International Journal for Equity in Health最新文献

{"title":"The role of social sciences in addressing inequality related to Neglected Tropical Diseases (NTDs).","authors":"Papreen Nahar, Laura Dean, Mirgissa Kaba, Rosalind McCollum, Brianne Wenning, Daniel Argaw Dagne","doi":"10.1186/s12939-026-02997-7","DOIUrl":"10.1186/s12939-026-02997-7","url":null,"abstract":"<p><p>Neglected tropical diseases remain powerful markers of health inequity whose burdens are shaped not only by pathogens and treatment gaps, but also by stigma, marginalisation, gendered labour, poverty, weak infrastructure, fragile referral systems, limited awareness at the community level, and uneven policy implementation. The papers in this special collection show how people affected by mycetoma, podoconiosis, scabies, leprosy, Buruli ulcer, Chagas disease, and leishmaniasis navigate complex social worlds in which diagnosis, care seeking, therapeutic choice, participation in interventions, and public representation are all structured by inequity. Together, the contributions demonstrate the unique value of social science in illuminating lived experiences, contextualising health system performance, and reframing policy questions. The ethnographic, qualitative, participatory, and mixed-methods studies included in this collection bring to light the breadth and depth of experiences of those affected by NTDs, ranging from explorations of stigma, fear, trust, and resilience through to unseen dynamics impacting and influencing everyday life. The use of social sciences reveals that equitable responses to neglected tropical diseases must acknowledge the role of stigma, medical pluralism, gender, migration, ecology, institutions, and the contingent realities of policymaking, rather than relying on biomedical solutions alone. Neglected Tropical Diseases (NTDs) remain among the clearest expressions of global health inequity. They are pervasive among populations living with poverty, weak infrastructure, precarious livelihoods, poor housing, inadequate sanitation, and limited access to timely and respectful care. In as much as the burden of NTDs is not only biomedical, it also has social, moral, and political features. The papers in this special collection show that inequality is produced not simply by pathogens, but by stigma, marginalisation, gendered labour, delayed diagnosis, fragile referral systems, uneven implementation of interventions, and the persistent distance between policy ambitions and lived realities. This special collection brings together diverse and nuanced perspectives of NTD-related experiences across a range of conditions and settings. The papers move across mycetoma, podoconiosis, scabies, leprosy, Buruli ulcer, Chagas disease, and leishmaniasis, while also addressing broader questions of policy, advocacy, implementation, and health system transformation. Taken together, they make a compelling case that equity-oriented responses to NTDs must move beyond treatment alone and engage seriously with the social worlds in which illness is recognised, interpreted, hidden, negotiated, and managed. The contributions further extend these discussions of stigma, violence, and structural inequity. The studies demonstrate how people affected by skin NTDs experience intersecting forms of stigma, emotional, physical, financial, and gender-based viol","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13729598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149320914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Striving to protect and reconnect: narratives of motherhood in the context of homelessness.","authors":"Tommy Carlsson, Elisabet Mattsson, Jenny Eriksson Lundström, Sophie Nadia Gaber","doi":"10.1186/s12939-026-03087-4","DOIUrl":"10.1186/s12939-026-03087-4","url":null,"abstract":"<p><strong>Background: </strong>Homelessness is a critical determinant of health that disproportionately affects women and children. While adverse health consequences of homelessness are well established, less is known about how mothers sustain care, dignity, and wellbeing under such conditions. Drawing on feminist perspectives and an Inclusion Health framework, the aim was to explore women's lived experiences of motherhood in the context of homelessness.</p><p><strong>Methods: </strong>A qualitative study was conducted using narrative interviews with twelve women in Sweden who had lived experience of homelessness and were mothers of children under eighteen. Participants were recruited through four civil society organisations. Data were analysed using Lindseth and Norberg's phenomenological-hermeneutic method, involving naïve reading, structural analysis, and comprehensive interpretation. A participatory approach was applied through collaboration with the Women's Advisory Board for Inclusion Health, comprised of women with lived experience of homelessness, who contributed as co-researchers to study design and interpretation of findings.</p><p><strong>Results: </strong>Through our interpretation of the narratives, motherhood was understood as both a source of vulnerability and a moral practice through which women sustained family life amid systemic adversity. Three interrelated themes characterised the women's experiences. First, mothers encountered fragmented welfare systems that demanded accountability yet offered limited continuity or trust, compelling them to struggle for recognition and care. Second, housing instability and separation from children fractured the women's sense of identity and belonging, revealing how structural insecurity and stigma disrupted maternal roles. Third, mothers sought to protect and reconnect with their children, demonstrating resilience as a relational process rooted in care, responsibility, and love.