International Journal for Equity in Health最新文献

{"title":"Correction: Applications of equity frameworks in theory-based health behavior interventions: a scoping review.","authors":"Katherine S Gallagher, Kristefer Stojanovski, Kristen Ogarrio, Laura Wright, Melissa Fuster, Caryn N Bell","doi":"10.1186/s12939-025-02517-z","DOIUrl":"10.1186/s12939-025-02517-z","url":null,"abstract":"","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"142"},"PeriodicalIF":4.5,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101810","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":"Who pays more? Exploring cost disparities in medication abortion access across socio-demographic groups in Ghana.","authors":"Caesar Agula, Yuliya A Kulikova, Omkar Patange, Adriana Biney, Michael Kuhn, Pearl Kyei, Patrick Asuming, Ayaya A Bawah","doi":"10.1186/s12939-025-02500-8","DOIUrl":"10.1186/s12939-025-02500-8","url":null,"abstract":"<p><strong>Background: </strong>Medication abortion (MA) may be accessed covertly in private pharmacies and clinics due to abortion-related stigma. Stigmatization may lead to information asymmetry, resulting in price discrimination. The existing literature on abortion in Ghana has primarily focused on factors associated with abortion stigma. However, the potential variations in MA cost have not been explored. Thus, we aim to explore the potential disparities in MA cost based on women's socio-demographic status in Ghana.</p><p><strong>Methods: </strong>We used data from a study that recruited women who accessed MA using mifepristone and misoprostol combination from selected private pharmacies and clinics in Ghana. The study employed a non-inferiority and prospective design, and women were recruited as they exited the selected facilities after obtaining the MA pills. Our final analysis included 929 pharmacy clients and 1,045 clinic clients. To understand the variability in MA cost, we initially conducted two decomposition analyses using the variance and Blinder-Oaxaca techniques, followed by linear regressions to identify the socio-demographic factors that predict MA cost.</p><p><strong>Results: </strong>The average costs of MA were approximately US$ 46.00 and US$ 24.00 for the clinic and pharmacy groups, respectively. Additionally, the cost varied between pharmacy and clinic groups and within each group. A greater segment of the variation among the clinic group stemmed from between facilities (78 percent), whereas, among the pharmacies, the bigger share came from within facilities (57 percent). Regression results further indicate that the cost of MA increased among women with higher education, those who have not been in a union with a partner and those who accessed MA in clinics.</p><p><strong>Conclusions: </strong>MA cost in Ghana is largely based on providers' discretion and at the facility's management level. Additionally, the cost differs by women's socio-demographic attributes. To reduce the disparities in MA costs, developing guidelines to address the health system challenges regarding MA provision and access is important. Educational programs on MA access, provision and legal framework could also reduce abortion-related stigma and cost variations.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"144"},"PeriodicalIF":4.5,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101831","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":"Frequency of interpersonal discrimination experiences - differences between inpatient and outpatient care and associations with delayed and forgone care.","authors":"Olaf von dem Knesebeck, Demet Dingoyan, Anna Makowski, Jens Klein","doi":"10.1186/s12939-025-02512-4","DOIUrl":"10.1186/s12939-025-02512-4","url":null,"abstract":"<p><strong>Background: </strong>While the number of studies investigating the magnitude, reasons, and possible consequences of perceived discrimination in health care is growing, many of these studies do not differentiate between structural and interpersonal discrimination in health care. The latter rests upon stereotypes and takes place in direct interactions between the health care provider and the patient. In this study, we explore the frequency and main reasons of different interpersonal discrimination experiences in inpatient and outpatient care in Germany and associations of discrimination with delayed and forgone care.</p><p><strong>Methods: </strong>Analyses were based on an online survey among the adult population in Germany (N = 3,246). A modified version of the Everyday Discrimination Scale was used to assess interpersonal discrimination experiences in inpatient and outpatient care. For each of the experiences, the main reason(s) for discrimination was ascertained. Indicators of delayed and forgone care referred to necessary doctor visits in the last 12 months.</p><p><strong>Results: </strong>Analyses revealed that two thirds (66%) of the respondents reported at least one of five experiences in inpatient or outpatient care. The experience that people in health care acted as if they were better than oneself was reported most frequently (41.3% in outpatient care and 27.7% in inpatient care). All discrimination experiences were significantly more frequent in outpatient care than in inpatient care. Age and health insurance were the most frequently reported reasons for the discrimination experiences. There was a significant association of the frequency of interpersonal discrimination experiences with delayed and forgone care.