International Journal for Equity in Health最新文献

{"title":"Impact of an innovative case-based payment reform on hospital cost variation: insights from cerebral infarction inpatients in China.","authors":"Yining Wang, Shiting Liu, Xinyu Zhang, Haifeng Ma, Xiaohua Ying","doi":"10.1186/s12939-025-02447-w","DOIUrl":"10.1186/s12939-025-02447-w","url":null,"abstract":"<p><strong>Background: </strong>Variations in hospital costs often indicate deficiency in efficient and standardised care. Case-based provider payment systems are utilised globally to address these issues. In China, an innovative case-based payment scheme called the Diagnosis-Intervention Packet (DIP) under the global budget framework has been progressively implemented. However, evidence regarding its effectiveness and potential mechanisms underlying its impact is limited. This study aimed to investigate the impact of DIP reform on hospital cost variations among patients with cerebral infarction (CI) and to explore potential pathways through quality-cost trade-offs.</p><p><strong>Methods: </strong>This cross-sectional study analysed de-identified discharge records of patients from City G, China, between January 2018 and December 2022. The study included 293,255 cases discharged with CI from 185 hospitals. Interrupted time series models were used to assess the overall and heterogeneous impacts on hospital cost variations, measured by the coefficient of variation (CV) and interquartile range (IQR) of the hospital-level average cost per case. The contribution of each itemised cost was quantified using grey relational analysis. Quality measures were compared across hospital groups organised based on the hospitals' relative cost rankings.</p><p><strong>Results: </strong>Following the DIP reform, a significant immediate decline of 0.137 (p = 0.031) was observed in the CV. The quarterly trends in CV decreased by 0.001 (p = 0.954) and IQR by 103.40 RMB ($14.48; p = 0.389). Subgroup analyses found significant reductions in secondary hospitals, surgical groups, and medication costs, with medication costs aligning the most with the total change. Given hospital convergence toward the average cost level, no association between costs and quality was observed. Hospitals transitioning from the high-cost category experienced a reduction in in-hospital mortality (-0.5%). Similarly, those moving from the average- to low-cost category demonstrated decreased mortality (-0.7%) and complications (-0.5%).</p><p><strong>Conclusions: </strong>Our findings revealed a concentrated distribution of post-reform hospital costs without compromising quality. These findings suggest the effectiveness of case-based payment systems in reducing hospital cost variations and improving healthcare efficiency, potentially because providers adopt more standardised behaviours in response to incentive changes. This study offers insights to other countries on payment systems as leverage to achieve efficient, equitable, and high-value care.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"78"},"PeriodicalIF":4.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663362","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":"Breaking the cycle: how Spain's dependency care system creates occupational inequalities in geriatric nursing assistants and the need for reform.","authors":"Mireia Campoy-Vila, Albert Espelt, Júlia Jubany, Olga Borao, Anna Canet-Torres, Carles Muntaner","doi":"10.1186/s12939-025-02426-1","DOIUrl":"10.1186/s12939-025-02426-1","url":null,"abstract":"<p><strong>Background: </strong>The implementation of Spain's Dependency Law aimed to enhance care for those with dependency needs. However, its focus on privatized service provision has raised concerns about potential inequalities in working conditions for geriatric nursing assistants working in long-term care, particularly regarding resources, workload, and labour protections between public and private ownership. This study aims to explore the employment conditions, working conditions and health status of geriatric nursing assistants in Spanish nursing homes, specifically examining the potential impact of facility ownership type.</p><p><strong>Methods: </strong>We conducted a descriptive cross-sectional study including geriatric nursing assistants working in nursing homes in Spain in the year 2022. The final sample consisted of 344 nursing assistants recruited using the snowball and self-selection sampling methods. Data were collected using a computerized, self-administered questionnaire. The variables studied encompassed employment and working conditions and health-related factors, including physical and mental health status assessed using 12-Item Short Form Health Survey (SF-12v1), physical activity levels, and characteristics of back pain. To examine the association between the descriptive variables and facility ownership, Poisson regression models with robust variance were fitted.</p><p><strong>Results: </strong>Nursing assistants in private nursing homes were significantly more likely to report worse working and health-related conditions (aPR = 1.19, 95% CI: 1.07-1.32) compared to those in public facilities. For example, only 22.6% of public workers felt they lacked time for tasks, compared to 48.2% in private nursing homes. Similarly, emotional exhaustion was more prevalent among private staff (86.6% vs. 71.7%).