SSM - Health Systems最新文献

{"title":"Towards social enterprises that digitally engage citizens for integrated people-centred health services: Organisational case studies and a framework analysis of community health alliances","authors":"Myron Anthony Godinho (Research Fellow) ,&nbsp;Siaw-Teng Liaw (Emeritus Professor) ,&nbsp;Padmanesan Narasimhan ,&nbsp;Md Mahfuz Ashraf","doi":"10.1016/j.ssmhs.2025.100096","DOIUrl":"10.1016/j.ssmhs.2025.100096","url":null,"abstract":"<div><h3>Introduction</h3><div>Globally, social enterprises are being explored for their potential to act as socially responsible, privately-owned providers of community-focused primary care. In this study, we tested a framework on how social enterprises could use digital health and citizen engagement to actualise the WHO strategies for integrated people-centred health services (IPCHS) using case studies of two Community Health Alliances (CHAs) in Sydney, Australia.</div></div><div><h3>Methodology</h3><div>We constructed cases studies of two CHAs using a combination of documentary analysis (57 documents), and semi-structured interviews (14 participants) that were coded using both inductive and deductive approaches. Case study findings were used to conduct a framework analysis to test, validate, and revise the framework, based on a recommended approach for organisational case study research.</div></div><div><h3>Results</h3><div>Our case analysis demonstrated that CHAs use digital health and citizen engagement to co-produce services in ways that actualise the IPCHS strategies. Framework analysis demonstrated that enterprise, digital health, and citizen engagement enable each other and co-create IPCHS. The framework was revised to reflect novel observations. Findings indicated that the CHAs we studied do not yet operate as social enterprises, with ongoing challenges related to value capture, their ownership model, and their formalisation as independent entities.</div></div><div><h3>Conclusion</h3><div>Stakeholders attributed CHAs’ operational challenges to the early stage of maturity. To address this, our future work will develop a maturity model and toolkit to implement and evaluate social enterprises that use digital health and citizen engagement to co-produce IPCHS.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100096"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awareness and usability of community and facility-based health sector client feedback mechanism in Tanzania public health system. A mixed methods study","authors":"James T. Kengia ,&nbsp;Pius Kagoma ,&nbsp;Ally Kinyaga ,&nbsp;Helga Mutasingwa ,&nbsp;Simon Debere ,&nbsp;Robert Smith ,&nbsp;Marcos Robert Mzeru ,&nbsp;Rashid Mbunda ,&nbsp;Claud Kumalija ,&nbsp;Paul Chaote ,&nbsp;Felix Sukums ,&nbsp;Msafiri Kabulwa ,&nbsp;Eliud Eliakimu ,&nbsp;Rashid S. Mfaume ,&nbsp;Ntuli A. Kapologwe ,&nbsp;Paschal Ruggajo ,&nbsp;Wilson C. Mahera ,&nbsp;Albino Kalolo","doi":"10.1016/j.ssmhs.2025.100133","DOIUrl":"10.1016/j.ssmhs.2025.100133","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Client feedback systems are increasingly becoming important in person-centered health care. The systems provide opportunities to the public to interact with the health care providers and policymakers, present their concerns related to the performance of the health care system in order to improve the quality, equity, and responsiveness in the provision of services, hence increase social accountability. This study aimed to assess the situation of client feedback systems in Tanzania, focusing on the awareness and usability of existing facility- and community-based feedback platforms from the client’s perspective.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The study employed a concurrent mixed-method design using both quantitative and qualitative methods. Quantitatively, surveys were administered in July 2023 to 1009 clients who received either inpatient or outpatient services from 109 health care facilities in 20 councils across 10 regions of Tanzania mainland to gather structured data on satisfaction levels, perceptions of feedback mechanisms, and suggestions for improvement. Qualitative data were collected through Focus group Discussion (FGD) to get in-depth healthcare workers and or clients’ perspectives and experiences. These methods provided nuanced information, contextual insights, and a deeper understanding of the client feedback process. Combining these approaches yielded a comprehensive, multi-dimensional view of the client feedback mechanism landscape. We used Generalized Linear Mixed Model and thematic analysis for quantitative and qualitative data respectively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Our findings revealed that, the majority of the clients were aware of their right to provide feedback (79.78 %), and in particular familiar with the suggestion box (82.95 %) followed by phone calls (34.49), nevertheless most of them never provided feedback (67.3 %). Phone calls (83.75) and SMS (44.10 %) were the most preferred platforms to provide feedback. Comparatively, clients attending higher level health facilities, clients who visited facilities 4–5 times or more, those who received services for 45–60 min or more and those who were aware of existence of client feedback system than their counterparts were significantly more likely to provide feedback. Moreover, in qualitative findings availability of real time feedback, authenticity, user-friendliness of the system, digitalization, clarity in referral pathway and information use to support decisions and quality improvement was important factors to enhance usability.