</p><p><strong>Conclusions: </strong>Experiences of interpersonal discrimination in health care were a frequent phenomenon in Germany and were significantly associated with unmet need. Such experiences must be considered an important issue for public health. Possible interventions to tackle discrimination include measures to reduce stereotypes and the abolition of the dual structure of statutory and private health insurance.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"139"},"PeriodicalIF":4.5,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093465","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 impact COVID-19 pandemic on coverage and inequalities in childhood immunization in Peru.","authors":"Larissa A N Silva, Francine S Costa, Bianca O Cata-Preta, Luis Huicho, Claudio F Lanata, Maria Ana Mendoza Araujo, Theresa J Ochoa, Tewodaj Mengistu, Dan Hogan, Aluisio J D Barros, Cesar G Victora","doi":"10.1186/s12939-025-02505-3","DOIUrl":"10.1186/s12939-025-02505-3","url":null,"abstract":"<p><strong>Background: </strong>We examined the impact of COVID-19 on childhood immunization coverage and inequalities in Peru, focusing on pentavalent, rotavirus, and pneumococcal (PCV) vaccines. Since the 1990s, Peru has worked to improve childhood vaccine coverage, but the COVID-19 pandemic posed significant challenges to the health system.</p><p><strong>Methods: </strong>We analysed data from nationally representative health surveys conducted annually between 2015 and 2023. The surveys measured vaccine coverage among children aged 18-29 months, namely three doses for pentavalent and PCV and two doses for the rotavirus vaccine, based on data from home-based records. We studied inequalities at the individual child level using the slope index of inequality (SII) based on household wealth quintiles.</p><p><strong>Results: </strong>In 2019, the home-based record coverage levels for pentavalent, PCV and rotavirus vaccines were 78.0%, 74.5%, and 75.9%, respectively. In 2020, these rates dropped significantly due to pandemic disruptions: PCV and pentavalent coverage fell by 14% points, and rotavirus by 12 points. By 2021, coverage levels improved, returning to pre-pandemic rates by 2022 and 2023. Individual-level analyses showed that pro-rich inequalities were present during the full study period, but these increased sharply during the pandemic in 2020, with poorer children experiencing more significant drops in coverage than wealthier children. This trend reversed by 2021 and 2022 when inequality measures returned to pre-pandemic levels. Due to reasons that are still unclear, inequality increased again in 2023. Nevertheless, the confidence intervals for the summary inequality measures are wide and must be interpreted cautiously.</p><p><strong>Conclusions: </strong>The COVID-19 pandemic temporarily disrupted Peru's childhood immunization efforts, particularly affecting poorer populations, but coverage rebounded to pre-pandemic levels by 2022. These findings contribute to the scant literature on the pandemic's impact on vaccine equity.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"138"},"PeriodicalIF":4.5,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078061","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":"Designing accessible and independent living spaces for visually impaired individuals: a barrier-free approach to interior design.","authors":"Anushka Patil, Smruti Raghani","doi":"10.1186/s12939-025-02503-5","DOIUrl":"10.1186/s12939-025-02503-5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Globally, 39 million people are blind, and an additional 246 million experience moderate to severe visual impairment (WHO, 2021). These impairments severely affect navigation, safety, and daily-task performance. Studies show that 70% of individuals with visual impairments face falls annually, and many report challenges with spatial awareness and cognitive load. Adaptive design offers solutions that utilize sensory input, spatial predictability, and barrier-free layouts to address these challenges. This study explores accessible interior design principles to empower visually impaired individuals with greater independence and comfort in their homes. This study investigates the principles of adaptive design in creating safe, independent, and comfortable living spaces for individuals with visual impairments, a condition affecting over 285 million people worldwide, according to the World Health Organization (WHO). The research emphasizes barrier-free environments with unobstructed pathways, tactile and auditory cues, and consistent spatial arrangements to enhance accessibility. By integrating sensory elements like contrasting textures, lighting, and acoustic treatments, the project aims to foster spatial awareness, safety, and autonomy. Engaging visually impaired residents in the design process ensured tailored solutions that empower independence and well-being. The findings highlight the transformative potential of inclusive design in enriching the daily lives of those with visual challenges.