International Journal for Equity in Health最新文献

{"title":"Implementing integrated mental health and substance use disorder services in Indian primary care: a multi-state CFIR-based qualitative study.","authors":"Abhishek Ghosh, Yatan-Pal-Singh Balhara, Neha Dahiya, Ajay-Parsottamdas Chauhan, Limalemla Jamir, Anindo Majumdar, Arpit Parmar, Johnson-Pradeep Ruben, Chirag Parmar, Renjith-R Pillai, Anshika Chaudhry, Ramakrishna Bhooma Goud, Ashoo Grover, Debadatta Mohapatra, Sharad Philip, Roshan Fakirchand Sutar, Blessy B George, Pragyapti Malav, Debasish Basu, Shankar Prinja, Nagma Imam, Manju Mehra, Kashish Ranchan, Manya Shukla, G V Aishwarya, Aakanxa Naik, Priyambada Bhagawati, Riya Kaur Bhatia, Deeptiben Bhatt, Deepti Dabar, Subhra Mallisha, Tamanna Nasrin, Salinee Panda, Supriya Shivashankar, Gunjan Singh, Deeksha Vazalwar, Pulkit Verma","doi":"10.1186/s12939-026-02986-w","DOIUrl":"10.1186/s12939-026-02986-w","url":null,"abstract":"<p><strong>Background: </strong>Integrating mental health & substance use disorders (MSUDs) care into other NCDs remains a priority for bridging India's wide treatment gap. While national programs such as District Mental Health Programme and Ayushman Bharat have laid foundational pathways, translating policy into everyday practice continues to face substantial challenges. This study explored how mental health services are being implemented across seven Indian states, using the Consolidated Framework for Implementation Research (CFIR) to unpack the multilevel factors influencing sevice delivery.</p><p><strong>Methods: </strong>We undertook a qualitative implementation study in Assam, Gujarat, Haryana, Karnataka, Madhya Pradesh, Odisha, and Punjab. The data included 211 in-depth interviews and 28 focus group discussions across seven states for the following cadres: medical officers (MO), community health officers (CHOs), Accredited Social Health Activists (ASHA), nurses, clinical psychologists, patients, caregivers, and policymakers. A combination of CFIR framework-guided and inductive thematic analysis was used to generate both cross-cutting and site-specific insights.</p><p><strong>Results: </strong>While most respondents supported mental health integration in principle, they reported barriers such as strained frontline capacities, absence of structured protocols, stigma-related avoidance, limited availability of medicines and inconsistent referral pathways. Training uptake was uneven, and consultation times were often too brief to manage mental health needs effectively. However, promising practices were identified, e.g. Gujarat's \"Therapeutic Thursdays,\" Haryana's use of teleconsultation, and community mobilization efforts in Odisha and Assam. Increased Workload, lack of mental health-specific incentives, and digital infrastructure gaps were common challenges. Engagement from local champions (Individuals who dedicate themselves to supporting, marketing, and 'driving through' an implementation) was perceived to help adress structural gaps, but was rarely systematized.</p><p><strong>Conclusion: </strong>This study highlights how integration efforts are shaped by the depth of contextual dynamics. Strengthening digital tools, clarifying referral pathways , and reinforcing the health workforce through supervision and incentives are urgent priorities.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov - CTRI/2024/08/072748, registered on 20th August 2024, ( http://ctri.nic.in ).</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13576301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976724","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":"\"Not only standing for, but standing up for diversity\": an intersectional qualitative analysis of how university students embody and resist discrimination.","authors":"Laura Pilz González, Christina Prediger, Christiane Stock, Hürrem Tezcan-Güntekin, Katherina Heinrichs","doi":"10.1186/s12939-026-03003-w","DOIUrl":"10.1186/s12939-026-03003-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Universities are key social institutions that shape student health, wellbeing, and future trajectories. However, they are also embedded in, and contribute to, existing social inequities. Students holding marginalised positions consistently report experiences of discrimination within higher education. Such experiences adversely affect their mental health, sense of belonging, and academic trajectories. Much of this research relies on single-axis analyses, failing to capture the complexity of discrimination. Therefore, this study takes an intersectional, qualitative multi-level approach to explore how university students in Germany experience discrimination during their studies and how this shapes their mental health and wellbeing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Fifteen semi-structured, problem-centred interviews were conducted with university students who reported experiencing discrimination. Data were qualitatively analysed using the Intersectional Multilevel Analysis (IMA) framework by Winker and Degele, linking individual meaning-making and self-positioning to symbolic representations and social structures. Our approach combined inductive reconstruction of students' self-positionings with deductive contextualisation of how discrimination operates across interpersonal, institutional, and structural levels.