</p><p><strong>Conclusions: </strong>Motherhood in the context of homelessness is an existential and moral struggle shaped by structural insecurity that constrains mothers' agency and undermines their credibility. Maternal resilience is revealed not just as personal endurance, but also as a relational process grounded in connection, care, and responsibility. Advancing health equity for mothers experiencing homelessness requires welfare and health systems that prioritise relational trust, continuity of support, and the recognition of lived experience as legitimate knowledge.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13737938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149333849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gendered ageism among women undergoing mastectomy across two life stages: early adulthood and later life in Pakistan.","authors":"Tauheed Zahra","doi":"10.1186/s12939-026-03082-9","DOIUrl":"10.1186/s12939-026-03082-9","url":null,"abstract":"<p><p>This qualitative study examines how gender and age shape breast cancer and mastectomy experiences among women in Pakistan. Using critical phenomenology and drawing on 12 in-depth interviews with women across two distinct age groups (early adulthood and later life), the study identifies three key themes regarding age- and gender-based inequalities that shape women's access to care. These inequalities are produced not only within the healthcare system but also through social and familial structures: [1] From Surveillance to Neglect: Age-Stratified Gatekeeping and Delayed Diagnosis, [2] Sacrificial femininity and internalized ageism, [3] Mastectomy as age-stratified embodied threat. Findings show that men act as financial and moral gatekeepers, limiting women's healthcare access, especially for young married women regarded as reproductive assets. Older women experience internalized ageism, viewing their bodies as less worthy of care. Although participants reported no age-based discrimination from healthcare providers, their accounts highlighted that gendered ageism operates strongly in pre-clinical family and community contexts, determining who is allowed to seek care and when. The study demonstrates that the most critical barriers to timely breast cancer treatment are not biomedical but social, cultural, and age gendered.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13693215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare providers' use and acceptance of translation technologies in multilingual healthcare settings: a cross-sectional study.","authors":"Annika Kreienbrinck, Saskia Hanft-Robert, Muhammed-Talha Topçu, Ovidiu Oltean, Alina-Ioana Forray, Răzvan Mircea Cherecheș, Mike Mösko","doi":"10.1186/s12939-026-03085-6","DOIUrl":"10.1186/s12939-026-03085-6","url":null,"abstract":"<p><strong>Background: </strong>Language barriers remain a major challenge to equitable healthcare delivery. While qualified interpreters are considered the preferred standard, their availability is often limited. Translation technologies are therefore increasingly used in practice. However, quantitative evidence on how healthcare providers use these tools, how they evaluate them, and which factors are associated with their acceptance remains limited.</p><p><strong>Methods: </strong>A cross-sectional online survey was conducted among healthcare and psychosocial service providers across a range of clinical settings. Inferential analyses were restricted to the German sample (n = 258), with Romanian data (n = 185) used for exploratory descriptive comparison. The survey assessed experiences with language barriers, communication strategies, and acceptance of translation technologies based on the Technology Acceptance Model. Descriptive analyses characterised use patterns, and multivariable ordinary least squares regression with HC3-robust inference examined factors associated with behavioural intention to use translation technologies.</p><p><strong>Results: </strong>A total of 443 healthcare providers were included. Translation technologies were used by 65.0% of providers in the previous three months, often in the absence of formal organisational support, training, or guidelines. Use varied descriptively across country samples and professional groups, with higher use observed in the German sample and among medical-technical and nursing staff. Acceptance was moderately positive, with perceived usefulness showing the strongest controlled association with behavioural intention to use translation technologies (β = 0.44, p < 0.001). Organisational factors and contextual concerns were not independently associated with behavioural intention. Providers reported concerns regarding accuracy and data privacy, and more cautious use in contexts requiring nuanced, relational communication.</p><p><strong>Conclusions: </strong>Translation technologies appear to function as pragmatic, ad hoc solutions to communication challenges in multilingual healthcare. While these tools may facilitate basic communication, their limitations in complex interactions and the absence of governance frameworks raise important considerations for their safe and equitable implementation. Rather than replacing professional interpreting services, translation technologies may be best understood as complementary resources within a broader communication strategy. Their contribution to equitable care will depend on how they are implemented to support meaningful communication and address the needs of service users facing language barriers.