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Abstract
PURPOSE OF REVIEW This review aims to examine (i) the aetiology of obesity; (ii) how and why a perception of personal responsibility for obesity so dominantly frames this condition and how this mindset leads to stigma; (iii) the consequences of obesity stigma for people living with obesity, and for the public support for interventions to prevent and manage this condition; and (iv) potential strategies to diminish our focus on personal responsibility for the development of obesity, to enable a reduction of obesity stigma, and to move towards effective interventions to prevent and manage obesity within the population. RECENT FINDINGS We summarise literature which shows that obesity stems from a complex interplay of genetic and environment factors most of which are outside an individual's control. Despite this, evidence of obesity stigmatisation remains abundant throughout areas of media, entertainment, social media and the internet, advertising, news outlets, and the political and public health landscape. This has damaging consequences including psychological, physical, and socioeconomic harm. Obesity stigma does not prevent obesity. A combined, concerted, and sustained effort from multiple stakeholders and key decision-makers within society is required to dispel myths around personal responsibility for body weight, and to foster more empathy for people living in larger bodies. This also sets the scene for more effective policies and interventions, targeting the social and environmental drivers of health, to ultimately improve population health.
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Affiliation(s)
- Susannah Westbury
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia.
| | - Oyinlola Oyebode
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Thijs van Rens
- Department of Economics, University of Warwick, Coventry, UK
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Tumlinson K, Britton LE, Williams CR, Wambua DM, Onyango DO, Senderowicz L. Contraceptive method denial as downward contraceptive coercion: A mixed-methods mystery client study in Western Kenya. Contraception 2022; 115:53-58. [PMID: 35779578 PMCID: PMC9672661 DOI: 10.1016/j.contraception.2022.06.014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study uses mixed methods to quantify the frequency of method denial in Western Kenya and describe how this barrier impacts contraceptive access. STUDY DESIGN We estimate the frequency of method denial using data from mystery clients deployed to 57 randomly selected public-sector facilities located in Western Kenya. These quantitative data are triangulated with data from 8 focus group discussions, 19 key informant interviews, and 2 journey mapping workshops with contraception clients and providers. RESULTS In 21% of mystery client visits, the client was denied their preferred contraceptive method. In 13% of visits, mystery clients were unable to procure any method. Method denial was primarily motivated by provider-imposed requirements for HIV or pregnancy testing, or by provider bias against young, unmarried, or nulliparous women. Method denial also occurred because of provider reluctance to offer certain methods. Focus group discussion participants and interviewees confirmed the frequency and reasons for method denial and identified this practice as a substantial barrier to reproductive autonomy. CONCLUSION Method denial disrupts contraceptive access among women who have already overcome financial and logistical barriers to arrive at a health care facility. Further attention to this barrier is required to promote reproductive autonomy among women in Western Kenya. IMPLICATIONS Providers may impose unnecessary restrictions on contraceptive access that limit the ability of women to achieve their desired family size. Unwarranted method denial occurs in approximately one out of every 5 visits to public-sector facilities in Western Kenya and presents a major impediment to reproductive autonomy and justice.
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Affiliation(s)
- Katherine Tumlinson
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States; Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States.
