International Journal for Equity in Health最新文献

{"title":"Evaluating and addressing demographic disparities in medical large language models: a systematic review.","authors":"Mahmud Omar, Vera Sorin, Reem Agbareia, Donald U Apakama, Ali Soroush, Ankit Sakhuja, Robert Freeman, Carol R Horowitz, Lynne D Richardson, Girish N Nadkarni, Eyal Klang","doi":"10.1186/s12939-025-02419-0","DOIUrl":"10.1186/s12939-025-02419-0","url":null,"abstract":"<p><strong>Background: </strong>Large language models are increasingly evaluated for use in healthcare. However, concerns about their impact on disparities persist. This study reviews current research on demographic biases in large language models to identify prevalent bias types, assess measurement methods, and evaluate mitigation strategies.</p><p><strong>Methods: </strong>We conducted a systematic review, searching publications from January 2018 to July 2024 across five databases. We included peer-reviewed studies evaluating demographic biases in large language models, focusing on gender, race, ethnicity, age, and other factors. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tools.</p><p><strong>Results: </strong>Our review included 24 studies. Of these, 22 (91.7%) identified biases. Gender bias was the most prevalent, reported in 15 of 16 studies (93.7%). Racial or ethnic biases were observed in 10 of 11 studies (90.9%). Only two studies found minimal or no bias in certain contexts. Mitigation strategies mainly included prompt engineering, with varying effectiveness. However, these findings are tempered by a potential publication bias, as studies with negative results are less frequently published.</p><p><strong>Conclusion: </strong>Biases are observed in large language models across various medical domains. While bias detection is improving, effective mitigation strategies are still developing. As LLMs increasingly influence critical decisions, addressing these biases and their resultant disparities is essential for ensuring fair artificial intelligence systems. Future research should focus on a wider range of demographic factors, intersectional analyses, and non-Western cultural contexts.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"57"},"PeriodicalIF":4.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"I would be very proud to be part of an initiative that didn't exclude people because it was hard\": mapping and contextualising health equity responsibilities and decision-making tensions in the implementation of a multi-level system reform initiative.","authors":"Tristan Bouckley, David Peiris, Devaki Nambiar, Samuel Prince, Sallie-Anne Pearson, Gill Schierhout","doi":"10.1186/s12939-025-02405-6","DOIUrl":"10.1186/s12939-025-02405-6","url":null,"abstract":"<p><strong>Background: </strong>Health systems face competing demands when implementing health sector reforms. While health equity principles are generally promoted during reform discussions, they are often deprioritised during implementation. This qualitative study aimed to (1) identify how implementers and designers expected health equity to be included in the implementation of a place-based health system reform initiative, and (2) identify factors that influenced prioritisation of health equity during early implementation.</p><p><strong>Method: </strong>We conducted eighteen semi-structured interviews in 2022 and 2023 with a purposive sample of senior policy executives, programme managers and clinicians involved in the design and early implementation of a place-based health system reform initiative in New South Wales, Australia. Informed by a grounded approach, data were analysed inductively drawing on a constant comparative approach. Emerging health equity definitions and expectations informed the development of a Theory of Change (ToC) articulating participants' expectations about how health equity was intended to be embedded in the programme. We also identified opportunities and challenges to prioritise action to address health equity throughout implementation, which informed critical appraisal of the ToC.</p><p><strong>Results: </strong>We identified diffuse actions and responsibilities to address health equity in this state-wide, place-based health reform, articulating these actions and responsibilities in a ToC. This showed diffuse responsibilities for health equity across system levels. We also identified six critical decision-making tensions that influenced health equity prioritisation during early implementation, reflecting participants' perceptions that health equity prioritisation was in conflict with attention to other priorities. These were equity-efficiency; localisation-capacity for health equity; diffuse responsibilities-enforceability; invisible-vocal sub-populations; and health equity-sustainable business models for private providers.