International Journal for Equity in Health最新文献

{"title":"Beyond the Gini index: a poverty-normalized spatial Bayesian model for assessing territorial inequality.","authors":"Xavier Perafita, Marta Solans, Laura Vilà-Quintana, Maria Antònia Barceló, Marc Saez","doi":"10.1186/s12939-026-02890-3","DOIUrl":"10.1186/s12939-026-02890-3","url":null,"abstract":"<p><strong>Background: </strong>The Gini index is one of the most widely used measures of income inequality. However, it has limitations in allowing reliable comparisons across areas with different socio-economic structures, particularly in small populations, where the index can be highly unstable. This study explores a simple modification of the Gini index that can overcome some of these limitations.</p><p><strong>Methods: </strong>We propose a modification of the original Gini index that incorporates the poverty rate as an offset. Combined with Bayesian spatial modelling, this approach improves the precision and comparability of small-area estimates, by providing measures of inequality conditional on local poverty levels. To illustrate it, income data from 8,043 Spanish municipalities for the year 2022 were used, and the spatial patterns of the normalized Gini index were compared with those obtained from the original index.</p><p><strong>Results: </strong>The normalized Gini index revealed spatial inequality patterns that were overlooked by the original index. The new approach identified municipalities with higher levels of inequality than expected given their poverty rates in Andalusia, Extremadura, and Murcia, in contrast to lower inequality in Catalonia, Basque Country, Madrid, and Balearic Islands. In addition, while the original Gini index increased with population density and urbanization, the normalized version showed an opposite trend, with higher relative inequality observed in rural and low-density municipalities after accounting for local poverty levels.</p><p><strong>Conclusions: </strong>Given its simplicity, reliance on widely available indicators, and adaptability to different territorial scales, the proposed method offers a useful measure for describing income inequality conditional on a region's poverty level and informing local redistributive policies.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13397631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148029316","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":"Taking stock of intersectionality-informed policy guidance for post-pandemic recovery: a scoping review.","authors":"Gemma Hunting, Olena Hankivsky, Ashlee Christoffersen","doi":"10.1186/s12939-026-02853-8","DOIUrl":"10.1186/s12939-026-02853-8","url":null,"abstract":"<p><strong>Background: </strong>COVID-19 was a catalyst for popularizing intersectionality, an approach now recognized as central to understanding the inequitable consequences of COVID-19 and as a necessary lens for recovery. Yet, a key question remains: Did the pandemic provide the stimulus for improving or advancing operational policy-relevant guidance for intersectionality? Answering this is critical, given persistent calls for practical policy guidance for operationalizing intersectionality. This article explores this question by first providing a brief overview of intersectionality, including its value-added in relation to equity-promoting public policies. We then summarise how intersectionality was taken up during and post-pandemic, situating these trends within the broader field of intersectionality-informed research and policy. Following this, we present findings derived from a review of guidance for applying intersectionality in the context of COVID-19.</p><p><strong>Methods: </strong>The literature reviewed derives from a larger scoping review (conducted by the authors) of guidance (including tools, guides, and frameworks) intended to facilitate the application or operationalization of intersectionality as relevant to public policy. Inclusion criteria for the scoping review included English language, any date (to end of 2023), presents user-friendly guidance, mentions policy, and contains intersectional* in the title.</p><p><strong>Results: </strong>Our findings show that despite much discussion on intersectionality in relation to COVID-19 and the increase in intersectionality guidance since the outbreak, little guidance was developed on how to conduct intersectionality-informed analysis in relation to COVID-19 or post-pandemic recovery. Yet, our analysis also shows that the guidance focused on COVID-19 stands out as more robust than the majority of intersectionality guidance produced to date. Specifically, the COVID-19 guidance reflects the foundational tenets of intersectional analysis and action, boosting its potential to capture and address inequities. This is in contrast to the broader scoping review which indicates that most existing intersectionality guidance has failed to do this.