</p><p><strong>Conclusions: </strong>The results highlight the negative impact of neoliberal policies, particularly the privatization of nursing homes, on the working conditions of geriatric nursing assistants, exacerbating health inequalities. A shift towards a community-based care model with increased public investment is essential to improve working conditions, promote healthy aging, and enhance the quality of care provided by nursing assistants.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"77"},"PeriodicalIF":4.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657274","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":"Does the charitable medical assistance program impact catastrophic medical expenditures for families of children with leukemia? An evidence-based study in China.","authors":"Jun Su, Yu-Qing Zhang, Di Shao, Jia-Min Wang, Wei Hao, Yan-Xiu Liu, Long Wang, Xiao-Jie Sun","doi":"10.1186/s12939-025-02442-1","DOIUrl":"10.1186/s12939-025-02442-1","url":null,"abstract":"<p><strong>Background: </strong>Pediatric leukemia is the most prevalent childhood cancer in China, exerting a considerable financial impact on affected families. Despite the mandatory participation of all Chinese children in the Resident Basic Medical Insurance, out-of-pocket (OOP) expenses remain substantial for families of children with leukemia. However, charity assistance has been shown to help mitigate these financial burdens. The \"Love Union Project\" is a comprehensive charitable medical assistance program designed to support families of children with leukemia within China's multi-tiered healthcare security system. This study was designed to evaluate the impact of the \"Love Union Project\" on reducing the incidence of catastrophic health expenditure (CHE) among families of children with leukemia in China.</p><p><strong>Methods: </strong>The study involved 85 children in the intervention group from H city and 36 matched control children from S and Y cities. Data on demographics, medical expenses, and assistance were collected. Non-normally distributed costs were reported as medians. Multivariate logistic regression analyzed the impact of the \"Love Union Project\" on CHE.</p><p><strong>Results: </strong>Thanks to the program's intervention, the CHE rate among the intervention group decreased from 75.3% to 65.9%, while the incidence of CHE in the control group was 75.0%. Compared to families with children aged 0-6 years, those aged 7-12 were more likely to incur CHE (OR 5.224; 95% confidence intervals 1.412-19.322). Families with five or more members were also at higher risk of CHE than those with four members or fewer (OR 2.847; 95% confidence intervals 1.056-7.676). Additionally, families with a monthly income of CNY8000($1,120) or more were less likely to experience CHE than those with a monthly income of CNY4000($560) or less (OR 0.257; 95% confidence intervals 0.072-0.923). Lastly, families receiving assistance from the \"Love Union Project\" reported significantly lower CHE rates than those who didn't receive such support (OR 0.151; 95% confidence intervals 0.044-0.524).</p><p><strong>Conclusion: </strong>While medical insurance provides limited relief, the \"Love Union Project\" enhances economic resilience for families of children with leukemia. Attention should focus on younger patients, larger households, lower-income families, and those not receiving charity support.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"75"},"PeriodicalIF":4.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648523","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":"Examining the magnitude of inequality and inequity in use of healthcare resources among older Australians with cognitive decline.","authors":"Brenda Gannon, Phyo Myat Aung, Aarushi Dhingra, Yaying Zhou","doi":"10.1186/s12939-025-02432-3","DOIUrl":"10.1186/s12939-025-02432-3","url":null,"abstract":"<p><strong>Background: </strong>This study investigates whether healthcare utilisation among older Australians is equitable, particularly focusing on people with cognitive decline from age 50. It investigates the economic concept of horizontal inequity in various types of healthcare use among older Australians and compares inequity among three groups: a representative sample of all individuals aged 50 and above, those with cognitive impairment, and individuals with a disability. Additionally, we examine changes in these patterns over time.</p><p><strong>Methods and data: </strong>This study utilizes cross-sectional data for 2013 and 2017 from the Household, Income and Labour Dynamics in Australia (HILDA) survey to investigate four types of healthcare utilisation-general practitioner (GP), specialist, dental, and hospital admissions. We calculate the concentration index to measure the inequality and inequity in use. To quantify inequity, we correct for differences in needs and health status, following the indirect standardisation approach.</p><p><strong>Results: </strong>Our findings suggest that among the three samples, the inequity faced by older Australians with cognitive impairment is the most pronounced. Individuals with higher socioeconomic status used dental care more, while GP visits were concentrated among the lower socioeconomic groups in 2013. By 2017, all types of healthcare except GP visits favour the better-off people (pro-rich). Among those with disabilities, we find a pro-rich distribution of dental care in both 2013 and 2017, and pro-rich inequity in the usage of specialist visits, even after adjusting for needs.