</p><p><strong>Conclusion: </strong>The distribution of heath equity responsibilities, as we demonstrated through a ToC of a decentralised, place-based reform, present risk to health equity prioritisation. Risks were particularly present when local resourcing and capacity were stretched, and limited policy guardrails were in place to counteract decision-making tensions, such as clear health equity accountabilities, responsibilities, and actions.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"54"},"PeriodicalIF":4.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500954","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":"An analytical approach towards attaining leave no one behind using patterns and distributions of inequalities in antenatal and facility delivery coverage in Uttar Pradesh, India.","authors":"Vasanthakumar Namasivayam, Ravi Prakash, Bidyadhar Dehury, Shajy Isac, Fernando C Wehrmeister, Marissa Becker, James Blanchard, Ties Boerma","doi":"10.1186/s12939-025-02411-8","DOIUrl":"10.1186/s12939-025-02411-8","url":null,"abstract":"<p><strong>Background: </strong>Leave No One Behind (LNOB) is a central, transformative promise of the 2030 Agenda for Sustainable Development Goals. To attain LNOB, systematic analysis of patterns and distributions of inequalities in coverage of health outcomes on a continuous basis at different program delivery layers is required to design tailored health interventions. We analysed the patterns of change and geographic distribution of inequalities in coverage of antenatal care and facility-based delivery in Uttar Pradesh (UP), India and developed a framework to guide health programmers to understand inequalities better, to accelerate progress by reaching those left behind.</p><p><strong>Methods: </strong>Data from five-rounds of National Family Health Survey (1992-2021) and two-rounds of Community Behaviour Tracking Survey (2014-2018) is used. Education and wealth have been used as stratifiers. Three measures of inequality- mean difference from mean, slope index of inequality, and inequality pattern index are used to depict the state, district and sub-district level inequalities.</p><p><strong>Results: </strong>UP observed a substantial reduction in the education-related inequality in ANC and facility-delivery during 1992-2021. The slope index of inequality declined from 65.3 [95%CI:60.0-70.6] to 9.3 [95%CI:7.8-10.8] for ANC and from 44.7 [95%CI:38.5-50.9] to 29.9 [95%CI:27.8-32.0] for facility-delivery during 1992-2021. The inequality pattern index showed that, with improved reach of interventions, many districts moved towards bottom inequality from top inequality for any ANC while fewer districts for facility-delivery. Even in districts with high coverage and low inequality, sub-district level(blocks) inequality persisted. Similarly, in blocks with high coverage and low inequality, Accredited Social Health Activist (ASHA) level inequality persisted. Interestingly, for the same ASHA area, the patterns of inequality differed for any ANC and facility delivery; in some districts, inequality direction changed based on the stratifier chosen.</p><p><strong>Conclusions: </strong>The proposed health equity framework suggests that to achieve LNOB status, understanding inequality with the coverage status is important. If coverage is high and inequality persists, identify the program layer at which maximum inequality persists to identify the left behinds. Whereas, if coverage is poor, programs are required to improve coverage first. Findings also call for a systematic way of collecting and organizing granular data to understand inequality and identify the left-behinds.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"55"},"PeriodicalIF":4.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500984","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":"Association of federal poverty level with healthcare expenditures among opioids users in the United States (2008-2019): a serial cross-sectional study.","authors":"Mark Bounthavong, Kangho Suh, Aryana Sepassi, Britney Stottlemyer, Patrick Spoutz, Laura Hart, Meng Li","doi":"10.1186/s12939-025-02413-6","DOIUrl":"10.1186/s12939-025-02413-6","url":null,"abstract":"<p><strong>Background: </strong>Opioid users across federal poverty levels have varying healthcare consumption, which could influence public health policies to address the opioid crisis. To better understand this relationship, we evaluated the associations between federal poverty level (FPL) with healthcare costs and utilizations among adult opioid users in the United States (US).