</p><p><strong>Conclusion: </strong>It is pressing that researchers, policy actors and practitioners who seek to take up intersectionality in their work critically take stock of promising practices in intersectionality guidance - exemplified by the COVID-19 guidance reviewed in this article - to strengthen how inequities are captured and addressed.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13397774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148005228","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":"Optimal insurance coverage and pricing of outpatient drugs in Iran: a cost- and chronicity-based adaptation of the vertical equity model.","authors":"Shekoofeh Sadat Momahhed, Atefehsadat Haghighathoseini","doi":"10.1186/s12939-026-02889-w","DOIUrl":"10.1186/s12939-026-02889-w","url":null,"abstract":"<p><strong>Objective: </strong>To estimate welfare-optimal insurance coverage and drug prices in Iran's NHI outpatient market, using drug cost and chronicity as proxies for patient financial vulnerability in the absence of income data.</p><p><strong>Setting: </strong>A complete administrative census of 88,565 outpatient prescription claims across all NHI fund types and provinces in Iran, fiscal year 2023, covering 7,977 unique pharmaceutical products.</p><p><strong>Design: </strong>Cross-sectional welfare analysis using the Westerhout-Folmer framework, adapted to replace income-based vertical equity with drug costliness and treatment chronicity as observable equity axes. Drugs were grouped into four categories (Low-cost Acute, High-cost Acute, Low-cost Chronic, High-cost Chronic). Claims-derived parameters were used to estimate consumer and supply-side surplus, insurer spending, and total welfare under observed versus second-best optimal scenarios, with sensitivity analyses over the social cost of public funds and fixed provision costs.</p><p><strong>Results: </strong>The welfare model recommended higher insurance coverage than currently observed for all four equity groups, with zero bounding violations in any sensitivity scenario. The largest coverage gap was identified for Low-cost Chronic drugs (Δr = + 0.279; observed mean 0.493, optimal 0.773) - the group with the lowest observed coverage ratio of all categories and the oldest mean patient age (64.1 years). Low-cost Acute drugs had the second largest gap (Δr = + 0.260). High-cost groups, which already benefit from cost-tier formulary reimbursement, showed smaller but positive recommended increases (+ 0.032 and + 0.081 respectively). Positive welfare gaps were observed for all groups (median per drug: Int$ +308 to + 436 PPP). All directional findings were fully stable across all 12 sensitivity scenarios.</p><p><strong>Conclusion: </strong>Iran's NHI under-covers low-cost chronic medicines, leaving patients with the highest recurrent out-of-pocket burden despite the lowest reimbursement rates. Increasing coverage for this group is the most welfare-improving and administratively feasible reform within the current system. The framework also offers a replicable, income-independent approach to equity-oriented pharmaceutical policy in comparable middle-income settings.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13292526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148005211","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":"Exploring perspectives of knowledge users about reporting on health equity in observational studies: a qualitative study informing the development of the STROBE-Equity reporting guideline.","authors":"Dana Simpson, Omar Dewidar, Elizabeth Ghogomu, Khadija Aliyeva, Zulfiqar Bhutta, Lucy C Barker, Luis Gabriel Cuervo, Holly N Ellingwood, Sonya Faber, Cindy Feng, Sarah Funnell, Billie-Jo Hardy, Janet Hatcher Roberts, Tanya Horsley, Alison Krentel, Julian Little, Michelle Kennedy, Tamara Kredo, Elizabeth Kristjansson, Daeria O Lawson, Michael Johnson Mahande, Zack Marshall, G J Melendez-Torres, Lawrence Mbuagbaw, Miriam Nkangu Nguilefem, Ekwaro A Obuku, Ebenezer Owusu-Addo, Tomas Pantoja, Kevin Pottie, Anita Rizvi, Larissa Shamseer, Peter Tugwell, Janice Tufte, Xiaoqin Wang, Charles S Wiysonge, Taryn Young, Vivian Welch, Janet Jull","doi":"10.1186/s12939-026-02876-1","DOIUrl":"10.1186/s12939-026-02876-1","url":null,"abstract":"<p><strong>Background: </strong>Health inequities arising from systemic factors and contextual conditions result in avoidable and unjust differences in health outcomes, with profound social and economic implications. Health inequities can frequently go unreported in observational studies. Observational studies can uniquely inform