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Students experienced discrimination as an embodied process shaped by microaggressions, institutional rigidity, and unequal power relations - particularly within student-lecturer dynamics. These dynamics involved intersecting forms of inequity, including racism, sexism, xenophobia, classism, language-based exclusion, ableism, caregiving discrimination, and ageism, experienced not as isolated categories but as overlapping, context-dependent processes. Participants described how the experienced discrimination settled into the body through emotional, cognitive, and physical manifestations expressed as fear, anger, exhaustion, and burnout, accompanied by existential questioning and disrupted identities. These embodied effects were not isolated reactions but ongoing responses to inequity. Alongside these harms, students exercised agency through strategies of endurance, withdrawal and resistance as forms of embodied survival work in response to persistent inequities. Overall, discrimination emerged as a relational and institutional process involving fluid interpersonal dynamics and contextual negotiations through which students' academic trajectories and relationships to power are continuously (re)produced.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Discrimination in higher education must be recognised as not only a social issue, but also a critical public health concern determining students' mental health and wellbeing. Addressing its embodied consequences demands institutional accountability and policies that move beyond symbolic diversity rhetoric toward meaningful structural and cultural tra","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906198","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 while caregiving: a life course qualitative study of left-behind older parents caring for adult children with schizophrenia in rural China.","authors":"Yubing Chen, Sheng Bao","doi":"10.1186/s12939-026-03015-6","DOIUrl":"10.1186/s12939-026-03015-6","url":null,"abstract":"<p><strong>Background: </strong>Older adults left behind in rural areas due to large-scale migration often serve as the primary caregivers for their adult children with schizophrenia. This study explores their long-term caregiving experiences, focusing on how caregiving responsibilities are distributed within families, how older caregivers find meaning in their role, and how sustained caregiving reshapes their expectations about aging and death.</p><p><strong>Methods: </strong>Using a life course perspective, this study conducted semi-structured in-depth interviews with 14 older caregivers in rural Fujian Province, China. Data were analyzed by two researchers using reflexive thematic analysis.</p><p><strong>Results: </strong>Three core themes were identified. First, older adults' assumption of caregiving responsibilities was the outcome of a family-level division of labor and compromise, driven by the need to sustain the household's livelihood. Second, the illness of an adult child interrupted that child's expected social development and independence, compelling older parents to continue intensive caregiving instead of stepping back from family responsibilities in later life, and they drew on fatalistic beliefs to find meaning in this disrupted trajectory. Third, declining physical capacity exacerbated concerns about losing the ability to provide care, while anxiety about care continuity after death led some caregivers to develop unconventional expectations about the order of death.</p><p><strong>Conclusions: </strong>These findings show that long-term caregiving responsibility for people with schizophrenia in rural China falls mainly on older parents, which points to the need for a sustainable community support system that fairly distributes caregiving responsibility among families, communities, and public services.