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender-transformative action as a strategy for health system strengthening: a framework for advancing equity, accountability, and resilience.","authors":"Morie Vandi, Augustus Osborne","doi":"10.1186/s12939-026-03070-z","DOIUrl":"10.1186/s12939-026-03070-z","url":null,"abstract":"<p><p>Gender inequity is embedded in the organisation, financing, leadership, and everyday practice of health systems. It shapes who receives care, who provides it, who advances into decision-making roles, whose labour is undervalued, and whose safety is treated as negotiable. While health systems are often presented as neutral institutions, they frequently reproduce the gendered hierarchies of the societies in which they operate. This viewpoint argues that gender-transformative action should be treated as a core strategy for health system strengthening rather than as a peripheral equity concern. It proposes a three-domain framework for understanding and addressing gender inequity in health systems: capacity, institutional structures, and contextual barriers. Capacity refers to the ability of health workers, managers, educators, and policymakers to recognise and respond to gender bias in policy and practice. Institutional structures refer to the formal and informal rules that shape leadership, pay, career progression, workplace safety, budgeting, and accountability. Contextual barriers refer to the wider social conditions that influence whether people can access services and whether workers can participate equitably in institutional life, including restrictive gender norms, unpaid care burdens, violence, insecurity, and economic dependence. Drawing on purposively selected evidence from diverse settings, the paper examines how inequity is reproduced across these domains and outlines four practical areas for action: gender-sensitive training and mentorship, equitable governance and workforce reform, community engagement and norm change, and strengthened digital gender data systems. It argues that isolated or symbolic interventions are unlikely to produce durable change unless they alter the distribution of power, resources, and institutional recognition. Gender-transformative action is therefore not an optional addition to health policy, but a practical requirement for building health systems that are more equitable, accountable, resilient, and capable of advancing universal health coverage and the Sustainable Development Goals. As a viewpoint, the framework is offered as an analytic and planning aid rather than as an empirically validated model. Evidence on how gender-transformative reforms interact across domains remains limited, and the claims made here about what such reform can achieve should be read as arguments for a direction of travel rather than as established effect estimates.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13685318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leading by example: a migrant health researcher's journey from participation to epistemic justice and migrant-centred governance in public health research.","authors":"Maria Gabriela Uribe Guajardo","doi":"10.1186/s12939-026-03055-y","DOIUrl":"10.1186/s12939-026-03055-y","url":null,"abstract":"<p><p>Participatory and co-produced approaches are increasingly promoted in migrant health research to improve equity and ensure research reflects community priorities. Despite growing guidance on conducting research with migrants, migrants remain underrepresented in research leadership, governance, agenda-setting, and knowledge production. Drawing on lived experience as both a migrant and public health researcher, this reflective paper examines the evolution of a program of research spanning health and social care integration, public health emergency preparedness, and international collaborations with migrant communities, frontline workers, and researchers. The paper traces a progression from a focus on service responsiveness and integration towards broader questions of participation, power-sharing, and knowledge justice. Findings highlight the importance of sustained relationships, and community partnerships in generating meaningful and actionable evidence. The work demonstrates how recognising migrants as legitimate knowledge holders through shared governance, remuneration, authorship, and leadership roles can strengthen both the quality and relevance of research. These experiences illustrate a shift from consultation and collaboration towards migrant-led approaches to knowledge generation. The next stage of migrant health research should move beyond participation and co-production towards epistemic justice and migrant-centred governance. This requires challenging traditional hierarchies of expertise and recognising migrants not only as research participants but as leaders, agenda-setters, and producers of knowledge. Such approaches offer a pathway towards more equitable, accountable, and responsive public health research, policy, and practice.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gendered forms of intergenerational solidarity in the COVID-19 pandemic: an intersectional perspective on the public renegotiation of a moral resource for future health crises in Germany.","authors":"Eva Katharina Boser, Lena Dörmann, Niklas Ellerich-Groppe","doi":"10.1186/s12939-026-03014-7","DOIUrl":"10.1186/s12939-026-03014-7","url":null,"abstract":"<p><strong>Background: </strong>During the COVID-19 pandemic, 'intergenerational solidarity' became a prominent buzzword in public debates. At the same time, a resurge of ageist stereotypes could be observed that proved to be a constant structuring element in the public renegotiation of intergenerational solidarity. Despite a growing body of research indicating that the COVID-19 pandemic also had a significant impact on inequalities related to other social categories, such as gender, the interplay between appeals for intergenerational solidarity and other social inequalities in public debates has received limited attention.