{"title":"Rare blood, rare voices: a participatory approach to advancing transfusion equity in the Bedouin community.","authors":"Sagit Kedem-Yemini","doi":"10.1186/s12939-025-02643-8","DOIUrl":"10.1186/s12939-025-02643-8","url":null,"abstract":"","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"260"},"PeriodicalIF":4.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12512828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258173","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}
Anna Volkmer, Jessica Jiang, Sebastian Crutch, Kerry Dathan, Emma Harding
{"title":"Barriers and facilitators to accessing support for people affected by rare dementias who are from culturally, ethnically and linguistically diverse backgrounds.","authors":"Anna Volkmer, Jessica Jiang, Sebastian Crutch, Kerry Dathan, Emma Harding","doi":"10.1186/s12939-025-02634-9","DOIUrl":"10.1186/s12939-025-02634-9","url":null,"abstract":"<p><strong>Background: </strong>It can take several years for people with rare dementias to receive a diagnosis. People from non-White and linguistically diverse backgrounds are also often diagnosed with dementia later than their White, English-speaking counter parts. These factors are likely to delay access to support for people who have rare dementias and who are from diverse backgrounds. This study aimed to investigate facilitators and barriers to people with rare dementia diagnoses who are from culturally, ethnically and linguistically diverse backgrounds in accessing appropriate diagnostic and post-diagnostic support services.</p><p><strong>Methods: </strong>Purposive sampling was used to recruit 10 people affected by a diagnosis of rare dementia who were from culturally, linguistically and/or ethnically diverse backgrounds. Semi-structured interviews explored experiences and perspectives in accessing care and post-diagnostic support. Reflexive thematic analysis was used to extract key themes.</p><p><strong>Results: </strong>Six themes were identified: (1) There is a lack of awareness amongst cultures perpetuated by intersectionality, (2) Carers experience tensions, (3) No society deals well with dementia, (4) Culture, language and ethnicity is a barrier in both directions, (5) Language as a barrier: languages spoken and language(s) lost, (6) What service providers need to do.</p><p><strong>Discussion: </strong>This study identified a lack of awareness of dementia within cultures as well as the wider community that was exacerbated by additional issues such as geographic, financial and gender disparities. Clinical care recommendations synthesised from the study results highlight a need to increase awareness of rare dementias within culturally diverse communities, as well as improving cultural competence within health and social care staff.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"261"},"PeriodicalIF":4.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12512257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258166","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}
Amanda Echeverría-Guevara, Paula M Luz, Débora C Pires, Emilia M Jalil, Hugo Perazzo, Thiago S Torres, Sandra W Cardoso, Guilherme T Goedert, Daniel Csillag, Eduardo M Peixoto, Breno Augusto Bormann de Souza Filho, Carlos A M Costa, Rodrigo T Amancio, Cleber V B D Santos, Nadia C P Rodrigues, Beatriz Grinsztejn, Valdilea G Veloso, Claudio J Struchiner, Lara E Coelho
{"title":"Prevalence of chronic non-communicable diseases and multimorbidity among adults living in slums in Rio de Janeiro, Brazil: a population-based survey.","authors":"Amanda Echeverría-Guevara, Paula M Luz, Débora C Pires, Emilia M Jalil, Hugo Perazzo, Thiago S Torres, Sandra W Cardoso, Guilherme T Goedert, Daniel Csillag, Eduardo M Peixoto, Breno Augusto Bormann de Souza Filho, Carlos A M Costa, Rodrigo T Amancio, Cleber V B D Santos, Nadia C P Rodrigues, Beatriz Grinsztejn, Valdilea G Veloso, Claudio J Struchiner, Lara E Coelho","doi":"10.1186/s12939-025-02599-9","DOIUrl":"10.1186/s12939-025-02599-9","url":null,"abstract":"<p><strong>Background: </strong>Multimorbidity accounts for 77% of overall mortality in low- and middle-income countries, with scarce prevalence estimates among populations living in slums. This study aims to estimate the prevalence and factors associated with chronic non-communicable diseases (CNCD) and multimorbidity among adults living in a large slum complex in the city of Rio de Janeiro, Brazil.</p><p><strong>Methods: </strong>Adults aged 18 or older who resided in the Manguinhos slum complex and participated in a cross-sectional study conducted between September 15, 2020, and February 10, 2021 were included in the analyses. We estimated the prevalence of self-reported CNCD by gender and age strata. Multimorbidity was defined as the presence of at least two CNCD. Logistic regression models were used to assess the association of demographic and behavioral variables with multimorbidity.