| | - Laura E Britton
- Columbia University School of Nursing, New York City, New York, United States
| | - Caitlin R Williams
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States; Department of Mother and Child Health, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | | | - Dickens Otieno Onyango
- Kisumu County Department of Health, Kisumu, Kenya; Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands
| | - Leigh Senderowicz
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States
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Onyango DO, Tumlinson K, Chung S, Bullington BW, Gakii C, Senderowicz L. Evaluating the feasibility of the Community Score Card and subsequent contraceptive behavior in Kisumu, Kenya. BMC Public Health 2022; 22:1960. [PMID: 36280808 PMCID: PMC9592126 DOI: 10.1186/s12889-022-14388-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/17/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Women seeking family planning services from public-sector facilities in low- and middle-income countries sometimes face provider-imposed barriers to care. Social accountability is an approach that could address provider-imposed barriers by empowering communities to hold their service providers to account for service quality. Yet little is known about the feasibility and potential impact of such efforts in the context of contraceptive care. We piloted a social accountability intervention-the Community Score Card (CSC)-in three public healthcare facilities in western Kenya and use a mix of quantitative and qualitative methodologies to describe the feasibility and impact on family planning service provision. METHODS We implemented and evaluated the CSC in a convenience sample of three public-sector facility-community dyads in Kisumu County, Kenya. Within each dyad, communities met to identify and prioritize needs, develop corresponding indicators, and used a score card to rate the quality of family planning service provision and monitor improvement. To ensure young, unmarried people had a voice in identifying the unique challenges they face, youth working groups (YWG) led all CSC activities. The feasibility and impact of CSC activities were evaluated using mystery client visits, unannounced visits, focus group discussions with YWG members and providers, repeated assessment of score card indicators, and service delivery statistics. RESULTS The involvement of community health volunteers and supportive community members - as well as the willingness of some providers to consider changes to their own behaviors-were key score card facilitators. Conversely, community bias against family planning was a barrier to wider participation in score card activities and the intractability of some provider behaviors led to only small shifts in quality improvement. Service statistics did not reveal an increase in the percent of women receiving family planning services. CONCLUSION Successful and impactful implementation of the CSC in the Kenyan context requires intensive community and provider sensitization, and pandemic conditions may have muted the impact on contraceptive uptake in this small pilot effort. Further investigation is needed to understand whether the CSC - or other social accountability efforts - can result in improved contraceptive access.
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Affiliation(s)
- Dickens Otieno Onyango
- Kisumu County Department of Health, Kisumu, Kenya ,grid.7692.a0000000090126352Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands
| | - Katherine Tumlinson
- grid.10698.360000000122483208Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA ,grid.10698.360000000122483208Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Stephanie Chung
- grid.10698.360000000122483208Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Brooke W. Bullington
- grid.10698.360000000122483208Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA ,grid.10698.360000000122483208Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Catherine Gakii
- Innovations for Poverty Action-Kenya (IPA-K), Nairobi, Kenya
| | - Leigh Senderowicz
- grid.28803.310000 0001 0701 8607Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, WI USA
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Delaruelle K, Buffel V, Van Canegem T, Bracke P, Ceuterick M. Mind the Gate: General Practitioner's Attitudes Towards Depressed Patients with Diverse Migration Backgrounds. Community Ment Health J 2022; 58:499-511. [PMID: 34085187 DOI: 10.1007/s10597-021-00844-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
This study aims to examine (a) whether there are differences in general practitioners' (GPs) attitudes towards native Belgian patients, patients of foreign descent and asylum seeking patients who all express symptoms of major depression, and (b) whether these differences depend on GPs' experience with cultural competency training and interethnic contact. Using a video vignette study among 404 Flemish (Belgium) GPs, we find evidence of a provider bias. While GPs regard a patient of foreign descent as less trustworthy and less able to adhere to medical recommendations than a native Belgian patient, they also hold more pessimistic views on a potential recovery of an asylum seeking patient. In addition, we find that cultural competency training might alter GPs' attitudes of asylum seeking patients in a positive way. Summarized, our research highlights the need to target stereotypes among GPs for interventions designed to reduce migration-based disparities in healthcare use and health status.
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Dickson C, Ramsay J, VandeBurgh J. Barriers for Ethnic Minorities and Low Socioeconomic Status Pediatric Patients for Behavioral Health Services and Benefits of an Integrated Behavioral Health Model. Pediatr Clin North Am 2021; 68:651-658. [PMID: 34044991 DOI: 10.1016/j.pcl.2021.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The integrated behavioral health care model in primary care has the potential to reduce barriers to care experienced by children and families from ethnic minorities and low socioeconomic status. Limited access to pediatric behavioral health care is a significant problem, with up to 40% of children and adolescents with identified mental disorders and only 30% of them receiving care. Barriers include transportation, insurance, and shortage of specialists. Primary care provider bias, decreased knowledge and feelings of competence, and cultural beliefs and stigma also affect earlier diagnosis and treatment, particularly for Hispanic families with low English proficiency and African Americans.