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The research involved case studies, user interviews, and participatory design workshops with visually impaired individuals aged between 18 and 75. Key challenges included trip hazards, inconsistent layouts, and sensory overload. Design strategies such as tactile navigation systems, acoustic enhancements, and optimized lighting layouts were tested. Tactile navigation systems use textured flooring, Braille signage, and raised pathways to aid visually impaired individuals. Acoustic enhancements include sound cues, echolocation-friendly materials, and noise reduction techniques to improve spatial awareness. Optimized lighting layouts feature uniform illumination, glare reduction, and adaptive lighting to enhance visibility. These strategies are implemented through tactile paving, contrasting textures, natural sound sources, sound-absorbing panels, motion-activated LEDs, and diffused lighting. Together, they create an accessible environment that enhances safety, independence, and ease of navigation for visually impaired individuals, ensuring a more intuitive and user-friendly spatial experience. Over 80% of participants highlighted the need for tactile and auditory cues to aid navigation. Feedback loops ensured practical and effective outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Implementing adaptive design features resulted in a 40% reduction in reported falls and a 25% decrease in cognitive fatigue during","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"137"},"PeriodicalIF":4.5,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078057","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":"Differences in timeliness, completeness and drop-out rates of MMRV and DTP containing vaccines among Ultra-Orthodox Jews and others in a deprived Northern Israel city: an ecological study.","authors":"Avraham Jacobson, Sivan Spitzer, Michael Edelstein","doi":"10.1186/s12939-025-02504-4","DOIUrl":"https://doi.org/10.1186/s12939-025-02504-4","url":null,"abstract":"<p><strong>Background: </strong>The Ultra-Orthodox Jewish (UO) population has been affected by pertussis, polio, and measles outbreaks. Safed, a deprived, undervaccinated city in Israel's North, has a large UO population concentrated in specific neighborhoods. We determined whether in Safed UO population concentration was associated with DTP- containing and MMRV1 vaccines coverage, timeliness and drop-out rates.</p><p><strong>Method: </strong>For each of Safed's statistical areas, we estimated UO population based on the proportion of votes for UO political parties in Israel's 2020 general elections. We determined whether this proportion was associated with timely and delayed MMRV1 and DTP vaccine coverage for children born 2017-2022 using simple linear regression. We compared DTP and MMRV1 coverage and drop-out rates in UO areas (> 50% vote for UO parties) to others, using chi-square tests.</p><p><strong>Results: </strong>All eligible 4385 children residing in Safed were included in the MMRV1 and DTP analyses. Vaccine coverage was significantly lower in UO areas compared to non-UO for all doses of DTP and MMRV1 at expected age (-11.8, -15.8, -16.6, -11.8 and - 7.1% points (pp) respectively, P < 0.005) - and at 36 months old (-0.5, -3.9, -6.2, -9.3 and - 2% points respectively, P < 0.005). Gaps narrowed more for MMRV1 (from 7.1 to2 pp), than for DTP4 (from 11.8 to9.3 pp). Increasing UO vote was associated with decreased timely coverage for DTP but not MMRV. DTP1-4 drop-out rates were larger in the UO areas than in non-UO areas (26.2% vs. 18%).</p><p><strong>Conclusions: </strong>Vaccine coverage was lower in UO neighborhoods, even in a peripheral city where coverage in non-UO areas is already low. Coverage differences between UO and non-UO populations decreased with time for MMRV1 but not DTP. Our findings suggest timeliness should be considered alongside non-vaccination, and vaccination behavior may be vaccine-specific in the UO population.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"136"},"PeriodicalIF":4.5,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078059","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":"Indigenous Peoples' responses to evacuation for birth in Ontario: conceptualizing risk through an Indigenous midwifery-led approach.","authors":"Erika Campbell, Melanie Murdock, Sarah Durant, Carole Couchie, Carmel Meekis, Charitie Rae, Julie Kenequanash, Lisa Boivin, Jacob Barry, Arthi Erika Jeymohan, Karen Lawford","doi":"10.1186/s12939-025-02491-6","DOIUrl":"10.1186/s12939-025-02491-6","url":null,"abstract":"<p><strong>Background: </strong>Currently, pregnant Indigenous Peoples living in remote, rural, and northern Indigenous communities in Canada are subjected to evacuation birth policy, whereby they are evacuated out of their community to large, urban hospitals to give birth. Evacuation for birth is assumed to decrease biomedical risk because people are birthing in hospitals. In Canadian health systems, evaluating and mitigating biomedical risk has become a standard in health decision-making but this framework disregards Indigenous ontologies and epistemologies that guide Indigenous people in their evaluation of health risk. In this study, we sought to understand how pregnant Indigenous people in Ontario conceptualise health and risk.