</p><p><strong>Methods: </strong>A serial cross-sectional study using pooled data (2008-2019) from the Medical Expenditure Panel Survey (MEPS) was used to evaluate the association between FPL with healthcare expenditures among a representative sample of the US adult population with > = 1 opioid prescription. FPL was defined as Poor/Near Poor-Income, Low-Income, Middle-Income, and High-Income. Healthcare expenditures included costs and resource utilization. Survey weights were applied to generate standard errors for the representative sample of the US population. Generalized linear models were constructed to evaluate the association between FPL and healthcare expenditures adjusting for confounders. FPL groups were stratified by insurance coverage, frequency of opioid prescriptions filled, and pain level to evaluate their impact on healthcare expenditures.</p><p><strong>Results: </strong>Total weighted sample was 27,289,263 respondents; 21.6% in Poor/Near Poor-Income, 14.9% in Low-Income, 28.6% in Middle-Income, and 34.9% in High-Income groups. The average annual increase in total healthcare costs for the Poor/Near Poor-Income group was $451 (95% CI: $142-$761), $275 (95% CI: $48-$502) for the Low-Income group, $640 (95% CI: $447-$834) for the Middle-Income group, and $618 (95% CI: $360-$877) for the High-Income group. Between-group comparisons yielded significant increases in average annual total healthcare costs for Middle- and High-Income groups versus Low-Income group; significant increases in average annual emergency room costs between Middle- versus Low-Income groups, and significant increases in average annual inpatient costs between Middle-Income versus Poor/Near Poor- and Low-Income groups. Stratified analyses yielded several significant increases in average annual costs and expenditures. However, no differences were reported for respondents who were uninsured across FPL groups.</p><p><strong>Conclusions: </strong>Respondents across FPL groups consumed healthcare at various rates, particularly when stratified by insurance coverage, frequency of opioid prescriptions filled, and pain level. FPL plays an important role in healthcare consumption, but further research is needed to understand these mechanisms and their impact on the opioid crisis.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"51"},"PeriodicalIF":4.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11849152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492000","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":"Reproductive agency and the acceptability of divorce, abortion, and homosexuality among migrants from the Middle East and Africa living in Sweden-a cross-sectional analysis.","authors":"Mia L van der Kop, Karin Båge, Veronika Tirado, Anna Kågesten, Bi Puranen, Rachael Sorcher, Anna Mia Ekström, Elin C Larsson","doi":"10.1186/s12939-025-02400-x","DOIUrl":"10.1186/s12939-025-02400-x","url":null,"abstract":"<p><strong>Background: </strong>Sweden has a longstanding history of promoting sexual reproductive health and rights. Reproductive decision-making is a fundamental right, but an individual's decision-making power differs across contexts. We examined self-reported reproductive agency and the acceptability of divorce, abortion and homosexuality among migrants in Sweden originating from the Middle East or North Africa (MENA) and Sub-Saharan Africa (SSA).</p><p><strong>Methods: </strong>This cross-sectional study used face-to-face interview data from the 2018-2019 Migrant World Values Survey (MWVS) and included individuals 18-49 years old who migrated to Sweden from MENA or SSA. Partial proportional odds models were used to estimate adjusted odds ratios (aOR) and corresponding confidence intervals (CI) of associations between sociodemographic factors and two outcomes: 1) reproductive agency (decision-making power on when, with whom, and how many children to have), measured on a 10-point scale categorized as low (1-4), moderate (5-7), and high (8-10); and 2) the Choice Sub-Index (CSI), a composite index of the acceptability of divorce, abortion, and homosexuality, categorized as 0- < 0.4 (low), 0.4- < 0.7 (moderate), and 0.7-1.0 (high).</p><p><strong>Results: </strong>Between September 2018 and November 2019, 7991 participants responded to the MWVS, of whom 4669 met the inclusion criteria. Almost 3/4 (73%) of respondents expressed a high degree of reproductive agency, but less than five per cent of respondents had a high value on the CSI. Living in Sweden ≥ 4 years was associated with higher values on the CSI (aOR 1.76, 95% CI 1.15-2.67), while identifying as Muslim was associated with having a low value on the CSI (aOR 0.44, 95% CI 0.32-0.63). Neither duration of time in Sweden nor identifying as Muslim were associated with reproductive agency. Age and reason for migration (family reunification or as a refugee) were not associated with either outcome.