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Improving the usability of client feedback system is essential to attain person-centered health care and advance universal health coverage. The majority of the clients attending heath care facilities are aware of their right to provide feedback, nevertheless, most of them never provide feedback. Our study, have shed light on the need to invest on user friendly syst","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100133"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145094924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pooling resources for better health: Exploring pooled procurement for health technologies globally and potential application in Asia","authors":"Annapoorna Prakash ,&nbsp;Sarin K C ,&nbsp;Kalipso Chalkidou ,&nbsp;Ngawang Dema ,&nbsp;Yot Teerawattananon ,&nbsp;Saudamini Vishwanath Dabak","doi":"10.1016/j.ssmhs.2025.100103","DOIUrl":"10.1016/j.ssmhs.2025.100103","url":null,"abstract":"<div><div>Pooled procurement, a collaborative approach where two or more buyers pool their funds to procure health products together, has emerged as a potential solution to increase affordability and timely availability of health technologies. This collaborative approach, utilised by sub-national, national, regional and global initiatives, combines buying power to negotiate lower prices and ensure timely access to health products and improve the efficiency of the procurement process. However, successful implementation requires building consensus among different participating stakeholders, harmonisation of regulations and logistics, among others. In Asia, there is potential for applying pooled procurement. Existing mechanisms could be leveraged and at minimum, coordination and information sharing may be initiated. Potential priority areas for exploring pooled procurement across countries are for high-cost medicines, antibiotics, life-saving medical devices and vaccines. The success of any pooled procurement arrangement will depend on addressing each country's unique challenges and goals and taking a multi-pronged approach to strengthening regional solidarity and long-term sustainability.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100103"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing the role and functions of CHWs in service of a people-centred community health system in sub-Saharan Africa. A realist synthesis","authors":"Usangiphile E. Buthelezi ,&nbsp;André J. van Rensburg ,&nbsp;Mosa Moshabela ,&nbsp;Zamasomi Luvuno ,&nbsp;Tasneem Kathree ,&nbsp;Arvin Bhana ,&nbsp;Inge Petersen","doi":"10.1016/j.ssmhs.2025.100089","DOIUrl":"10.1016/j.ssmhs.2025.100089","url":null,"abstract":"<div><h3>Introduction</h3><div>The role of Community Health Workers (CHWs) in sub-Saharan Africa is critical to achieve people-centred health systems. Despite a large evidence base, there is a dearth of knowledge regarding the contextual factors and mechanisms that shape CHW performance in providing people-centred care. This study aims to map out conditions that enable people-centred care by CHWs in sub-Saharan Africa by identifying the key mechanisms and contextual factors.</div></div><div><h3>Methodology</h3><div>A realist synthesis approach was employed to explore how, why, and under what conditions CHW interventions lead to desired outcomes for people-centred care. A systematic review of the literature was undertaken from 2014 to 2024, focusing on studies conducted in sub-Saharan Africa. The review followed a six-phase process, including the development of the initial programme theory, search for evidence, evidence review and quality appraisal, data extraction, data synthesis and analysis, and refinement of the programme theory, followed by formulation of context-mechanism-outcome (CMO) configurations.</div></div><div><h3>Results</h3><div>This synthesis included 36 studies from 14 sub-Saharan African countries. In total, 101 CMO configurations were identified and condensed into 17 preliminary configurations. Specific contexts and mechanisms emerged that influence outcomes related to CHW programmes. The study identified trust, motivation, and adaptive leadership as fundamental meta-mechanisms that challenge the siloed structure of the IPCHS framework, emphasizing the need for greater flexibility to capture interactions across different strategies of the framework.