</p><p><strong>Methods: </strong>We collected data through semi-structured interviews with 43 participants who have been evacuated for birth or are kin of an evacuee who live in Ontario, Canada.</p><p><strong>Results: </strong>Risks associated with evacuation for birth were conceptualised by participants in a wholistic manner based on principles of self-determination. Participants identified multiple risks that shaped their overall assessment of health risk when facing evacuation for birth including the risk of being separated from kin, confronting a lack of health services, and experiencing discrimination. As participants spoke about risk, they reimagined perinatal care to mitigate these risks, which requires bringing birth back to Indigenous communities through Indigenous midwifery.</p><p><strong>Conclusions: </strong>We outline actions to limit the practice of evacuation for birth, support the return of birth to Indigenous communities, and expand understandings of risk within policy and clinical practice.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"135"},"PeriodicalIF":4.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964712","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 impact of a disparity-reduction intervention on outcomes of patients with acute coronary syndrome in the emergency department: a clinical trial.","authors":"Mehdi Moradinia, Sajad Yarahmadi, Mehdi Birjandi, Mohammad Gholami","doi":"10.1186/s12939-025-02496-1","DOIUrl":"10.1186/s12939-025-02496-1","url":null,"abstract":"<p><strong>Background: </strong>Patients with acute coronary syndrome (ACS) who belong to marginalized groups often do not receive equitable treatment and care when they are referred to emergency departments (ED), and this can have negative consequences for these patients. Therefore, this study aimed to evaluate the impact of a disparity-reduction intervention on outcomes of patients with ACS in the ED.</p><p><strong>Methods: </strong>This randomized clinical trial included 264 ACS patients, randomly allocated into intervention (n = 132) and control group (n = 132). The intervention involved improving the triage process by (1) welcoming nurses and (2) conducting specialized triage. Also, a patient navigation (PN) program was implemented, comprising (1) emergency care comprehensive management, (2) supportive education and counseling, and (3) clinical actions with follow-up care. In the control group, standard triage and routine care were provided. Outcomes assessed included pain intensity, patient opinion of pain management, illness perception, threat perception, and short and long-term outcomes.</p><p><strong>Results: </strong>The results showed that after the intervention, pain intensity and threat perception decreased significantly in the intervention group compared to the control group (P < 0.001). Moreover, the opinion of pain management-assessed only post-intervention-was significantly more favorable in the intervention group than in the control group (P < 0.001). Illness perception scores also increased more prominently in the intervention group than in the control group (P < 0.001). Short-term outcomes showed improvement in the intervention group compared to the control group (P < 0.05). Long-term outcomes revealed that the intervention group experienced better results than the control group in specialist visits, exercise stress tests, echocardiography, and readmissions (P < 0.05).</p><p><strong>Conclusion: </strong>Interventions such as improving the triage process and the PN are important in reducing disparities and improving patient outcomes. These findings underscore the effectiveness of tailored strategies in promoting equitable care in ED.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"133"},"PeriodicalIF":4.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984522","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":"Public assistance program and food diversity among older people: a cross-sectional study using the Japan Gerontological Evaluation Study data : Public assistance program and food diversity.","authors":"Kotone Tanaka, Daisuke Nishioka, Atsushi Nakagomi, Keiko Ueno, Kazushige Ide, Shiho Kino, Nobuko Murayama, Katsunori Kondo","doi":"10.1186/s12939-025-02494-3","DOIUrl":"10.1186/s12939-025-02494-3","url":null,"abstract":"<p><strong>Background: </strong>Food diversity plays an important role in people's healthy and affluent lives. However, poverty and eating alone can create multi-dimensional barriers to food diversity. Although public assistance programs guarantee a minimum income to people in need, financial support alone may not be sufficient to support the health of people in poverty. This study aimed to identify the differences in food diversity intake between older recipients of public assistance and non-recipients.