</p><p><strong>Conclusion: </strong>Pronounced disparities are observed among older people with cognitive impairment. Further targeting of policies to improve access to healthcare for older vulnerable Australians is recommended, to help achieve equitable and universal coverage in Australia.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"76"},"PeriodicalIF":4.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648468","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":"Equity of access in rural and metropolitan dementia diagnosis, management, and care experiences: an exploratory qualitative study.","authors":"Hannah Gulline, Sarah Carmody, Mark Yates, Amelia Bevins, Amy Brodtmann, Samantha M Loi, Yen Ying Lim, Heather Macklin, Karen Glennen, Michael Woodward, Scott Ayton, Darshini Ayton","doi":"10.1186/s12939-025-02434-1","DOIUrl":"10.1186/s12939-025-02434-1","url":null,"abstract":"<p><strong>Background: </strong>The limited allocation of resources to rural and regional communities is a major contributor to healthcare inequities in Australia. Distribution of health service resources between metropolitan and rural communities commonly sees highly populated areas prioritised over more sparsely populated and geographically vast areas. As such, challenges impacting dementia diagnosis, management, and care in metropolitan areas are experienced more acutely in rural areas. This study aimed to examine equity of access to dementia diagnosis, management, and care services amongst people who experienced the process of dementia diagnosis as a patient or significant other (partner/spouse, adult children, siblings, and friends) throughout rural and metropolitan Australia.</p><p><strong>Methods: </strong>This exploratory qualitative study consisted of thirty-three online semi-structured interviews with thirty-seven people with experience of the dementia diagnosis process as a patient and/or significant other. Interviews explored symptoms of dementia, health professionals consulted, tests conducted, and challenges faced throughout the diagnosis and post-diagnosis process. Rurality was defined by the Australian Statistical Geography Standard Remoteness Areas (ASGS-RA) and the Modified Monash Model (MMM). Thematic analysis was conducted, with Russell's (2013) Dimensions of Access framework (geography, affordability, availability, acceptability, accommodation, awareness, and timeliness) guiding data analysis.</p><p><strong>Results: </strong>Participants were distributed across various regions of Australia: seven interviews from inner regional Australia, five interviews from outer regional Australia, and twenty-one interviews from metropolitan areas. Disparities in access between metropolitan and rural areas emerged in five key dimensions: 1) geography impeding ability to access services; 2) affordability of travel expenses; 3) availability of healthcare and support services; 4) acceptability of available health professionals and services; and 5) awareness of local services and resources. The dimensions of accommodation and timeliness of care were experienced as challenges irrespective of location, with lengthy appointment wait times and difficulty navigating complex systems. However, rurality often compounded the challenges in dementia diagnosis, management, and care.</p><p><strong>Conclusions: </strong>Significant health inequities persist between rural and metropolitan communities that must be prioritised in endeavours to promote equitable dementia diagnosis, management, and care. Targeted action to address disparities is vital to mitigate the impact of rurality, particularly as clinical practice evolves with research advancements.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"74"},"PeriodicalIF":4.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648467","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":"Identifying mechanisms by which social determinants of health impact TB diagnostic evaluation uptake in Uganda: a qualitative study.","authors":"Talemwa Nalugwa, Kristi Sidney Annerstedt, Sarah Nabwire, Nora S West, Jillian L Kadota, Salla Atkins, Adithya Cattamanchi, Knut Lönnroth, Achilles Katamba, Priya B Shete","doi":"10.1186/s12939-025-02437-y","DOIUrl":"10.1186/s12939-025-02437-y","url":null,"abstract":"<p><strong>Background: </strong>Social and structural determinants of health (SDoH) are associated with tuberculosis (TB) outcomes but often unaddressed in TB care programs. We sought to describe the mechanism by which SDoH impact completion of TB diagnostic evaluation in Uganda using an implementation science framework rooted in behavioral theory.</p><p><strong>Methods: </strong>Trained research staff interviewed 24 purposively sampled adults undergoing TB diagnostic evaluation at six community health centers in Uganda between February-August 2019. Framework analysis was used to construct themes linked to SDoH across the TB diagnostic evaluation cascade of care. Themes were then mapped to domains of the capability, opportunity, and motivation behavior change model (COM-B).</p><p><strong>Results: </strong>Barriers related to SDoH were identified across the diagnostic evaluation cascade of care and associated with domains central to uptake of testing and treatment. These included: limited knowledge about TB diagnosis and treatment (psychological capability); low socioeconomic status and competing financial priorities (physical opportunity); internalized and anticipated stigma of TB diagnosis, lack of social support programs and limited social support/social capital (social opportunity, reflective motivation); trust (or distrust) in the government health facility to provide quality care (reflective motivation); and fear and shame about worsening poverty (automatic motivation). Facilitators to engagement with the TB cascade of care included encouragement from friends and family to seek testing (automatic motivation, social opportunity), and trust that healthcare providers were acting in their best interests (social opportunity).