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911887","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":"Born to clean? Caste, occupation and health - an exploration among sanitation workers in Dindigul, Tamil Nadu, India.","authors":"K Vigneshwaran, C Krishnendhu, Rakhal Gaitonde","doi":"10.1186/s12939-026-02963-3","DOIUrl":"10.1186/s12939-026-02963-3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Sanitation work in India remains concentrated among the Scheduled Castes despite constitutional protections and modernisation. Although this concentration is widely recognised, it has not been systematically incorporated into empirical analyses examining the mechanisms through which caste operates. This paper also describes the development of variables that aim to go beyond mainstream descriptive variables. It specifically examines the association between intergenerational occupational continuity and mental health outcomes (depression, anxiety, and stress) among sanitation workers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cross-sectional survey of 243 sanitation workers was conducted in Dindigul Municipal Corporation, Tamil Nadu, January-February 2025. Based on initial meetings and discussions with sanitation workers, as well as a review of the literature, measures were developed to capture the experiences of intergenerational sanitation work and of continuing in sanitation. Structured interviews collected data on parental and grandparental occupations, desire to leave sanitation work, and mental health outcomes assessed using the Depression, Anxiety, and Stress Scale (DASS-21). Bivariate analysis was used to screen covariates; multivariable binary logistic regression was then fitted for each outcome. Full bivariate tables are provided as Supplementary Material.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Nearly half (49.8%) reported both parents and grandparents in sanitation work; 64.2% had at least one parent in sanitation. Among those with parents in \"other\" occupations, employment remained confined to precarious manual labour - wage labour (44.8%), agriculture (21.8%), and casual loading (14.9%) - with no formal employment across generations. While 74.5% cited family tradition as the reason for entering sanitation work, 66.7% expressed a desire to leave if given alternative opportunities, and 69.5% explicitly attributed their entry into the job to their caste \"background.\" Workers from multi-generational sanitation families were significantly more likely to have severe or extremely severe depression (adjusted OR [AOR] = 3.59, 95% CI: 1.95-6.80, p &lt; 0.001, adjusted for tobacco use) and severe or extremely severe anxiety (AOR = 10.8, 95% CI: 3.65-46.4, p &lt; 0.001). For stress, intergenerational occupational status was not an independent predictor in multivariable analysis; stress was significantly and independently predicted by alcohol use (AOR = 20.5, 95% CI: 8.18-58.3) and tobacco use (AOR = 24.5, 95% CI: 10.1-67.9), suggesting its burden is channelled through substance use patterns rather than occupational inheritance directly.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Sanitation work functions as a caste-bound occupation marked by intergenerational continuity and severely constrained intergenerational mobility. Intergenerational occupational status, as measured by a variable developed through a bottom-up process, independently predic","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864088","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":"Determinants of health literacy in early childhood care among marginalized ethnic communities: a cross-sectional study in three border provinces of Thailand.","authors":"Nathamon Wutthipan, Kunnara Maneekunwong, Pimkanabhorn Trakooltorwong, Srisuluk Kietmaneerat, Chuntana Reangsing, Khanittha Pitchalard, Salisa Kodyee, Katemanee Moonpanane","doi":"10.1186/s12939-026-02990-0","DOIUrl":"10.1186/s12939-026-02990-0","url":null,"abstract":"<p><strong>Background: </strong>Early childhood development metrics remain substandard among marginalized ethnic minority communities in three border provinces of Thailand. This study evaluated the levels and determinants of health literacy (HL) among primary caregivers to contextualize its role in mitigating adverse child health outcomes.</p><p><strong>Methods: </strong>A community-based, cross-sectional correlational study employing multi-stage cluster random sampling was conducted between July and October 2024. Sample size was determined using an a priori power analysis for multiple linear regression (f² = 0.05, α = 0.05, power = 0.80, 19 predictors), yielding a minimum of 351 participants; 380 caregivers were enrolled. Data were collected using the validated 61-item Parental Health Literacy Scale assessing five HL domains. Multiple linear regression with simultaneous variable entry identified independent determinants of overall HL.</p><p><strong>Results: </strong>Among the 380 participants, the largest ethnic group was Thai-Yai (23.95%), followed by Thai-Lue (19.74%), Hmong (19.21%), Akha (17.37%), Lahu (14.47%), Chinese-Yunnan (3.95%), Lee-Soo (1.05%), and Yao (0.26%). Caregivers demonstrated moderate health literacy in the functional, cognitive, critical, and behavioral domains, but exhibited low proficiency in the interactive domain (communicating care needs), resulting in a moderate overall composite score (135.04/199 = 67.9%). Multiple linear regression demonstrated that interpersonal professional support, specifically nurse-led counselling, strongly predicted health literacy proficiency (B = 9.318, p = 0.027). Other significant predictors included receiving information from provincial hospitals (B = 9.013, p = 0.030) and early childhood development centers (B = 7.531, p = 0.032), perceived financial adequacy (B = 3.470, p = 0.013), formal educational attainment (B = 3.064, p = 0.007), and parity (B = 3.252, p = 0.006), identifying primigravida caregivers as a vulnerable demographic.