</p><p><strong>Methods: </strong>This cross-sectional study utilized data from the Japanese Gerontological Evaluation Study (2022), involving 14,467 participants aged 65 years and older. The Dietary Variety Score (DVS), ranging from 0 to 10 (higher scores indicate higher dietary variety), assessed dietary diversity based on the regular consumption of ten food groups. Receiving public assistance was categorized as \"yes\" or \"no.\" Eating together was defined as eating with others every day. To assess the relationship between receiving public assistance and the DVS, we calculated the unstandardized coefficient (β) and p values using a general linear model. Additionally, the interaction between public assistance and eating together was examined. As covariates, we adjusted for sociodemographic factors such as age, disease, marital status, and living alone.</p><p><strong>Results: </strong>Men recipients of public assistance had a lower DVS, even after adjusting for sociodemographic factors (adjusted β: -0.72, p = 0.04). For women, no association was seen between receiving public assistance and a lower DVS (adjusted β: -0.19, p = 0.66). An interaction between public assistance and eating together was observed among men (p = 0.07).</p><p><strong>Conclusions: </strong>Even after adjusting for sociodemographic factors, men recipients of public assistance have less food diversity than non-recipient men. Men recipients were more likely to increase their food diversity by eating together. To ensure recipients' rights to food security, the public assistance program should provide additional support to integrate recipients into communities that enable them to eat together in addition to providing financial support.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"134"},"PeriodicalIF":4.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985738","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 participation through women's health collectives promoted by India's National Urban Health Mission: a realist evaluation in Chhattisgarh state.","authors":"Shriyuta Abhishek, Samir Garg, Mukesh Dewangan, Ashu Sahu, Lalita Xalxo, Prabodh Nanda, Pradeep Tandan, M Jawed Quereishi, Anand Kumar Sahu","doi":"10.1186/s12939-025-02498-z","DOIUrl":"https://doi.org/10.1186/s12939-025-02498-z","url":null,"abstract":"<p><strong>Background: </strong>The urban poor especially women slum dwellers face health inequity including disproportionate challenges in participating meaningfully in government programmes on health and its social determinants. To allow equitable participation of the urban poor in health, India's National Urban Health Mission has promoted women's health collectives known as the Mahila Arogya Samitis (MAS) in urban slums since 2013. No evaluations of this important government initiative are available.</p><p><strong>Methods: </strong>A realist evaluation was conducted. A sequential exploratory mixed-method approach involving the following steps was applied - 1) Developing the Initial Programme Theory on action and outcomes of MAS; 2) Testing the programme theory through quantitative and qualitative methods; and 3) Refining and consolidating the theory.</p><p><strong>Results: </strong>Over three years preceding the survey, 59.1% of MAS in Chhattisgarh had taken action on healthcare related problems, 74.1% on food-security and nutrition, 60.8% on gender-based violence, 56.4% on drinking water, 70.8% on sanitation and 64.1% on social environment related issues. Around 95.3% MAS had taken action on at least one of the above six domains. The community participation through MAS was not limited to increased uptake of healthcare services but to a wider people-centred agenda on social determinants of health. The MAS were able to devise multiple strategies for identifying and solving the problems. Participatory selection of women as MAS members, autonomy in decision making, appropriate training design, regular meetings and facilitation provided to MAS by the community health workers emerged as the main enablers to their human-rights orientation and action. Their work is facilitated by the supervisory cadre under the Mitanin program under the leadership of State Health Resource Centre. The social recognition gained by women members of MAS acted as the key source of motivation to sustain their action. However, there are limitations to the actions taken by MAS. The action taken by MAS remained limited to their immediate surroundings, and they were unable to improve public accountability at the higher echelons, or bringing policy-level changes.</p><p><strong>Conclusion: </strong>The MAS experience in Chhattisgarh offers an example of effective community participation of urban poor in health through a process that empowers the underprivileged women. Equitable community processes require appropriate design and need to be nurtured through capacity building and facilitation guided by a similar ethos. The government can further enhance community participation and advance equity in health by allowing collectives such as the MAS a greater say in health planning and monitoring.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"132"},"PeriodicalIF":4.5,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007210","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}