</p><p><strong>Conclusions: </strong>Biomedical interventions alone are unlikely to address the spectrum of SDoH-related barriers to equitable completion of TB diagnostic evaluation. Linking barriers to a behavior change model such as COM-B may help guide the design and evaluation of appropriate people-centered strategies that integrate social and economic supports with clinical and public health programs or services.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"73"},"PeriodicalIF":4.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634028","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":"Study on the \"digital divide\" in the continuous utilization of Internet medical services for older adults: Combination with PLS-SEM and fsQCA analysis approach.","authors":"Wang Yu, Ying Ji, Zhijing Li, Kun Wang, Xue Jiang, Chun Chang","doi":"10.1186/s12939-025-02418-1","DOIUrl":"10.1186/s12939-025-02418-1","url":null,"abstract":"<p><strong>Background: </strong>With the rapid digitalization of healthcare and an aging population, understanding the factors influencing older adults' sustained adoption of Internet medical services is critical. However, existing research often oversimplifies these factors by relying on linear models. This study integrates Partial Least Squares Structural Equation Modeling (PLS-SEM) and fuzzy-set Qualitative Comparative Analysis (fsQCA) to explore the complex pathways driving continued use.</p><p><strong>Methods: </strong>A survey of 1,920 older adults (60-75 years) in China assessed satisfaction, e-health literacy, self-efficacy, social support, social influence, social participation, and willingness to use Internet medical services. PLS-SEM examined the relationships between variables, while fsQCA identified multiple configurations leading to sustained use.</p><p><strong>Results: </strong>PLS-SEM identified satisfaction as the strongest predictor of sustained use (β = 0.281, p < 0.001), acting as both a direct determinant and a mediator for e-health literacy and social participation. Social influence (β = 0.189, p < 0.001) and social support (β = 0.172, p < 0.001) also contributed significantly. FsQCA revealed six distinct configurations, with satisfaction and e-health literacy as core conditions across most pathways.</p><p><strong>Conclusions: </strong>By integrating linear and configurational approaches, this study provides a nuanced understanding of older adults' digital healthcare behaviors. Enhancing satisfaction, digital literacy, and social engagement is key to fostering sustained adoption. Tailored interventions based on distinct configurations can maximize the effectiveness of digital health programs.</p><p><strong>Implications: </strong>This research bridges gaps in understanding complex behaviors and provides actionable insights for policymakers and healthcare providers, highlighting the critical role of digital literacy and social support.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"71"},"PeriodicalIF":4.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614398","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":"Barriers to health, social and long-term care access among older adults: a systematic review of reviews.","authors":"Estela Cabañero-Garcia, Roberto Martinez-Lacoba, Isabel Pardo-Garcia, Elisa Amo-Saus","doi":"10.1186/s12939-025-02429-y","DOIUrl":"10.1186/s12939-025-02429-y","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to analyse the different barriers to accessing healthcare, social services and long-term care among older adults.</p><p><strong>Methods: </strong>A systematic review and narrative synthesis were conducted to analyse barriers to accessing healthcare, social care and long-term care services among older adults. We followed the PRISMA guidelines. A systematic search was conducted in the PubMed, Scopus, and Web of Science databases.</p><p><strong>Results: </strong>Seventenn studies were included in the systematic review. Seven articles were systematic reviews, six were scoping reviews, two were literature reviews, one was a rapid review and the last one was an integrative review. The results show that the different types of barriers that hinder access to services for older adults are, on the demand side, socioeconomic factors; and on the supply side, geographical factors. Community factors and the digital divide are on both the supply and demand side. Interaction between barriers should be considered.</p><p><strong>Conclusion: </strong>Adequate access to social and health services is crucial for the health and well-being of older adults and to guarantee equity in health. In summary, access to health services for older adults is determined by a heterogeneous interaction of these factors, on both the demand and supply side. Overcoming these barriers requires a comprehensive approach involving the collaboration of governments, healthcare providers, communities and older adults themselves.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"72"},"PeriodicalIF":4.