</p><p><strong>Methods: </strong>To examine how appeals to intergenerational solidarity and gender-related aspects are intertwined in times of crisis, we provide an intersectional perspective on the public renegotiation of intergenerational solidarity during the COVID-19 pandemic, using the example of the German media debate. Based on a qualitative content analysis of articles from two major German weekly newspapers, Die Zeit and Welt am Sonntag, published between March 2020 and June 2022 (n = 351), we identified two paradigmatic cases for an intersectional in-depth-analysis, focusing primarily on the categorial intersection of age and gender within the material.</p><p><strong>Results: </strong>We can observe not only a resurge of ageism and age-related stereotypes in these media representations regarding various aspects of intergenerational solidarity, but also their entanglement with gender norms. Prevailing notions of intergenerational solidarity in the media continue to rely on gendered and age-based assumptions that shape how the moral actors, the basis, contributions, and normative goals of intergenerational solidarity are elucidated. We critically discuss these claims against the backdrop of broader intersectional feminist philosophy literature on structural social inequities and injustices.</p><p><strong>Conclusions: </strong>Our findings illustrate the significance of a gendered and heteronormative generational divide in appeals for intergenerational solidarity that include pertinent gender and age stereotypes. Intergenerational solidarity proves to be a moral resource in times of crisis, even though it often runs the risk of reiterating and perpetuating gendered ageism. However, approaches from intersectional feminist philosophy can help to conceptualize intergenerational solidarity as a diversity-sensitive moral resource in impending health crises in Germany and beyond.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health conditions and referral patterns among people experiencing homelessness: a 10-Year longitudinal study of specialized primary care in Hamburg, Germany.","authors":"Daniel Tajdar, Dagmar Lühmann, Valentina Paucke, Matthias Augustin, Rachel Sommer, Brigitte Stephan, Juliane Traxler, Johanna Sophie Bobardt-Hartshorn, Thomas Kloppe, Martin Scherer, Carolin van der Leeden, Ingmar Schäfer","doi":"10.1186/s12939-026-03071-y","DOIUrl":"10.1186/s12939-026-03071-y","url":null,"abstract":"<p><strong>Background: </strong>Homelessness has increased substantially across Europe in recent years and is associated with a high burden of disease and premature mortality. However, longitudinal evidence on the spectrum of health conditions and healthcare referral patterns among people experiencing homelessness remains limited. This study aimed to describe the most common diagnoses in this population and examine their associations with referral to specialist outpatient care and referral to hospital.</p><p><strong>Methods: </strong>We conducted a retrospective longitudinal study using routinely collected clinical data from three specialized primary care centers for people experiencing homelessness in Hamburg, Germany. Data from 5,055 patients attending 13,330 consultations between June 5, 2013, and March 28, 2024, were analyzed. Diagnoses were coded by healthcare professionals according to ICD-10 criteria. The primary outcomes were referral to specialist outpatient care and referral to hospital. Associations between diagnoses and referral outcomes were assessed using regression analyses and are presented as odds ratios (ORs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>The mean age of patients was 44.6 years (SD, 13.2), and 4,207 (83.2%) were male. Mental and behavioral disorders were the most frequently recorded diagnoses (1,436 patients, 28.4%), particularly disorders related to psychoactive substance use (817, 16.2%) and alcohol use (592, 11.7%). Overall, 10.9% of consultations resulted in referral, including 5.5% to specialist outpatient care and 5.4% with referral to hospital. Alcohol-related disorders (OR, 1.76; 95% CI, 1.39-2.23) and injuries and poisoning, including drug intoxication (OR, 1.64; 95% CI, 1.31-2.05), were significantly associated with referral to hospital. Referral to specialist outpatient care was more likely among older patients (OR per 10-year increase, 1.34; 95% CI, 1.22-1.47) and those presenting with musculoskeletal conditions. Most consultations (89.1%) did not result in a documented referral.</p><p><strong>Conclusions: </strong>Specialized primary care services were able to address the majority of health problems among people experiencing homelessness, with referral required in only a minority of consultations. Strengthening and integrating such services may improve access to care and support continuity of treatment across healthcare settings. Further research should evaluate interventions targeting mental health and substance use disorders, which represented the most common health concerns. Alcohol-related disorders were also associated with increased referral to hospital.