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that integrating CHWs into formal systems, aligning CHW-specific interventions with community-based initiatives, establishing intersectoral partnerships, and updating the IPCHS framework to incorporate adaptive leadership and feedback mechanisms can enhance the delivery of people-centred care.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100089"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving access to skilled maternal health services among pregnant women with disabilities in Uganda: What are disability-responsive maternal health services?","authors":"Milly Nakatabira ,&nbsp;Elizabeth Ekirapa-Kiracho ,&nbsp;Christine Aanyu ,&nbsp;Heang-Lee Tan ,&nbsp;Rebecca R. Apolot ,&nbsp;Nukhba Zia ,&nbsp;Dan Kajungu ,&nbsp;Abdulgafoor M. Bachani ,&nbsp;Rosemary Morgan","doi":"10.1016/j.ssmhs.2025.100087","DOIUrl":"10.1016/j.ssmhs.2025.100087","url":null,"abstract":"<div><h3>Background</h3><div>Pregnant women with disabilities (WWDs) face increased challenges in accessing skilled birth health services than women without disabilities, especially in low and middle-income countries, which puts them at a higher risk of worse maternal health outcomes. Limited studies have been conducted in Uganda that address the needs of pregnant WWDs from a health system perspective. This paper aims to explore the demand and supply side needs of pregnant WWDs in Uganda and explain what disability-responsive maternal health services look like at the health systems level.</div></div><div><h3>Methods</h3><div>A qualitative study was conducted in Iganga and Mayuge districts in Eastern Uganda. Thirteen key informant interviews were conducted with district health team members and community leaders. In-depth interviews were conducted with 12 WWDs and 12 caregivers, and eight focus group discussions were conducted with health workers, community members, and traditional birth attendants. Analysis was done manually using the framework approach.</div></div><div><h3>Results</h3><div>Barriers included a lack of disability-friendly transport to get to the facility of choice, a lack of childbirth autonomy, poor attitudes and disrespectful maternity care by health workers, physical inaccessibility of health facility infrastructure, lack of specialized medical equipment to meet the needs of pregnant WWDs, and lack of health worker training to meet the unique needs of WWDs.</div></div><div><h3>Conclusion</h3><div>There is a need for holistic, multifaceted, and multisectoral approaches to ensure disability-responsive maternal health services at the health systems level. This includes policies that support inclusive maternal health services that meet the needs of pregnant WWDs, dedicated funding and prioritization of disability-related health interventions, improved physical environment of health facilities to make them more accessible to PWDs, a trained workforce to meet the health needs of pregnant WWDs at all health system levels and overcome poor attitudes and disrespectful maternity care towards WWDs, and disability data which is disaggregated by key social stratifiers to guide planning, monitoring and decision-making around disability-responsive maternal health services.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100087"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143942158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI prescription systems automation: Regulatory and educational challenges in the USA and Europe","authors":"Francesco Andrea Causio ,&nbsp;Ciro Pappalardo ,&nbsp;Salvatore Palazzo ,&nbsp;Chiara Barneschi ,&nbsp;Francesca Aurora Sacchi ,&nbsp;Alice Ravizza ,&nbsp;Davide Golinelli","doi":"10.1016/j.ssmhs.2025.100115","DOIUrl":"10.1016/j.ssmhs.2025.100115","url":null,"abstract":"<div><div>Western healthcare systems face escalating pressures from chronic disease prevalence, aging populations, increasing healthcare demands, and rising costs. Artificial Intelligence (AI) solutions offer transformative potential by enhancing clinical decision-making and healthcare management, optimizing resource allocation, improving patient outcomes, and accelerating innovation. However, the integration of AI into healthcare raises unresolved questions regarding transparency, algorithmic accountability, legal liability, and data governance, highlighting significant systemic risks. The regulatory frameworks adopted by the European Union (EU) and the United States (US) differ significantly, shaped by contrasting legal traditions and policy objectives. This paper critically examines these divergent regulatory approaches, focusing on the recent Healthy Technology Act 2025 proposal in the US, which would enable AI to prescribe medications autonomously. We discuss legal, ethical, and educational challenges arising from this regulatory divergence, ultimately providing insights and recommendations for policymakers, healthcare organizations, and technology developers.