how we understand and address persisting health inequities through collecting, reporting and analyzing health equity factors using 'inclusive' methodological considerations. While the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) reporting guideline aims to improve observational study reporting quality, existing extensions lacked a specific focus on health equity. Engaging those who will use or be impacted by research (\"knowledge users\"), including participant-research collaborators, is central to bridging the gap between knowledge production and real-world application. Therefore, the purpose of this study was to gather a range of perspectives from these knowledge users as part of, and to inform, the development of the STROBE-Equity guideline extension, which aims to improve the reporting of equity-relevant considerations in observational studies.</p><p><strong>Methods: </strong>This study used a qualitative description approach, employing semi-structured key informant interviews and framework analysis to collect and analyze the views of researchers, policymakers, decision-makers, funders, journal editors, ethicists, and participant-research collaborators. Participants were purposefully sampled to reflect diverse perspectives from knowledge users with relevant experience on health equity reporting.</p><p><strong>Results: </strong>Eleven key informants participated in the interviews. Information from interviews was categorized into seven themes: \"Clarifying equity\", \"Equity is dynamic\", \"The challenges of making equity claims\", \"Making reporting on equity feasible\", \"Using reporting guidelines to manage tension\", \"Potential for better outcomes\", and \"Nobody's perspective is neutral\". Participants emphasized the need for standardized equity-relevant reporting practices and offered insight into challenges, opportunities, and strategies for integrating equity-relevant considerations into observational study reporting.</p><p><strong>Conclusions: </strong>Findings show that participants viewed equity as a complex concept and stressed the need for practical guidance to support equity reporting in observational studies. They highlighted barriers such as limited time, resources, and publication word limits, and perceived the STROBE-Equity extension as a valuable tool for structuring reporting, raising awareness, and encouraging reflection, with the potential to improve the quality and impact of equity-relevant research.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148005139","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":"Social determinants of intersectional inequalities in multimorbidity and its burden in China: a multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA).","authors":"Zhili Chen, Yaoda Hu, Huijing He, Qiong Ou, Yawen Liu, Tan Xu, Ji Tu, Zhiming Lu, Zichao Wang, Da Xu, Qing Wang, Zhujie Ran, Mengwei Zhang, Guangliang Shan","doi":"10.1186/s12939-026-02880-5","DOIUrl":"10.1186/s12939-026-02880-5","url":null,"abstract":"<p><strong>Background: </strong>Conventional epidemiological studies often rely on average associations for single social determinants, which may obscure heterogeneity across jointly defined social positions. This study applied an intersectionality-informed Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) approach to examine disparities in multimorbidity prevalence and burden among Chinese adults.</p><p><strong>Methods: </strong>We analyzed 25,409 participants from the 2023-2024 China National Health Survey. Intersectional strata were defined a priori by six social-position dimensions: age, sex, region, residence, educational attainment, and occupational status, yielding 127 observed strata. Multimorbidity was defined as having two or more of 14 chronic conditions, and burden was assessed using the Chinese Multimorbidity Weighted Index (CMWI). MAIHDA models were fitted separately for multimorbidity and CMWI to estimate stratum-specific predictions, variance partition coefficients (VPCs), proportional changes in variance (PCVs), and discriminatory accuracy. Sensitivity analyses examined age restriction, outcome definition, survey-site clustering, lifestyle adjustment, and birthplace-based residence classification.</p><p><strong>Results: </strong>Overall, multimorbidity prevalence was 22.96%, and mean CMWI was 1.32. Predicted multimorbidity prevalence ranged from 3.36% to 53.37%, and predicted CMWI ranged from 0.19 to 2.95. Higher predicted values were concentrated among older adults, northern residents, participants with lower education, and those who were farmers, unemployed, or retired. Intersectional strata accounted for 16.92% of total variation in multimorbidity and 13.74% in CMWI; discriminatory accuracy for multimorbidity was moderate (AUC = 0.75). Age explained the largest share of between-stratum variance, followed by occupational status and region. Additive main effects explained most between-stratum heterogeneity (PCVs: 82.69% for multimorbidity and 88.37% for CMWI), although residual stratum-specific deviations persisted in a subset of strata. Sensitivity analyses supported the robustness of the findings.