</p><p><strong>Conclusions: </strong>Nurse-led counselling, institutional health support from provincial hospitals and early childhood development centers, formal educational attainment, and parity are the primary modifiable determinants of HL in this population. Public health interventions must prioritize face-to-face, culturally congruent caregiver education delivered through dual-tiered institutional networks, with targeted support for first-time mothers.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13573410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148968258","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":"A critical reflection on community engagement in health equity research: translating principles into practice, navigating barriers, and compiling transferable lessons.","authors":"Hridaya Raj Devkota, Kul Shrestha, Sangita K Ram, Chandani Jha, Rakshya Khadgi","doi":"10.1186/s12939-026-02979-9","DOIUrl":"10.1186/s12939-026-02979-9","url":null,"abstract":"<p><strong>Background: </strong>Community and stakeholder engagement is widely recognized as essential for equity-oriented health research, yet evidence on how engagement principles are enacted within stratified contexts remains limited. Existing studies often emphasize participatory processes without examining how institutional conditions shape engagement quality and outcomes. Empirical analyses linking engagement practice to equity-relevant research effects are needed.</p><p><strong>Aim: </strong>This study examined how principles of inclusivity, reciprocity, social justice, and reflexivity were operationalized within a community-engaged maternal health equity study.</p><p><strong>Methods: </strong>A qualitative, theory-informed reflection design was employed within a health equity research project conducted in Madhesh Province of Nepal. Data sources included engagement activities with community and stakeholder participants, structured researcher debriefs, and a facilitated reflexivity workshop. Analysis followed a conceptual framework emphasizing engagement principles, structural mediation, reflexive practice, and proximal outcomes. Data were synthesized through iterative thematic analysis and integrative interpretation across evidence sources.</p><p><strong>Results: </strong>Engagement contributed to trust and transparency through iterative interaction and locally embedded facilitation. Community participation supported the contextual validity of findings by providing experiential knowledge that informed the analytical interpretation of inequities. Reflexive practice enabled adaptive implementation but was unevenly applied, often constrained by institutional timelines, resource limitations, and sociocultural hierarchy. Engagement influenced study design and interpretive framing, contributing to partial redistribution of epistemic authority while remaining structurally bounded. These dynamics illustrate engagement as a negotiated practice shaped by relational positioning and institutional context.</p><p><strong>Conclusion: </strong>Equity-oriented engagement can function as a relational and reflexive mechanism that supports more justice-oriented knowledge production. However, meaningful participation may require institutional conditions that support relational infrastructure, flexible implementation, and reflexive governance. Embedding these conditions within research systems is important for advancing equity-oriented health research practice.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880324","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 service disruptions under economic sanctions: evidence from Iran.","authors":"Shiva Malgard, Mahnaz Afshari, Seyyed Amir Yasin Ahmadi, Leila Doshmangir, Mohsen Asadi-Lari","doi":"10.1186/s12939-026-02987-9","DOIUrl":"https://doi.org/10.1186/s12939-026-02987-9","url":null,"abstract":"<p><strong>Background: </strong>Unilateral economic sanctions are increasingly recognized as factors associated with structural determinants of health, yet their implications for health service delivery require in-depth examination. In Iran, these pressures appear to extend beyond medicine shortages to affect financing, procurement, infrastructure, workforce capacity, and continuity of care.