International Journal for Equity in Health最新文献

{"title":"Nurses' work in relation to patient health outcomes: an observational study comparing models of primary care.","authors":"Nicolette Sheridan, Karen Hoare, Jenny Carryer, Jane Mills, Sarah Hewitt, Tom Love, Timothy Kenealy","doi":"10.1186/s12939-024-02288-z","DOIUrl":"10.1186/s12939-024-02288-z","url":null,"abstract":"<p><strong>Background: </strong>Māori are over-represented in Aotearoa New Zealand morbidity and mortality statistics. Other populations with high health needs include Pacific peoples and those living with material deprivation. General practice has evolved into seven models of primary care: Traditional, Corporate, Health Care Home, Māori, Pacific, Trusts / Non-governmental organisations (Trust/NGOs) and District Health Board / Primary Care Organisations (DHB/PHO). We describe nurse work in relation to these models of care, populations with high health need and patient health outcomes.</p><p><strong>Methods: </strong>We conducted a cross-sectional study (at 30 September 2018) of data from national datasets and practices at patient level. Six primary outcome measures were selected because they could be improved by primary care: polypharmacy (≥ 65 years), glucose control testing in adults with diabetes, immunisations (at 6 months), ambulatory sensitive hospitalisations (0-14, 45-64 years) and emergency department attendances. Analysis adjusted for patient and practice characteristics.</p><p><strong>Results: </strong>Nurse clinical time, and combined nurse, nurse practitioner and general practitioner clinical time, were substantially higher in Trust/NGO, Māori, and Pacific practices than in other models. Increased patient clinical complexity was associated with more clinical input and higher scores on all outcome measures. The highest rates of preventative care by nurses (cervical screening, cardiovascular risk assessment, depression screening, glucose control testing) were in Māori, Trust/NGO and Pacific practices. There was an eightfold difference, across models of care, in percentage of depression screening undertaken by nurses and a fivefold difference in cervical screening and glucose control testing. The highest rates of nurse consultations afterhours and with unenrolled patients, improving access, were in PHO/DHB, Pacific, Trust/NGO and Māori practices. Work not attributed to nurses in the practice records meant nurse work was underestimated to an unknown degree.</p><p><strong>Conclusions: </strong>Transferring work to nurses in Traditional, Health Care Home, and Corporate practices, would release general practitioner clinical time for other work. Worse patient health outcomes were associated with higher patient need and higher clinical input. It is plausible that there is insufficient clinical input to meet the degree of patient need. More practitioner clinical time is required, especially in practices with high volumes of complex patients.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"198"},"PeriodicalIF":4.5,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11451150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375402","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":"Interrogating the effectiveness of service engagement for underserved populations in complex health and social care systems: towards an equitable engagement strategy.","authors":"Brídín Carroll, Kieran Walsh","doi":"10.1186/s12939-024-02272-7","DOIUrl":"10.1186/s12939-024-02272-7","url":null,"abstract":"<p><p>There are increased sector-wide efforts within health and social care systems to engage those with lived experience in service design, delivery, and monitoring - aiming to secure more equitable health outcomes. However, critical knowledge gaps persist around how national whole-system engagement strategies can account for the challenges experienced by populations that encounter exclusion within complex multi-layered systems. This includes a failure to delineate shared challenges across groups, and to develop transferable cross-group frameworks to assist sector-wide change. There is, therefore, a danger that those groups already least heard will be collectively left behind. With a view to informing a more inclusive engagement strategy in Ireland, this national study aims to investigate multi-level (policy and strategic, operational, on-the-ground services, individual) shared challenges impacting engagement for five populations who have been identified as underserved groups in a complex health and social care system, including: (1) those who misuse drugs and alcohol, (2) those who are experiencing homelessness, (3) those experiencing mental health, (4) migrants and those of minority ethnicies, and (5) Irish Travellers. Adopting a mixed-methods approach which draws on an evidence-informed multistakeholder perspective, this study employs data from: focus groups and life-course interviews with lived-experience populations (n=136), five focus groups (n=39) and a national on-line survey (n=320) with population-specific services providers; and national-level stakeholder interviews (n=9). Two cross-group participatory consultative forums with lived-experience and provider participants (n=28) were used to co-produce priority action areas based on study findings. This article presents findings on shared challenges in engaging these groups around leadership and commitment, implementation and action, population capacities, trust, and representation, stigma, and discrimination. Derived from these challenges, six development areas are presented to advance an inclusive equitable engagement approach in Ireland. These comprise: 1) balancing top-down prioritisation, and bottom-up direction; 2) sustaining multi-level, multi-form implementation; 3) measuring effectiveness and action; 4) embedding inclusive equitable engagement; 5) trust as a prerequisite, and outcome; and 6) an equalising, agency empowering agenda.