</p><p><strong>Conclusions: </strong>Multimorbidity prevalence and burden were unevenly distributed across intersectionally defined social positions in China. Most heterogeneity reflected additive social-position gradients, particularly age, occupation, and region, with smaller residual deviations beyond additivity. These findings support proportionate universalism: universal chronic disease prevention and management should be strengthened, with additional support directed toward socially and regionally disadvantaged groups with greater burden.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13390269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147987336","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":"Aging under scarcity and insecurity: chronic disease, functional limitation, and basic need material insecurity among older adults in Haiti.","authors":"James Lachaud, Ruth Climat, Luckny Zephyr, Bogentson André, Marilisse Neptune Rouzier, Nixon Calixte","doi":"10.1186/s12939-026-02881-4","DOIUrl":"10.1186/s12939-026-02881-4","url":null,"abstract":"<p><strong>Background: </strong>Older adults in low-income and fragile states often age with intersecting burdens of chronic disease, functional decline, and material deprivation, yet they remain largely invisible in research and policy. In Haiti, recurrent political crises, violence, and weak health and social protection systems may amplify late-life inequities, but national data are scarce. We examined the distribution and social determinants of health, functioning, and material insecurity among older Haitian adults.</p><p><strong>Methods: </strong>We analyzed data from adults aged ≥ 60 years (n = 1,408) drawn from a 2024 nationally representative household survey on hypertension, plant use, and nutrition in Haiti. The survey used a two-stage stratified sampling design across all 10 departments, with household listing in selected census tracts and inclusion of all resident adults. We estimated weighted prevalences and 95% confidence intervals (CI) for self-rated health, vision and mobility limitations, hypertension, diabetes, psychosocial stress, food insecurity, water insecurity, and underweight (BMI < 23 kg/m²). Multivariable logistic and multinomial logistic regression models assessed associations with age, sex, marital status, rural residence, household socioeconomic status, and residence in areas classified as unsafe due to armed-group control. Analyses accounted for clustering at the household level.</p><p><strong>Results: </strong>Older adults experienced substantial multiple burdens. Poor self-rated health was reported by 29.9% (95% CI 26.3-33.8), vision impairment by 42.3% (95% CI 37.8-46.9), mobility limitation by 27.3% (95% CI 23.3-31.7), and high stress by 31.0% (95% CI 26.8-35.6). Hypertension affected 62.5% (95% CI 57.8-66.9) and diabetes 16.6% (95% CI 13.1-20.7). Food insecurity reached 53.0% (95% CI 48.3-57.6), water insecurity 28.4% (95% CI 24.1-33.2), and underweight status 60.5% (95% CI 55.7-65.2). Older age predicted poorer health, functional limitations, and stress. Women had higher odds of hypertension (OR 1.8, 95% CI 1.45-2.32) and tended toward worse functional outcomes. Rural residence was associated with poorer self-rated health (OR 1.9, 95% CI 1.46-2.47) and higher food insecurity, while higher socioeconomic status and living with a partner were partially protective. Residence in unsafe areas was linked to higher stress, hypertension, and food insecurity. Supplementary sex-stratified models suggested broadly similar patterns across men and women, although some associations differed in magnitude.</p><p><strong>Conclusions: </strong>Aging in Haiti is characterized by a high burden of chronic disease, functional impairment, and basic-need deprivation, patterned by sex, place, and household resources. These findings highlight the urgency of developing integrated chronic care, robust social protection, and food and water security policies that explicitly prioritize older adults in fragile health systems.