</p><p><strong>Conclusion: </strong>Our study found that migrants from MENA and SSA expressed a high degree of reproductive agency. Migrants had low values of a combined measure of the acceptability of divorce, abortion and homosexuality; however, acceptance increased with time spent in Sweden. Understanding factors associated with migrants' sense of reproductive agency and their values and how these change over time in Sweden provides a foundation for working towards equitable sexual and reproductive health and rights.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"53"},"PeriodicalIF":4.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11853754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492008","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":"Insights for dementia risk reduction among lower SES adults in OECD countries: scoping review of interventions targeting multiple common health risk factors.","authors":"Amy L Coates, Hannah L Fair, Emma J Lea, Kathleen V Doherty","doi":"10.1186/s12939-025-02386-6","DOIUrl":"10.1186/s12939-025-02386-6","url":null,"abstract":"<p><p>The number of people living with dementia is expected to rise to 153 million cases globally by 2050. This will come at a high economic and human cost to societies with disproportionate effects on socioeconomically disadvantaged groups who experience greater exposures to- and fewer protections from- the environmental, social and behavioural drivers of dementia risk. Almost half (45%) of dementia incidence could theoretically be prevented or delayed by addressing 14 modifiable risk factors. While several studies have demonstrated the feasibility of multidomain dementia risk reduction interventions in relatively older, educated and wealthy populations, we are not aware of any studies to date explicitly targeting younger adults (< 50 years) with lower socioeconomic status. To inform future strategies, we conducted a scoping review of intervention studies targeting multiple 'dementia-related' risk factors among adults with lower socioeconomic status in developed country contexts. We identified 1003 unique records; 34 met our criteria for inclusion - involving more than 17,500 participants from 13 countries. While none of the studies explicitly targeted dementia risk reduction, they reported on 30 relevant multidomain interventions targeting common risk factors associated with dementia including; diet (28), physical inactivity (27), obesity (22), diabetes (9), hypertension (8), smoking (6), alcohol use (6), depression (3) and social isolation (1). While most studies recorded positive effects on one or more health behaviours, there was a diversity in the design, approach and outcomes of interventions, with significant intervention effects being associated with the use of a wider range of behaviour change techniques. We suggest that designing interventions to reduce dementia risk and disparities requires a high degree of contextual specificity and propose a structured and participatory approach.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"52"},"PeriodicalIF":4.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11853287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492004","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":"Emerging trends and cross-country health inequalities in congenital birth defects: insights from the GBD 2021 study.","authors":"Hanjun Liu, Kebin Chen, Tingting Wang, Xiaorui Ruan, Jianhui Wei, Jiapeng Tang, Liuxuan Li, Jiabi Qin","doi":"10.1186/s12939-025-02412-7","DOIUrl":"10.1186/s12939-025-02412-7","url":null,"abstract":"<p><strong>Background: </strong>Previous studies predominantly focused on single types of congenital birth defects (CBDs) or specific national prevalence. This study adopts a holistic perspective to assess current trends and health inequalities in birth incidence rate of various types of CBDs, providing novel insights to inform public health policy formulation.</p><p><strong>Methods: </strong>Global, socio-demographic index (SDI) regional, and country-specific estimates incidence cases and rate at birth of CBDs from 1990 to 2021 were derived from the Global Burden of Disease (GBD) 2021. Joinpoint analysis and autoregressive integrated moving average predictive models were employed to evaluate temporal trends in the birth incidence rate of CBDs for the period 2022-2031. Additionally, analysis of associations and health inequalities were conducted to examine the relationship between SDI and the birth incidence rate of CBDs across countries.