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100115"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144904057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organisational learning culture in maternity units: A mixed-method study in rural district hospitals in KwaZulu-Natal, South Africa","authors":"Christiane Horwood ,&nbsp;Lyn Haskins ,&nbsp;Veronique Filippi ,&nbsp;Loveday Penn-Kekana ,&nbsp;Samuel Manda ,&nbsp;Sphindile Mapumulo ,&nbsp;Silondile Luthuli ,&nbsp;Ruwayda Petrus ,&nbsp;Tanya Doherty","doi":"10.1016/j.ssmhs.2025.100081","DOIUrl":"10.1016/j.ssmhs.2025.100081","url":null,"abstract":"<div><h3>Background</h3><div>Building organisational learning in health facilities is a health system strengthening strategy that has particular relevance for rural health workers (HWs) who may be geographically isolated without access to learning opportunities or specialist support. We present the findings of a mixed methods study exploring organisational learning in rural hospital maternity units.</div></div><div><h3>Methods</h3><div>Data were collected from all cadres of HWs working in maternity units in 11 health facilities in two districts, including doctors, nurse managers, midwives and nursing assistants. A quantitative survey was conducted with all HWs using the validated Dimensions of Learning Organisation Questionnaire (DLOQ). We then conducted individual in-depth interviews with purposively selected HWs in each facility to explore their perceptions and experiences of learning, teamwork and leadership.</div></div><div><h3>Findings</h3><div>We completed 116 DLOQ self-administered questionnaires and conducted 35 in-depth interviews. Strategic leadership scored highest on the DLOQ, with HWs reporting that managers provided opportunities for mentoring and learning. Doctors and nurse managers experienced team learning, leadership and communication more positively than midwives and nursing assistants. Learning was driven by senior doctors and managers, frequently taking a top-down didactic approach rather than employing reflection and dialogue. This is supported by low DLOQ scores for inquiry and dialogue and empowerment among nurses compared to doctors and managers.</div></div><div><h3>Conclusions</h3><div>There is a need for shifts in learning approaches in maternity units from a didactic clinical focus to participatory dialogue and reflection, including interpersonal issues like respect and communication, and to ensure that all team members have access to learning opportunities.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100081"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators to collaboration between traditional and biomedical mental health services in a post-conflict healthcare system: A qualitative study in Tigray, Ethiopia","authors":"Kenfe Tesfay Berhe ,&nbsp;Hailay Abrha Gesesew ,&nbsp;Lillian Mwanri ,&nbsp;Paul Ward","doi":"10.1016/j.ssmhs.2025.100153","DOIUrl":"10.1016/j.ssmhs.2025.100153","url":null,"abstract":"<div><h3>Background</h3><div>The World Health Organisation advocates a biopsychosocial model combining traditional and biomedical care to address mental health gaps, especially in low-resource, conflict-affected health systems. This study explores the factors influencing collaboration between traditional and biomedical mental health services in Tigray, where research on such collaborative care remains limited.</div></div><div><h3>Methods</h3><div>In-depth interviews were conducted with 50 participants, including biomedical practitioners, traditional healers, and service users from both modalities of care in Tigray, Ethiopia. Interviews focused on perspectives of the need for more collaboration and the barriers and enablers to achieving a collaborative mental health system. A thematic framework analysis approach was employed for data analysis, utilising NVivo qualitative data analysis software.</div></div><div><h3>Results</h3><div>Traditional practitioners, biomedical practitioners, and their service users recognised the value of collaboration in mental health care in a post-conflict Tigray context, despite acknowledging the presence of challenges. Safety concerns, unclear roles, coordination gaps, and fear of combined treatment effects were barriers to collaboration. Facilitators include opportunities arising from experience sharing by international organisations, as well as existing psychosocial and spiritual rituals.</div></div><div><h3>Conclusion</h3><div>The study revealed opportunities for collaboration between traditional and biomedical mental health services within post-conflict healthcare systems. Despite existing challenges, both practitioners and service users demonstrated a strong willingness to collaborate and utilise these services. These findings showed the need for contextual collaborative care strategies to enhance mental health care and foster community healing in post-conflict settings.