</p><p><strong>Main body: </strong>This policy commentary offers an in-depth analysis of how economic sanctions influence health service delivery in Iran, drawing upon a synthesis of existing literature and expert understanding of the Iranian context. The analysis highlights how sanctions may be linked to disruptions in multiple dimensions of service provision. Reported effects include weakened preventive and immunization services, fiscal and administrative pressures on health institutions, workforce constraints, reduced access to medical equipment and technologies, and diminished patient access to care. These pressures are associated with undermining procurement stability, delay service provision, increase waiting times, and exacerbate existing inequities, particularly in underserved populations and regions.</p><p><strong>Conclusion: </strong>Economic sanctions appear to act as profound structural pressures on Iran's health system, which may weaken its financial, organizational, and operational capacity. Strengthening health system resilience and safeguarding equitable access to essential services, informed by the challenges identified in this analysis, should therefore be central to policy and humanitarian responses.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13483838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792570","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":"The competition and cooperation mechanism of policy goals in China's diagnosis-related group: a quantitative analysis based on the BERTopic and Lotka-Volterra models.","authors":"Yuqi Zang, Siyu Li, Yanli Han","doi":"10.1186/s12939-026-02978-w","DOIUrl":"https://doi.org/10.1186/s12939-026-02978-w","url":null,"abstract":"<p><strong>Background: </strong>Aiming at the practical problems such as upcoding and decomposing hospitalizations emerging in China's Diagnosis-Related Group (DRG) reform, existing studies mostly attribute such issues to aspects like behavioral motivations, which fail to explain the root causes of the problems.</p><p><strong>Methods: </strong>This paper takes policy goals as the research starting point and constructs a three-dimensional analytical framework of \"identifying goals-quantifying relationships-explaining mechanisms\". Based on 377 DRG policy texts covering the central, provincial and municipal levels from 2009 to 2025, this study employs the BERTopic model to identify the policy goals of three phases in turn, visualizes the evolutionary characteristics of the goals through Jaccard similarity analysis, and introduces the Lotka-Volterra model to quantify the competitive and cooperative coefficients among the six major policy goals in the national promotion phase, further classifying their relationships into three types: cooperation, predation and competition.</p><p><strong>Results: </strong>The study finds that the policy goal system of China's DRG reform presents an evolutionary law from fragmented advancement to systematic improvement, with healthcare insurance fund management and controlling healthcare fees as the core thread running through all three phases. The six major policy goals in the national promotion phase are improving primary healthcare levels (G1), standardizing diagnosis and treatment behaviors (G2), controlling healthcare fees (G3), raising the use efficiency of fund (G4), enhancing service quality (G5), and reflecting the technical value of healthcare personnel (G6), among which there exist 6 groups of cooperative relationships, 5 groups of predatory relationships and 4 groups of competitive relationships. Specifically, G5 and G6 exhibit a prominent synergistic effect, while G5 is subject to the triple squeeze from G2, G3 and G4, and G1 is in a competitive relationship with G2, G3 and G4 respectively.</p><p><strong>Conclusions: </strong>From the perspective of policy design, this study reveals that the structural contradictions among DRG policy goals may induce healthcare institutions and healthcare personnel to adopt strategic behaviors under the pressure of multiple goals. This research provides a theoretical basis for optimizing DRG policy design and promoting goal coordination, and also offers reference significance for DRG reforms worldwide.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181707","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":"From knowledge accumulation to transformative action: research to catalyze progress on social determinants of health equity.","authors":"Julia Berenson, Robert Marten, Wenhui Mao, Debashis Basu, Monika Kosinska, Andrew Cassels, Gavin Yamey, Kumanan Rasanathan","doi":"10.1186/s12939-026-02900-4","DOIUrl":"10.1186/s12939-026-02900-4","url":null,"abstract":"<p><p>Despite three decades of expanding scholarship on social determinants of health (SDH), progress in reducing health inequities has remained limited. While the SDH framework has reshaped global health discourse and informed policy rhetoric, the translation of knowledge into transformative action has been insufficient. The gap between evidence and impact is not