</p><p><strong>Results: </strong>Globally, the birth incidence rate decreased from 5811.17/100k population in 1990 to 5563.72/100k population in 2021, with low SDI regions recording the lowest rate and cases. Joinpoint analysis revealed a global decrease in the birth incidence rate of CBDs (average annual percentage change, AAPC: -0.14%, 95%CI: -0.15% to -0.12%). The most significant decline was observed in neural tube defects (NTD) (AAPC: -1.35%, 95%CI: -1.42% to -1.28%). However, only birth incidence rate of orofacial clefts (OC) is projected to decrease globally the next decade. Within the five SDI regions, the birth incidence rate of OC is also projected to decrease probably. The analysis revealed negative correlations between congenital heart anomalies (CHA), NTD, and SDI, with NTD showing both absolute and relative health inequalities.</p><p><strong>Conclusions: </strong>Despite the general decline in overall birth incidence rate of CBDs, projections suggested a probable increasing trend for all types except OC. This underscores the necessity for enhanced surveillance and intervention measures. Furthermore, the successful prevention policies implemented for NTD could serve as effective models for addressing other types of CBDs, thereby improving the current global situation of CBDs.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"50"},"PeriodicalIF":4.5,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11844150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467950","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":"Socioeconomic trends in anxiolytic, hypnotic, and sedative use among secondary school students in Spain from 2010 to 2021: a repeated cross-sectional design.","authors":"Xabi Martinez-Mendia, Unai Martin, Anna Barbuscia, Amaia Bacigalupe","doi":"10.1186/s12939-025-02403-8","DOIUrl":"10.1186/s12939-025-02403-8","url":null,"abstract":"<p><strong>Background: </strong>The increasing use of anxiolytics, hypnotics, and sedatives (AHS) among adolescents is a growing public health concern. Social determinants such as gender or socioeconomic status have a significant influence on consumption levels. However, whether trends in adolescent AHS use show socioeconomic and gender disparities is unknown. The aim of this study is to examine the trends in gender and socioeconomic inequalities in secondary school students' AHS use in Spain from 2010 to 2021.</p><p><strong>Methods: </strong>A repeated cross-sectional analysis was conducted using data from the Survey on Drug Use in Secondary Education in Spain (n = 192,656), targeting students aged 14-18 years during 2010-2021. Gender-specific prevalences of AHS use were calculated according to the educational and occupational status of the mother, the father, and both parents. Chi-squared tests assessed statistical significance of the observed social gradients. The Relative Index of Inequality (RII) and Slope Index of Inequality (SII) with 95% confidence intervals were used to measure inequality magnitudes. Consumption trends were examined through prevalence ratios (PR) derived from age-adjusted robust variance Poisson models.</p><p><strong>Results: </strong>Statistically significant social inequalities in AHS use were identified among girls, which increased over time. These inequalities were particularly pronounced when considering maternal educational level (e.g. 2021: 21.5% vs. 16.3%; RII₂₀₂₁ = 1.37 [1.16-1.62]) and paternal occupational status (e.g. 2021: 23.2% vs. 16.5%). Trends showed a significant increase among all groups in both male and female students (e.g. both parents with primary education: PR₂₀₂₁ = 1.74 [1.23-2.47] and PR₂₀₂₁ = 1.83 [1.49-2.25], respectively).</p><p><strong>Conclusions: </strong>The findings highlight the necessity for developing equity-focused public health policies addressing adolescent AHS use, especially among disadvantaged female students. Further research is needed to explore the social determinants of adolescent AHS use, considering inequalities from an intersectional perspective.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"49"},"PeriodicalIF":4.5,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457970","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 people-centered care and inpatients' perceived experience in China: a nationwide cross-sectional study.","authors":"Zhixing Wang, Xueyao Wang, Herng-Chia Chiu, Xiangrong Kong, Qingfeng Li, Xu Ran, Yang Liu, Hailun Liang, Leiyu Shi","doi":"10.1186/s12939-025-02409-2","DOIUrl":"10.1186/s12939-025-02409-2","url":null,"abstract":"<p><strong>Background: </strong>The concept of People-Centered Care (PCC) is a prominent concept around the world, which is considered as an important concept and practice to promote health equity especially in China. Nevertheless, the association between PCC and the perceived experience of patients remains unclear, particularly from the perspective of the entire nation. This study examined the relationship between PCC and inpatients' perceived experience in China.