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13390292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147981727","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":"Evaluating the healthcare access of Syrians in Turkey: a mixed-method analysis.","authors":"Simon Ruhnke, Laura Hertner, Sibel Karadağ","doi":"10.1186/s12939-026-02868-1","DOIUrl":"10.1186/s12939-026-02868-1","url":null,"abstract":"<p><strong>Background: </strong>Turkey hosts one of the world's largest refugee populations, making refugee healthcare access a significant public health challenge and a contested policy issue. While Turkey provides free healthcare services to Syrians under Temporary Protection Status (TPS), scholarly debate continues regarding whether health equity has been achieved. Some studies suggest potential overutilization of services, while others identify persistent barriers to equitable access, particularly for Syrians without formal protection status.</p><p><strong>Methods: </strong>This mixed-methods study employed a sequential design combining quantitative and qualitative data. The quantitative component analyzed household survey data from 2,497 face-to-face interviews (1,258 Syrian and 1,239 Turkish respondents) across 20 Turkish provinces in 2022. Healthcare utilization was measured through doctor visits and emergency department visits in the previous 12 months. The qualitative component included 20 semi-structured interviews with Syrians in Istanbul and Gaziantep conducted in 2023-2024, capturing diverse registration statuses and ethnic backgrounds. The analysis was guided by the Behavioral Model of Health Service Use, examining predisposing, enabling, and need factors affecting access to healthcare.</p><p><strong>Results: </strong>The quantitative analysis revealed no significant difference in predicted doctor visits between Syrian (79.8%) and Turkish (80.8%) respondents. However, Syrians showed significantly lower probability of emergency department utilization (25.4% vs. 31.75%). Among Syrians, income was a significant predictor of emergency care use, while Turkish proficiency and longer duration of stay were associated with increased healthcare utilization. Qualitative findings revealed stark disparities based on registration status: registered Syrians in their province of registration reported satisfaction with healthcare access, while those facing registration obstacles experienced severe barriers. Those with registration obstacles relied on expensive private care or informal Syrian clinics, creating distinct healthcare access hierarchies determined by legal status and economic resources.</p><p><strong>Conclusion: </strong>While Turkey's policy framework appears successful for registered Syrians residing in their provinces of registration, significant inequities persist. The restrictive TPS registration system creates a vulnerable subpopulation largely excluded from equitable healthcare access, particularly hospital care. Recent intensification of migration enforcement has exacerbated these disparities, indicating how migration policies directly undermine health equity. Rather than overutilization, the study found underutilization of emergency services by Syrians, contradicting popular narratives about refugee healthcare burden.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13214083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147981710","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":"\"Ich verstehe es nicht\": the necessity of integrating professional interpretation into the German healthcare system.","authors":"Hsin-Yu Lo, Silvia Copes, Connie Hoe","doi":"10.1186/s12939-026-02874-3","DOIUrl":"10.1186/s12939-026-02874-3","url":null,"abstract":"<p><p>The migrant and refugee population in Germany continued to grow over the past few years, reaching a record high in 2024. As the second top destination, just after the United States, Germany has yet to incorporate professional interpretation into its healthcare system to overcome language barriers. While community integration is important for migrants to find a sense of belonging, communicating critical and even urgent information regarding one's health in an unfamiliar language can have dire consequences. Under the International Human Rights Law, the government has an obligation to provide rights to healthcare for everyone living in the region. However, without an explicitly stated law that obligates the use of professional interpretation services, patients may experience more medical errors while providers and interpreters face additional work burden. Thus, we urge for the legal and structural integration of professional interpretation in healthcare, funded by the state or by health insurances.