</p><p><strong>Results: </strong>Of 3,119 participants, 37% were cisgender men and 63% cisgender women, most participants were aged between 45-64 years (36.4%). High blood pressure was the most common CNCD reported by men (29.7%) and women (36.3%), followed by obesity (men: 19%, women: 25.6%) and diabetes mellitus (men: 13.1%, women: 12.4%). We identified multimorbidity in 21.5% of men and 31% of women, older participants and those self-identified as Pardo or Black had higher odds of multimorbidity regardless of gender, women with private health insurance and reporting tobacco smoking had higher odds of multimorbidity.</p><p><strong>Conclusion: </strong>Our findings showed a high burden of CNCD and multimorbidity among people living in slums in a large metropolitan area in Latin America, highlighting an ongoing \"neglected epidemic\" that affect a substantial part of the urban population exposed to precarious living conditions and socioeconomic vulnerability.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"262"},"PeriodicalIF":4.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12512540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258178","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}
Carolina Braga Trabach, Nelio Neves Veiga-Junior, Priscilla Brenda Fonseca Dantas, Aline Aparecida Junqueira, Carina Cordeiro Nunes, Ana Luiza Sturião Vieira Santana, Ana Kaori Fecchio Matsubara, Luiz F Baccaro
{"title":"Postabortion contraception in Brazil: experience in a reference service during the covid-19 pandemic.","authors":"Carolina Braga Trabach, Nelio Neves Veiga-Junior, Priscilla Brenda Fonseca Dantas, Aline Aparecida Junqueira, Carina Cordeiro Nunes, Ana Luiza Sturião Vieira Santana, Ana Kaori Fecchio Matsubara, Luiz F Baccaro","doi":"10.1186/s12939-025-02493-4","DOIUrl":"10.1186/s12939-025-02493-4","url":null,"abstract":"<p><strong>Background: </strong>During the covid-19 pandemic, despite sexual and reproductive health (SRH) services being considered essential, in Brazil, only 55% of abortion services remained in operation. This restriction of access could lead to an increase in unplanned pregnancies, unsafe abortion practices, and, consequently, an increase in the maternal mortality rate. In addition to the difficulty of consolidating information for monitoring and evaluating SRH services. In this scenario, postabortion contraception (PAC) during hospital admission is essential, especially with the postabortion use of long-acting reversible methods (LARC), such as intrauterine devices (IUDs), since they are effective, economical, safe and with immediate contraception.</p><p><strong>Objective: </strong>To evaluate postabortion contraceptive methods, mainly LARC, during hospital admission after spontaneous abortion and legal termination of pregnancy and their associated factors through the abortion surveillance network.</p><p><strong>Methods: </strong>a cross-sectional study with women of any age admitted for spontaneous abortions or legal interruption procedures at the Women's Hospital at State University of Campinas (UNICAMP), Brazil, between July 2017 and November 2022. The study was approved by the Research Ethics Committee from UNICAMP. The dependent variable was IUD insertion. The independent variables were clinical, sociodemographic characteristics, vulnerable groups and period of hospitalization (pre-pandemic: until 10/03/2020; pandemic: from 11/03/2020). For statistical analysis, Cochran-Armitage trend tests and an adjusted logistic regression model were used, with the significance of the coefficients evaluated by the p-value, obtained through the Wald statistics associated with each parameter, as well as the confidence interval.</p><p><strong>Results: </strong>675 women were hospitalized during the period, 547 for spontaneous abortions and 128 for legal termination. Of these, 499 (79%) had at least one vulnerable factor and 45.2% started PAC during hospital stay, as injectables (48.5%), oral contraceptive pills (34.8% ) and IUDs (13.4%). There was a trend towards increased use of IUDs before hospital discharge (p < 0.01), especially in hospitalizations that occurred during the pandemic period, in the most vulnerable groups (p < 0.01) and women with previous abortions (p < 0.05). The factors independently associated with a higher frequency of IUD insertion were presence of 3 or more vulnerability factors (coefficient 4.50; 95% confidence interval [CI] 1.12 to 7.88; p = 0.01); hospitalization during the pandemic period (coefficient 2.56; CI 1.14-3.99; p < 0.01) and the number of abortions (coefficient 0.61; CI 0.09-1.13; p = 0. 02).</p><p><strong>Conclusion: </strong>Reducing access barriers to highly effective and long-acting contraceptives is an important step towards curbing the rates of unplanned pregnancies. Increasing rates of postabortion IUD use i","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"263"},"PeriodicalIF":4.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12512372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258143","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}
Abisola Esther Babatope, Oluyemi Adewole Okunlola, Idowu Peter Adewumi, Damola Olanipekun Ajisafe, Titilayo Yoyinsola Ajenifuja, Temitope Felix Ojomu