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614875","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":"Equity in epidemic response: an action-oriented framework for guiding public health in equitable responses to major infectious disease emergencies.","authors":"Precious-Junia de-Winton Cummings, Kelly K Baker, Leah Appell, Marina Del Rios, Daniel J Diekema, Tricia Kitzmann, Naomi Marroquin, Gus Raymond, Martha L Carvour","doi":"10.1186/s12939-025-02433-2","DOIUrl":"10.1186/s12939-025-02433-2","url":null,"abstract":"<p><strong>Background: </strong>A rapid and equitable response is paramount to mitigating the spread and impact of an infectious disease public health emergency. Unfortunately, public health responses often integrate equity as a secondary component rather than a foundational one-a decision that can result in disproportionate effects of the epidemic on vulnerable populations and that may further fuel or worsen the ongoing health emergency. This paper introduces a framework grounded in health equity principles to guide the design and implementation of response efforts during infectious disease emergencies.</p><p><strong>Methods: </strong>The Equity in Epidemic Response framework was developed by critically appraising and synthesizing several established models into an integrated framework, with active engagement from health professionals specializing in epidemiology, medicine, global health, mental health, community health, and health policy.</p><p><strong>Results: </strong>The framework covers six high-impact areas that should be addressed during an infectious disease public health emergency: community partnerships and engagement; communication; social and economic conditions; data systems and methods; health infrastructure and supply chains for preventives, therapeutics, and diagnostics; and accessibility of outbreak resources and essential health services. Key priorities and assessment indicators within each area were identified.</p><p><strong>Conclusions: </strong>Given the increasing threat of emerging and re-emerging infectious diseases, this framework reinforces the need to prioritize equitable approaches in responding to infectious disease public health emergencies to minimize health consequences, particularly among vulnerable populations. This framework is designed as a practical tool for public health professionals to guide major aspects of an epidemic response, ensuring thorough and equitable implementation of response efforts.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"69"},"PeriodicalIF":4.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11900141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614876","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":"Barriers and facilitators for engaging underrepresented ethnic minority populations in healthcare research: an umbrella review.","authors":"Shahina Pardhan, Tarnjit Sehmbi, Rumalie Wijewickrama, Hugo Onumajuru, Mapa Prabhath Piyasena","doi":"10.1186/s12939-025-02431-4","DOIUrl":"10.1186/s12939-025-02431-4","url":null,"abstract":"<p><strong>Background: </strong>Research highlights that participation of ethnic minority individuals in research is low when compared to white counterparts. This poses challenges for healthcare planning and delivery, as lack of representativeness in research means that findings are generalised across all ethnic groups, and do not provide stakeholders with a full picture of how minority populations are affected. This contributes to health inequalities as these populations may then be underserved and not get the best possible management if differences due to ethnicity were to exist. This study synthesises the barriers to engaging minority individuals in research to understand, and enablers to better engagement of different minority communities in healthcare research.</p><p><strong>Methods: </strong>Five databases were searched (MEDLINE, CINAHL, PsycINFO and Web of Science and EMBASE) up to 29th April 2024, resulting in 897 articles, of which 11 met the inclusion criteria. Data were extracted from reviews and synthesised using qualitative meta-aggregation techniques. The socio-ecological framework was applied to synthesise the main outcomes. A protocol for this review was registered on PROSPERO (CRD42024532686).</p><p><strong>Results: </strong>The main barriers for research participation included: mistrust of healthcare professionals, research and researchers; socioeconomic and logistical challenges; language and cultural barriers; lack of awareness; external influences and perceived bias. Facilitators to support better research participation included: Community engagement and personalised approaches; culturally sensitive research strategies; linguistically appropriate study materials and study advertising; education workshops.</p><p><strong>Conclusions: </strong>To enable wider participation, it is important to understand not only the barriers but also to employ culturally appropriate facilitators, engaging with patient and public involvement (PPI) groups that communities trust, offer cultural training for researchers, and adopt a more collaborative and transparent way of working. This overview highlights the work that needs to be done on an intrapersonal, interpersonal, community and policy level to make research accessible and inclusive for ethnic minority groups.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"70"},"PeriodicalIF":4.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614874","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}