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13182003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147972229","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":"Moving beyond good intentions: a qualitative study exploring healthcare professionals' perspectives on delivering equitable prenatal testing in the English NHS.","authors":"Michelle Peter, Clotilde Abe, Agnes Agyepong, Atinuke Awe, Rachael Buabeng, Morgan Daniel, Jane Fisher, Sasha Henriques, Kerry Leeson-Beevers, Lyn S Chitty, Melissa Hill","doi":"10.1186/s12939-026-02871-6","DOIUrl":"10.1186/s12939-026-02871-6","url":null,"abstract":"<p><strong>Background: </strong>Prenatal testing (prenatal screening and diagnostic testing) is a central component of prenatal care in the UK. Healthcare professionals (HCPs) play a key role in guiding parents through the testing pathway. Against a backdrop where Black and racially minoritised parents are disproportionately impacted by maternal health inequalities, little is known about how HCPs working in prenatal testing services navigate the delivery of equitable care in everyday practice. Understanding HCP perspectives is essential, especially as prenatal testing technology advances.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with 30 HCPs who deliver prenatal testing across England. Interviews explored experiences of discussing prenatal testing with parents from Black and racially minoritised backgrounds, influences on delivering equitable care, and views on service improvement. Data were analysed using codebook thematic analysis informed by Critical Race Theory to examine how structural factors shaped practice.</p><p><strong>Results: </strong>HCPs valued equitable care, making deliberate efforts to support parents' varying needs. However, four interrelated themes highlighted constraints on equitable delivery: unequal starting points for parents entering testing discussions; uneven clinical confidence and knowledge of genetics across the workforce; variability in support for culturally sensitive care; and reliance on informal, individual labour to address gaps in service design. These dynamics meant that equitable care was often pursued through personal adaptation rather than consistently supported systems.</p><p><strong>Conclusions: </strong>Providing equitable care cannot rely on individual effort. System-level investment in clinical education, service design, and organisational cultures that support culturally sensitive care is needed. With the expansion of prenatal genomics, addressing these structural conditions will be essential for ensuring the benefits of prenatal testing are realised equitably.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13339345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147929127","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":"'They don't see us to be sexual beings': barriers to sexual intimacy and reproductive rights among women with disabilities in northern Ghana.","authors":"John Kuumuori Ganle, Charlotte Ofori, Edward Akolgo Adimazoya","doi":"10.1186/s12939-026-02855-6","DOIUrl":"10.1186/s12939-026-02855-6","url":null,"abstract":"<p><strong>Background: </strong>Worldwide, women with disabilities experience more difficulty realising sexual intimacy and their reproductive rights compared to those without disability. However, contextual empirical evidence on specific barriers to sexual intimacy and reproductive rights in Sub-Saharan Africa is scant. The purpose of this study was to explore the barriers to achieving sexual intimacy and reproductive rights among women with disabilities in northern Ghana.</p><p><strong>Methods: </strong>A descriptive phenomenological qualitative study was conducted in Northern Ghana. A total of 77 reproductive-aged women with disabilities were purposively selected and individually interviewed. Thematic content analysis technique was used to analyse and present the data.</p><p><strong>Results: </strong>Women with disabilities encountered seven intersectional barriers to realising sexual intimacy and reproductive rights depending on disability type. These included negative public perception that women with disabilities are not sexually attractive; mobility challenges which limit opportunities for meeting potential sexual partners; lack of social support; fear that women with disabilities may give birth to children with disabilities; stereotypes that women with disabilities may not fulfil their mothering roles; limited access to reproductive health information and services; and the fact that they are often not believed in cases where they complain about sexual abuse.</p><p><strong>Conclusion: </strong>Public education about the sexuality and reproductive rights of women with disabilities is needed. Improvement in access to physical healthcare infrastructure as well as to essential reproductive health information and services would also be critical in helping WWDs realise their reproductive rights.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13335387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147929156","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}