{"title":"Patterns and dynamics of conflict-related sexual violence: an insight from 54 African countries.","authors":"Abisola Esther Babatope, Oluyemi Adewole Okunlola, Idowu Peter Adewumi, Damola Olanipekun Ajisafe, Titilayo Yoyinsola Ajenifuja, Temitope Felix Ojomu","doi":"10.1186/s12939-025-02619-8","DOIUrl":"10.1186/s12939-025-02619-8","url":null,"abstract":"<p><strong>Background: </strong>Conflict-related sexual violence (CRSV) remains a critical public health and human rights issue across Africa, affecting vulnerable populations including women, children, and marginalized groups. This study explores the patterns and dynamics of CRSV across 54 African countries between 2020 and 2024.</p><p><strong>Methods: </strong>Secondary, de-identified data were sourced from the Global Health Data Exchange (GHDx). Descriptive statistics were conducted using IBM SPSS v27 to determine the trends in types of sexual violence and perpetrators. Pearson's chi-square (χ²) and Fisher-Freeman-Halton tests were used to assess associations between variables. Count data panel regression using Stata 15 was applied to examine factors associated with both the frequency and mortality outcomes of CRSV.</p><p><strong>Results: </strong>Rape was the most prevalent form of sexual violence reported across the study period. Militants and national military forces were identified as leading perpetrators. Significant associations were found between types of sexual violence and perpetrator categories (χ²=208.209, p < 0.05), as well as between violence type and victim status (χ²=11.351, p = 0.040). Regression results revealed that perpetrators such as civilians (β = 0.897) and militants (β = 0.610) were more likely to be involved in multi-victim incidents. Sexual violence involving civilians was significantly associated with increased deaths (β = 1.342).</p><p><strong>Conclusion: </strong>CRSV in Africa is widespread and patterned by conflict dynamics and perpetrator type. These findings call for the strengthening of survivor-centered policy responses, improved data systems, and legal accountability mechanisms to address CRSV as a barrier to peace and development.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"256"},"PeriodicalIF":4.1,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12505701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250937","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":"Non-standard employment, paid sick leave, and income loss during COVID-19 self-isolation: cross-sectional findings from South Korea.","authors":"Sunoong Hwang","doi":"10.1186/s12939-025-02636-7","DOIUrl":"10.1186/s12939-025-02636-7","url":null,"abstract":"<p><strong>Background: </strong>Testing and isolation are crucial measures to control infectious diseases, yet limited research has examined inequalities in the impact of these measures on individual earnings. This study aimed to assess whether income loss during COVID-19 self-isolation varied by workers' employment type in South Korea.</p><p><strong>Methods: </strong>Cross-sectional data were collected via online surveys from March to September 2022. The analysis included 1,064 employees who tested positive for COVID-19, aged 20-65. Employment types were categorized as standard or non-standard, with the latter encompassing temporary, part-time, and atypical arrangements (multi-party employment arrangements or dependent self-employment). Multivariate logistic regression was used to examine the association between employment type and income loss during COVID-19 self-isolation. The mediating roles of access to paid sick leave and the level of compensation provided were assessed through a counterfactual framework.</p><p><strong>Results: </strong>Overall, 30.5% of participants experienced decreased earnings while self-isolating due to COVID-19 infection. After adjusting for covariates, non-standard workers were three times more likely (adjusted odds ratio 2.96 [95% confidence interval 2.10-4.15]) to experience this income loss compared to standard employees. Among non-standard worker subgroups, atypical workers faced the highest risk (4.06 [2.52-6.55]), followed by part-time (3.02 [1.78-5.13]) and temporary workers (2.25 [1.44-3.51]). This disparity in income loss was attributed to two distinct pathways: non-standard workers having less access to paid sick leave (coverage gap) and, when such leave was available, being more likely than standard workers to receive compensation that was insufficient to maintain pre-isolation earnings (adequacy gap). Our mediation analysis indicated that these two pathways contributed almost equally (51% and 49%, respectively) to the observed income disparities.</p><p><strong>Conclusion: </strong>Both expanding access to paid sick leave and ensuring adequate compensation rates are needed to enable non-standard workers to comply with pandemic control measures without fear of income loss.