätze und ihres Grades an Partizipation. Für Forschung und Lehre wird die Aufmerksamkeit auf das Spektrum forschender und prozessgestaltender partizipativer Methoden gelenkt, die es einzusetzen, zu beschreiben und zu vermitteln gilt.
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Affiliation(s)
- Azize Kasberg
- Alice Salomon Hochschule Berlin, Alice-Salomon-Platz 5, 12627, Berlin, Deutschland.
| | - Patrick Müller
- Alice Salomon Hochschule Berlin, Alice-Salomon-Platz 5, 12627, Berlin, Deutschland
| | - Claudia Markert
- Alice Salomon Hochschule Berlin, Alice-Salomon-Platz 5, 12627, Berlin, Deutschland
| | - Gesine Bär
- Alice Salomon Hochschule Berlin, Alice-Salomon-Platz 5, 12627, Berlin, Deutschland
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