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13732960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149320907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"eHealthism in inclusion health: a qualitative longitudinal study with women experiencing homelessness.","authors":"Sophie Nadia Gaber, Elisabet Mattsson, Anna Klarare, Jenny Eriksson Lundström, Penny Rapaport","doi":"10.1186/s12939-026-03061-0","DOIUrl":"10.1186/s12939-026-03061-0","url":null,"abstract":"<p><strong>Background: </strong>While inclusion health approaches are increasingly recognised in research, policy, and practice as essential to addressing health inequities and social exclusion, there is limited understanding of how women experiencing homelessness engage with digital health. This represents a salient knowledge gap, given the growing interest in digital health to improve access, flexibility, and patient empowerment for marginalised populations. This study aimed to explore: (1) how women experiencing homelessness access and use digital technologies to support their health and wellbeing in everyday life; and (2) how their engagement with digital health is shaped by, and shapes, their interactions with health and social care systems, as well as with third-sector organisations.</p><p><strong>Methods: </strong>This qualitative longitudinal study gathered data through narrative interviews and participant observations with nine women experiencing homelessness in London, England. Data were analysed using a three-phase phenomenological-hermeneutic approach inspired by Ricoeur's narrative and interpretation theory. Women with lived experience of homelessness contributed to the study design and recruitment processes, co-produced study materials, supported the analysis and interpretation of findings, and co-produced recommendations.</p><p><strong>Results: </strong>Using eHealthism as an interpretive lens, our analysis identified three themes: (1) Taking care of my health on my own terms - with or without digital tools; (2) When digital tools are not enough - I still need support; and (3) Digital health can work - but it's not the same as seeing someone face-to-face.</p><p><strong>Conclusions: </strong>Based on the findings, we propose a three-layer conceptual framework of exclusion mechanisms in eHealthism, along with corresponding recommendations for inclusion health. Together the individual, relational, and contextual layers of exclusion mechanisms challenge assumptions of individual responsibility and universal digital empowerment, highlighting the need for meaningful choice in hybrid care and for ongoing, trauma‑informed relational support. Addressing these complexities is essential for developing inclusive digital health strategies that advance health equity for women experiencing homelessness and other groups at risk of social exclusion.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community-led solutions to promote safe institutional deliveries in scattered tribal settlements of Madhya Pradesh, India.","authors":"Piyush Bhatt, Anviti Awasthi","doi":"10.1186/s12939-026-02849-4","DOIUrl":"10.1186/s12939-026-02849-4","url":null,"abstract":"<p><strong>Background: </strong>In Madhya Pradesh, India, the Department of Public Health and Medical Education has undertaken initiatives to promote institutional deliveries in aspirational districts through community engagement and the involvement of frontline health workers. However, in districts with scattered settlements, hilly terrain, and difficult-to-reach hamlets, geographic and infrastructural barriers continue to constrain maternal health outcomes. In the tribal district of Barwani, traditional beliefs and cultural preferences further reinforce the community's reliance on home-based deliveries, which increase the risk of preventable maternal and neonatal complications and deaths. To address these intersectional inequities in rural India, the Antara Foundation, a public health nonprofit, piloted a community-led Home Delivery Prevention Model in Pati block of Barwani district. The model aimed to quantify and address barriers contributing to home deliveries through the active involvement of the local community. Institutional delivery was used as a proxy indicator for access to institutional maternal care.</p><p><strong>Objective: </strong>This paper documents the implementation of the model that ensures institutional deliveries among pregnant women in 'hard-to-reach' hamlets (faliya) and explores how locally driven, community-led approaches can promote equitable access to public healthcare in remote, indigenous settings.</p><p><strong>Methodology: </strong>The model, designed in December 2023 with the help of community volunteers, was implemented from January to June 2024. A mixed-methods approach was used, with quantitative analysis of government data to identify pilot areas. Content analysis of the qualitative data, which was collected by the implementation team from pregnant women and their families through FGDs and interviews, informed the community action. A purposive sample of 127 pregnant women was selected across five sub-health centres (SHCs) with the highest number of home deliveries. Data collected was stored, handled and managed ethically throughout the pilot, guided by the Declaration of Helsinki 2024.</p><p><strong>Results: </strong>The intervention demonstrated preliminary improvements in family and local community support, resulting in institutional delivery for 83% of pregnant women who gave birth during the study period.</p><p><strong>Conclusion: </strong>This pilot study provides evidence that community-led models, grounded in local participation and integration with public systems, can enhance the uptake of institutional care in regions with high geographic and social inequities.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}