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"255"},"PeriodicalIF":4.1,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12505698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250926","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":"Voices across difference: a qualitative exploration of health-promoting dialogues between older migrant women and researchers in Norway.","authors":"Prabhjot Kour, Gemma K Agata, Esperanza Diaz","doi":"10.1186/s12939-025-02618-9","DOIUrl":"10.1186/s12939-025-02618-9","url":null,"abstract":"","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"258"},"PeriodicalIF":4.1,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12505572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250986","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":"Structural racism as a fundamental cause of health inequities: a scoping review.","authors":"Adnan Kisa, Sezer Kisa","doi":"10.1186/s12939-025-02644-7","DOIUrl":"10.1186/s12939-025-02644-7","url":null,"abstract":"<p><strong>Background: </strong>Structural racism is increasingly recognized as a fundamental cause of health inequities. It operates through laws, institutional policies, and systemic practices that disproportionately disadvantage racially and ethnically minoritized populations. Although the body of evidence on structural racism and health is expanding, much of it remains fragmented across disciplines and sectors. This scoping review synthesized peer-reviewed research by examining the pathways through which structural racism affects health, the most frequent outcomes, and the interventions and policies implemented to address these disparities.</p><p><strong>Methods: </strong>The review adhered to frameworks by Arksey and O'Malley, Levac et al., and the Joanna Briggs Institute. Six databases (MEDLINE, Embase, Web of Science, CINAHL, PsycINFO, and Scopus) were searched for English-language, peer-reviewed studies published before February 15, 2025, examining structural, systemic, or institutional racism in relation to health. Two reviewers independently screened and extracted data, and findings were analyzed using thematic synthesis.</p><p><strong>Results: </strong>Eighty-three studies met the inclusion criteria, covering healthcare, housing, the criminal legal system, environmental exposures, and other intersecting sectors. Structural racism was consistently associated with adverse outcomes in maternal and infant health, cancer, cardiovascular disease, HIV care, mental health, and COVID-19. Key mechanisms included redlining, residential segregation, carceral practices, discriminatory clinical treatment, and environmental injustice. Intersectional burdens were most pronounced among Black, Indigenous, LGBQ, immigrant, and socioeconomically marginalized groups. Although some promising interventions were identified, including culturally tailored perinatal care, community health worker models, and equity-focused quality improvement, few had been rigorously evaluated or embedded in broader structural policy changes.</p><p><strong>Conclusion: </strong>Structural racism was found to operate across institutional and societal systems to perpetuate health disparities. While targeted interventions show promise, significant gaps remain in the development and implementation of scalable, evidence-based reforms. To achieve health equity, public health strategies must prioritize cross-sectoral actions for confronting and dismantling the structural conditions that maintain racial injustice. This synthesis highlights the urgent need for scalable policy reforms and structural accountability measures across sectors.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"257"},"PeriodicalIF":4.1,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250902","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}
Emilie Op de Beeck, Hannah Ledegen, Gytha Slechten, Josefien Van Olmen, Hans De Loof, Hilde Bastiaens, Caroline Masquillier
{"title":"Understanding challenges in healthcare access: qualitative insights from healthcare providers and people living in socio-economically vulnerable circumstances.","authors":"Emilie Op de Beeck, Hannah Ledegen, Gytha Slechten, Josefien Van Olmen, Hans De Loof, Hilde Bastiaens, Caroline Masquillier","doi":"10.1186/s12939-025-02613-0","DOIUrl":"10.1186/s12939-025-02613-0","url":null,"abstract":"<p><strong>Introduction: </strong>Equitable access to healthcare is fundamental to improving population health outcomes, yet persistent disparities leave many underserved, particularly those in socio-economically vulnerable circumstances. In Belgium, unmet healthcare needs are disproportionately concentrated among low-income groups, migrants and individuals with low educational attainment. These structural inequities are reflected in poorer health outcomes, including reduced life expectancy and limited access to essential services such as dental, mental, and specialist care. Existing research has primarily taken cross-sectional approaches, failing to capture how barriers accumulate over time. To address this gap, this study adopts a longitudinal perspective to explore the cumulative nature of healthcare access barriers among socio-economically vulnerable populations in Belgium. It also incorporates the perspectives of both patients and healthcare providers.