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Affiliation(s)
- Cheryl Dickson
- Associate Dean Health Equity and Community Affairs, 1000 Oakland Drive, Kalamazoo, MI 49009, USA.
| | - Jessica Ramsay
- Western Michigan University Homer Stryker MD School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49009, USA
| | - Joshua VandeBurgh
- Department of Neurology, University of Minnesota Medical Center, 516 Delaware Street, SE 12-100 Phillips Wangensteen Building, Minneapolis, MN 55455, USA
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Roncoroni J, Frank M, Hudson A, Whitaker S, Edelman A, Garcia P, Leeper E, Carrasco V, Melendez D, Ratchford J. Latinx Patients' Perceptions of Culturally Sensitive Health Care and their Association with Patient Satisfaction, Patient-Provider Communication, and Therapeutic Alliance. J Racial Ethn Health Disparities 2021; 9:620-629. [PMID: 33721290 DOI: 10.1007/s40615-021-00994-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/06/2021] [Accepted: 02/07/2021] [Indexed: 11/25/2022]
Abstract
Latinx in the USA experience disparities in morbidity and mortality when compared to their non-Hispanic White counterparts. Patient-centered culturally sensitive health care (PC-CSHC) has been deemed a best practice approach to alleviate and eliminate these disparities. However, literature on how Latinx patients perceive their care and what indicators of PC-CSHC may be most related to treatment outcomes is limited. This study collected data from 81 adult Latinx participants who had been admitted to an inpatient care unit to understand the following: (a) their perception of their providers' PC-CSHC in three different areas: Competence/Confidence, Sensitivity/Interpersonal, and Respect/Communication; (b) whether there are differences between English- and Spanish-speaking Latinx patients in their perception of their providers' PC-CSHC; and (c) whether these PC-CSHC indicators were associated to patient satisfaction, patient-provider communication, and therapeutic alliance. Participants were mostly male, older than 55 years of age, and working or lower class, with English as their primary language. Results showed that patients rated their providers' Competence (M = 3.57, SD = .46) higher than both Sensitivity, t(68) = .04, p = .04, (M = 3.49, SD =.54), and Respect, t(53) = 2.765, p = .008, (M = 3.38, SD = .57). English-speaking Latinx were overall less satisfied with their providers than Spanish-speaking Latinx, in particular in their communication. Finally, higher provider cultural sensitivity appears to be a predictor of patient satisfaction, patient-provider communication, and working alliance. Implications for refining provider trainings to treat this vulnerable and understudied (i.e., Latinx) population are discussed.
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Affiliation(s)
- J Roncoroni
- Department of Counseling Psychology, University of Denver, Denver, CO, USA.
| | - Maria Frank
- Department of Medicine, Denver Health Hospital Authority, Denver, CO, USA
| | - Amy Hudson
- Department of Counseling Psychology, University of Denver, Denver, CO, USA
| | - S Whitaker
- Department of Research Methods and Statistics, University of Denver, Denver, CO, USA
| | - A Edelman
- Department of Counseling Psychology, University of Denver, Denver, CO, USA
| | - P Garcia
- Discovering Greatness, LLC, Rio Rancho, NM, USA
| | - E Leeper
- Pathways Transtion Programs, Inc., Decatur, GA, USA
| | - V Carrasco
- Department of Counseling Psychology, University of Denver, Denver, CO, USA
| | - D Melendez
- First Year Advising Center, Utah Valley University, Orem, UT, USA
| | - J Ratchford
- Department of Counseling Psychology, University of Denver, Denver, CO, USA
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Ceuterick M, Bracke P, Van Canegem T, Buffel V. Assessing Provider Bias in General Practitioners' Assessment and Referral of Depressive Patients with Different Migration Backgrounds: Methodological Insights on the Use of a Video-Vignette Study. Community Ment Health J 2020; 56:1457-72. [PMID: 32133547 DOI: 10.1007/s10597-020-00590-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
Although the prevalence of common mental health conditions such as depression and anxiety, is higher among people with a migration background, these groups are generally underrepresented in all forms of institutionalized mental health care. At the root of this striking discrepancy might be unequal referral by health care practitioners. In this article we describe the development of a quasi-experimental video vignette methodology to assess potential forms of unequal diagnosing, treatment and referral patterns, based on clients' migration background and asylum status. The presented methodology also allows to explore whether potential differences are related to provider bias, i.e. underlying attitudes and expectations held by general practitioners. Potential assets and drawbacks of this methodology are discussed in detail.