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100153"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing accountability in maternal and newborn health referrals through a network of care: A mixed methods implementation research in Makueni, Kenya","authors":"Jefferson Mwaisaka ,&nbsp;Melanie Olum ,&nbsp;Patricia Owira ,&nbsp;Dennis Mulwa ,&nbsp;Mwatha Stephen ,&nbsp;Samuel Mwaura ,&nbsp;Osborn K. Kiptoo ,&nbsp;Lisa Noguchi ,&nbsp;Anne Hyre ,&nbsp;Pooja Sripad","doi":"10.1016/j.ssmhs.2025.100155","DOIUrl":"10.1016/j.ssmhs.2025.100155","url":null,"abstract":"<div><div>Effective coordination and timely action are crucial for preventing and managing maternal and newborn health (MNH) complications. In low- and middle-income countries, these elements are often inadequate given complexity in health systems dynamics. A major challenge is the lack of accountability for actions and outcomes across interconnected health facilities alongside inefficient MNH referral systems. This study assessed changes in accountability within a broader implementation research effort assessing the feasibility, acceptability, and effectiveness of integrating a Network of Care (NoC) in Kenya. This mixed methods study assessed whether establishing a County-level NoC enhanced accountability in MNH referrals and relationships among health facilities. Quantitative data were collected through six rounds of phone surveys with MNH healthcare providers, while qualitative data was collected from focus group discussions with MNH healthcare providers and key informant interviews with county health managers at baseline, midline, and endline. Accountability outcomes were categorized under three themes: Proactive and Efficient MNH Referral Systems, Collaboration and Communication, and Trust among providers. Quantitative analysis indicated significant improvements (p &lt; 0.05) in 12 out of 17 accountability measures. Qualitative data highlighted enhanced referral systems, clarity of roles, peer learning, teamwork, respect, confidence and transparency within and across facilities, presenting an opportunity to enhance inter-facility accountability through a well-coordinated NoC. Study findings suggest that NoCs, which support efficient collaborative health systems decision-making and action to optimize person-centered outcomes, can enhance accountability in MNH and offer a transferable model for similar settings.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100155"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conceptualizing trans-inclusive healthcare in the United States: Environmental and interpersonal factors of healthcare provision","authors":"Jacob Goffnett ,&nbsp;Jarrod Call ,&nbsp;Jeff Ciak ,&nbsp;Em Medina ,&nbsp;Kelly L. Clary ,&nbsp;Rob Ventura ,&nbsp;Simran Sidhu","doi":"10.1016/j.ssmhs.2025.100112","DOIUrl":"10.1016/j.ssmhs.2025.100112","url":null,"abstract":"<div><h3>Purpose</h3><div>To create a framework of inclusive healthcare for transgender and gender-diverse patients comprising environmental, interpersonal, and intrapsychic factors.</div></div><div><h3>Background</h3><div>Transgender and gender-diverse individuals face significant barriers to accessing competent and affirming healthcare in the United States (U.S.), contributing to higher rates of behavioral health issues. Research has largely focused on interpersonal factors affecting access leaving environmental factors—shown to reduce anxiety and improve comfort—underexplored.</div></div><div><h3>Methods</h3><div>We conducted focus group interviews with 13 transgender and gender-diverse participants (M = 23 years old) in the U.S., utilizing a semi-structured guide and photo elicitation. Participants shared their healthcare experiences, discussing preferences and dislikes while reflecting on images of healthcare environments.</div></div><div><h3>Results</h3><div>Inclusive healthcare comprises environmental and interpersonal factors that enhance intrapsychic feelings of privacy, agency, comfort, and gender affirmation. Key environmental features include spacious, private layouts and culturally relevant symbols, while interpersonal factors highlight the importance of culturally competent care. Participants noted that inconsistencies between environments and interactions served as unique stressors.</div></div><div><h3>Conclusions</h3><div>To improve healthcare for transgender and gender-diverse patients, providers should emphasize privacy, agency, comfort, and gender validation through thoughtful environmental design that complement affirming interpersonal practices. Further research is necessary to validate these findings across diverse samples.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100112"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144694691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}