explained by political constraints alone but is also contributed to by the orientation, methods, and practices of SDH research itself. We identify key limitations in what is studied, how research is conducted, and who leads knowledge production. Thematic gaps include the dominance of descriptive research, limited evidence on effective policy interventions, insufficient engagement with structural determinants and political economy, and underdeveloped attention to emerging drivers such as climate change, digitalization, and commercial determinants. Methodological limitations include underuse of policy, implementation, modelling, and participatory approaches, alongside persistent data gaps. Deficiencies in research practice constrain the transformative potential of SDH scholarship, including a lack of multi-disciplinary work, limited community and policymaker engagement and leadership, and inequitable power dynamics in global health research itself. We propose a reorientation of SDH research toward agency and action with greater focus on solutions and implementation pathways, methodological pluralism, multisectoral and participatory knowledge production, improved communication and policy engagement, and reforms to research incentives, funding and governance. By repositioning SDH research as an active contributor to political and institutional change, researchers can more effectively support equitable and sustainable health outcomes in a global context increasingly inhospitable for attention to health equity.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13465890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148723385","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":"\"I don't like fitting a box, except the box I am\": genderqueer and nonbinary (GQNB) patient strategies for navigating healthcare.","authors":"Shanaya Sidhu, Jennifer T Anger, Victor Trasvina, Falisha Kanji, Kyle Okamuro, Sunny Mangiameli, Alan J Card, Tara Cohen, Hanna J Barton","doi":"10.1186/s12939-026-02906-y","DOIUrl":"10.1186/s12939-026-02906-y","url":null,"abstract":"<p><strong>Background: </strong>While genderqueer and nonbinary (GQNB) people comprise a significant percentage of the transgender community, very little research has explored the unique experiences and needs of GQNB patients. A critical challenge faced by GQNB patients is the degree to which health systems operate inside of a gender binary-as evidenced by the design of health technologies, organizational policies, and culture. Understanding how GQNB patients navigate health systems as they currently exist may give us insight into how to improve the design of those systems. This study aimed to identify GQNB patient strategies for navigating care.</p><p><strong>Methods: </strong>As part of the TRANS-SAFE study aimed at identifying system contributors to psychosocial safety of transgender and nonbinary patients, we conducted semi-structured interviews with GQNB patients (n = 21) and clinicians who care for GQNB patients (n = 23). We performed a deductive content analysis of the transcripts, applying a Human Factors Engineering-based work system model-The Systems Engineering Initiative for Patient Safety 2.0-and then reviewed coded excerpts to identify patient strategies, defined as \"any dynamic response to perceived work system barriers to, or facilitators of, timely and effective performance of effortful work activities in pursuit of the patient's health goals.\" Strategies were summarized and grouped by \"type\" and \"purpose\" through an iterative, team-based process and work system barriers for each strategy were identified.</p><p><strong>Results: </strong>We identified four types of strategies that GQNB patients employed. These strategies included (1) \"satisficing\" (i.e., accepting a solution, even if unideal, that sufficiently satisfies one's minimum requirements) around care, (2) leveraging tools/technologies or GQNB community expertise, (3) adjusting their behavior, and (4) taking ownership of their care. GQNB patients used strategies for five different purposes: (A) accessing care, (B) interacting with the health system broadly, (C) interacting with clinicians, (D) navigating clinical settings, and (E) interacting with the EHR.</p><p><strong>Conclusions: </strong>GQNB patients use a variety of strategies to ensure they receive appropriate and affirming care. These strategies point to the goals and needs of GQNB patients, yet primarily represent an attempt to receive the bare minimum in person-centered care. In fact, these strategies characterize patient work that is harmfully burdensome for this population. Studying the strategies leveraged by GQNB patients gives us insight into how we might improve health care for all patients.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13465386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725506","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}