</p><p><strong>Methods: </strong>The study utilized nationwide data collected from 351 healthcare facilities in 31 provinces representing all facility levels and types using proportional odds models. The five attributes of PCC encompass the following categories: continuity of care, information sharing, enhanced access, effectiveness, and respect, each contributing to improving health equity. Inpatients' perceived experience includes the following factors: inpatients' satisfaction with the hospitalization, the recognition of the hospital, and the recommendation of the hospital.</p><p><strong>Results: </strong>Concerning inpatients' overall satisfaction with the hospitalization, all PCC attributes had a positive effect on satisfaction, especially for inpatients with higher levels of care continuity and respect, contributing to health equity. Inpatients with a higher level of continuity were 3.66 times more likely to ameliorate their level of satisfaction from \"very unsatisfied\" to \"unsatisfied.\" Meanwhile, all PCC attributes had significantly positive effects on inpatients' recognition, with effectiveness and respect showing an even stronger association with health equity. Regarding inpatients' recommendation measures, all PCC attributes were positively associated, especially with higher levels of care continuity and effectiveness.</p><p><strong>Conclusion: </strong>People-centered care is positively associated with inpatients' perceived experience, and enhancing health equity through PCC attributes can further improve this experience. Further reform and practice should focus on the amelioration of continuity of care, promotion of information sharing between medical staff and patients, access and effectiveness of care, and respect for patients, all contributing to health equity.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"48"},"PeriodicalIF":4.5,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447631","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":"Unveiling the qualities of a 'good doctor': family carers' and healthcare professionals' perspective on dementia healthcare in India.","authors":"Upasana Baruah, Rachita Rao, Josefine Antoniades, Santosh Loganathan, Mathew Varghese, Claudia Cooper, Mike Kent, Briony Dow, Bianca Brijnath","doi":"10.1186/s12939-025-02408-3","DOIUrl":"10.1186/s12939-025-02408-3","url":null,"abstract":"<p><strong>Background: </strong>The escalating prevalence of dementia in India highlights the need for effective dementia care, particularly in a context marked by limited specialized services and resources. In response to this growing challenge, we sought to contribute to the understanding of societal expectations of multidisciplinary dementia care by exploring the qualities that family carers and healthcare professionals value in dementia care professionals within a multidisciplinary team in India.</p><p><strong>Methods: </strong>The aim of the study was to describe the perspectives of carers and healthcare professionals regarding the attributes of a 'good doctor' in the context of accessing care for individuals with dementia in India. The research involved qualitative face-to-face interviews with 19 family carers and 25 healthcare professionals in Bengaluru, India, with data collected between March and July 2022.</p><p><strong>Results: </strong>Using a thematic analysis framework, four main themes emerged: [1] accessibility and availability [2], empathetic engagement and effective communication [3], knowledge and competency, and [4] systemic reforms and culturally competent multilevel support. Public and professionals' perceptions of 'good' care appeared to have shifted from seeking cures to prioritizing time, counselling, and information, reflecting a more holistic understanding of support needed. Interviewees valued interactions in which they perceived practitioners acting with patience, compassion, respect for dignity of the person with dementia, and professional competence. Effective communication was key. Challenges in accessing quality dementia care included inadequate infrastructure, lack of specialized services, and long waiting times. The importance of multidisciplinary approaches and the need for systemic reforms to enhance service delivery were highlighted.</p><p><strong>Conclusion: </strong>Findings highlight a need for training programs for healthcare professionals to foster the values inherent to delivery of person-centered care.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"46"},"PeriodicalIF":4.5,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440816","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}