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Yirgu R, Wood SN, Karp C, Tsui A, Moreau C. "You better use the safer one… leave this one": the role of health providers in women's pursuit of their preferred family planning methods. BMC Womens Health 2020; 20:170. [PMID: 32787924 PMCID: PMC7425019 DOI: 10.1186/s12905-020-01034-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 07/26/2020] [Indexed: 02/02/2023]
Abstract
Background Universal access to quality sexual and reproductive health (SRH) services is pivotal to ensuring gender equality. In high-income countries, patient-provider interactions have been shown to shape women’s decisions about contraception, with poor exchanges decreasing method uptake and satisfaction. While significant progress has been made to increase women’s access to SRH services, in low- and middle-income countries, little is known about the quality of family planning patient-provider interactions. The primary objective of this analysis was to explore the role of health care providers in women’s family planning decision-making in Ethiopia. Methods From July to August 2017, 10 focus group discussions (n = 80) and 30 in-depth interviews were conducted with women aged 15–49 and men aged 18+ recruited via purposive sampling from urban and rural sites in Ethiopia. Semi-structured interview guides explored women’s and girls’ empowerment in SRH surrounding sex, childbearing, and contraception. All interviews were conducted in Amharic, audio-recorded, and transcribed verbatim into English. Inductive thematic analysis was used to analyze data. Eleven codes specific to provider services for family planning were reviewed and matrixes creates for synthesis. Results Three primary themes emerged: the role of providers in women’s awareness of and demand for family planning services; selection and uptake of contraceptive methods; and discontinuation and switching of contraceptive methods. Results indicate that health extension workers were central to women’s awareness of family planning, and health providers’ endorsements were instrumental in decisions to adopt methods. The majority of respondents described positive interactions with providers and appreciated thorough counseling when considering using or switching methods. Some women, however, described health providers directing them toward long-acting methods by communicating inaccurate information or emphasizing disadvantages of short-acting methods. A few women described provider reluctance or resistance to switching methods, especially from implants. Conclusions Women shared many narratives about the central roles health providers played in their awareness and decision-making for family planning. Those narratives also included provider bias against women’s preferred methods. Further research and program assessments are needed to ascertain the extent to which these biases hinder women’s decision-making autonomy in using contraception.
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Affiliation(s)
- Robel Yirgu
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Celia Karp
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Amy Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Soins et Santé primaire, CESP Centre for Research in Epidemiology and Population Health U1018, Inserm, F-94805, Villejuif, France
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Abstract
There is a need to increase improve the delivery of health care for sexual minorities. The lesbian, gay, bisexual, transgender, and queer (LGBTQ) community has historically experienced bias, discrimination, and perceived inadequate or inappropriate care. Reduction of this barrier can begin by providers addressing implicit bias and creating a welcoming, safe environment for all persons seeking care. Using preferred name and pronouns and obtaining a sexual health history that is individualized and free from assumption is imperative. This article provides interventions to diminish barriers to care and foster provider preparedness for the care of LGBTQ individuals.
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Affiliation(s)
- Justin M Waryold
- Department of Graduate Studies: Adult Health, Stony Brook University School of Nursing, 101 Nichols Road, HSC Level 2, Room 222, Stony Brook, NY 11794, USA; Department of Medicine, Stony Brook University School of Medicine, 101 Nichols Road, HSC Level 2, Room 222, Stony Brook, NY 11794, USA.
| | - Allyson Kornahrens
- Department of Graduate Studies: Family Health, Stony Brook University School of Nursing, 101 Nichols Road, HSC Level 2, Room 213-C, Stony Brook, NY 11794, USA
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