</p><p><strong>Method: </strong>A qualitative longitudinal approach using semi-structured interviews at three time-points with 16 people living in socio-economically circumstances was conducted. In the same period, 17 semi-structured interviews with healthcare providers (HCPs), such as general practitioners (GPs), dentists, pharmacists and psychologists were carried out. The sampling strategy included a combination of purposive and snowball sampling. Interviews were audiotaped and transcribed, then reflexive thematic analysis was carried out to ensure a transparent and rigorous analysis.</p><p><strong>Results: </strong>The study revealed that barriers to accessing care accumulate over time, particularly in the context of a fragmented healthcare system. Individuals living in socio-economically vulnerable circumstances often deprioritise their healthcare and need to repeatedly navigate the healthcare access continuum to address different health concerns, often involving multiple healthcare providers. Each iteration can introduce new provider-specific barriers, compounding the challenges and increasing the complexity of accessing healthcare. Participants with an informal social network or support from HCPs and societal organisations could temporarily overcome the barriers to access care.</p><p><strong>Conclusion: </strong>The study reveals the complex and cumulative barriers to healthcare access for socio-economically vulnerable individuals, including competing priorities, system fragmentation, and cultural and language challenges. While informal social networks provide some support, they are insufficient to address systemic issues. Integrating these networks with formal community outreach initiatives could improve coordination and access to healthcare.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"259"},"PeriodicalIF":4.1,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12505574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250981","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}
Pavani Rangachari, Khadija Al Arkoubi, Rajaa Shindi
{"title":"A multi-level framework for advancing digital health equity in learning health systems: aligning practice and theory with the Quintuple Aim.","authors":"Pavani Rangachari, Khadija Al Arkoubi, Rajaa Shindi","doi":"10.1186/s12939-025-02663-4","DOIUrl":"10.1186/s12939-025-02663-4","url":null,"abstract":"<p><p>Achieving digital health equity is essential to realizing the transformative goals of the Quintuple. Aim: optimizing patient experience, improving population health, supporting provider well-being, reducing costs, and advancing health equity. Yet significant disparities persist in access to digital tools, driven by both traditional and digital social determinants of health (SDOH), such as housing instability and limited broadband access. Health system responses often focus on downstream interventions to meet immediate needs, such as referrals for housing assistance or smartphone distribution, while upstream strategies, like partnerships to expand access to affordable housing or advocacy to improve broadband access, remain underutilized. Similarly, targeted tools for specific populations often lack corresponding universal strategies like digital literacy campaigns. The absence of systematic Electronic Health Record (EHR) integration of SDOH data further limits health systems' ability to identify disparities, tailor interventions, and support structural change. This paper introduces a theoretically grounded, multi-level framework for advancing digital health equity within Learning Health Systems (LHS). Drawing on insights from information systems theories, socio-ecological models, organizational learning, implementation science, and systems thinking, the framework supports alignment of equity-centered strategies across micro- (individual), meso- (organizational), and macro- (policy) levels. The framework is organized around three strategic domains: (1) building equity-driven data infrastructure through SDOH-EHR integration, (2) designing scalable, equity-centered interventions that balance targeted and universal approaches, and (3) leveraging strategic starting points to transition from downstream efforts to upstream reforms. Grounded in the U.S. context yet informed by international evidence, this framework offers a roadmap for aligning theory and practice to advance digital health equity in LHS. It is both actionable and adaptable, translating evidence and theory into a structured approach that healthcare systems can use to guide health equity initiatives. It illustrates how SDOH data can inform person-centered care, how targeted tools like multilingual telehealth apps can be integrated with universal strategies such as digital literacy campaigns, and how enabling services, community partnerships, and policy advocacy can catalyze longer-term structural reforms. Emphasizing continuous learning through feedback loops and multi-level alignment, the framework equips stakeholders to embed equity into LHS design and function, ultimately advancing sustainable progress toward the Quintuple Aim.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"253"},"PeriodicalIF":4.1,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12505594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244450","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}