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"197"},"PeriodicalIF":4.5,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11451094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371764","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":"Revisiting a decade of inequality in healthcare financial burden in Cambodia, 2009-19: trends, determinants and decomposition.","authors":"Adélio Fernandes Antunes, Theepakorn Jithitikulchai, Juergen Hohmann, Steffen Flessa","doi":"10.1186/s12939-024-02257-6","DOIUrl":"10.1186/s12939-024-02257-6","url":null,"abstract":"<p><strong>Background: </strong>Out-of-pocket healthcare expenditure (OOPHE) without adequate social protection often translates to inequitable financial burden and utilization of services. Recent publications highlighted Cambodia's progress towards Universal Health Coverage (UHC) with reduced incidence of catastrophic health expenditure (CHE) and improvements in its distribution. However, departing from standard CHE measurement methods suggests a different storyline on trends and inequality in the country.</p><p><strong>Objective: </strong>This study revisits the distribution and impact of OOPHE and its financial burden from 2009-19, employing alternative socio-economic and economic shock metrics. It also identifies determinants of the financial burden and evaluates inequality-contributing and -mitigating factors from 2014-19, including coping mechanisms, free healthcare, and OOPHE financing sources.</p><p><strong>Methods: </strong>Data from the Cambodian Socio-Economic Surveys of 2009, 2014, and 2019 were utilized. An alternative measure to CHE is proposed: Excessive financial burden (EFB). A household was considered under EFB when its OOPHE surpassed 10% or 25% of total consumption, excluding healthcare costs. A polychoric wealth index was used to rank households and measure EFB inequality using the Erreygers Concentration Index. Inequality shifts from 2014-19 were decomposed using the Recentered Influence Function regression followed by the Oaxaca-Blinder method. Determinants of financial burden levels were assessed through zero-inflated ordered logit regression.</p><p><strong>Results: </strong>Between 2009-19, EFB incidence increased from 10.95% to 17.92% at the 10% threshold, and from 4.41% to 7.29% at the 25% threshold. EFB was systematically concentrated among the poorest households, with inequality sharply rising over time, and nearly a quarter of the poorest households facing EFB at the 10% threshold. The main determinants of financial burden were geographic location, household size, age and education of household head, social health protection coverage, disease prevalence, hospitalization, and coping strategies. Urbanization, biased disease burdens, and preventive care were key in explaining the evolution of inequality.</p><p><strong>Conclusion: </strong>More efforts are needed to expand social protection, but monitoring those through standard measures such as CHE has masked inequality and the burden of the poor. The financial burden across the population has risen and become more unequal over the past decade despite expansion and improvements in social health protection schemes. Health Equity funds have, to some extent, mitigated inequality over time. However, their slow expansion and the reduced reliance on coping strategies to finance OOPHE could not outbalance inequality.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"196"},"PeriodicalIF":4.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11441229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346141","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":"Intersectionality matters for hispanic health: A replication study using the All of Us Research Program.","authors":"Mariana Rodrigues, Emma Risner, Brennan Rhodes-Bratton, Stephanie H Cook, Adolfo Cuevas","doi":"10.1186/s12939-024-02280-7","DOIUrl":"10.1186/s12939-024-02280-7","url":null,"abstract":"<p><strong>Background: </strong>Despite research dedicated to understanding the health profiles and health-related outcomes of Hispanic individuals, the prevailing body of literature frequently homogenizes the Hispanic population, failing to address the role of race in Hispanic health discourse. Thus, the current study applies an intersectional lens to identify health differences and similarities among Hispanic subgroups.</p><p><strong>Methods: </strong>Sociodemographic characteristics and health domain variables (i.e., health status, health services, and health behaviors) from participants (N = 11,192) were included in the analyses. Bivariate Chi-squared tests examined the relationship between sociodemographic and health domain variables Black Hispanic individuals, white Hispanic individuals, and non-Hispanic Black individuals.</p><p><strong>Results: </strong>Findings suggest that Non-Hispanic Black American individuals reported the highest rates of hypertension (49.09%) and diabetes (19.62%) compared to Black-Hispanic individuals (22.45% and 12.98%) and white Hispanic individuals (22.22% and 8.02%). Black Hispanic individuals reported the greatest proportion of asthma diagnoses (35.10%) and those who saw a doctor in the previous year (95.52%) compared to white Hispanic individuals (26.84%, and 91.10%, respectively) and non-Hispanic Black individuals ( 21.74%, and 94.69%, respectively).</p><p><strong>Conclusion: </strong>Specifically, we found that several health behaviors and health-related outcomes significantly varied across different racial/ethnic groups, demonstrating the advantage of an intersectional approach to identify health disparities among racially diverse ethnic groups.</p><p><strong>Public health significance: </strong>We encourage the development of health care services with an awareness of the complexities resulting from racial differences within the Hispanic diaspora.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"195"},"PeriodicalIF":4.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11441122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346136","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":"Correction: Measuring health equity in the ASEAN region: conceptual framework and assessment of data availability.","authors":"Capucine Barcellona, Yzabel Bryanna Mariñas, Si Ying Tan, Gabriel Lee, Khin Chaw Ko, Savina Chham, Chhea Chhorvann, Borwornsom Leerapan, Nam Pham Tien, Jeremy Lim","doi":"10.1186/s12939-024-02276-3","DOIUrl":"10.1186/s12939-024-02276-3","url":null,"abstract":"","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"194"},"PeriodicalIF":4.5,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11439305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346135","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":"\"Nothing about us, without us\": stakeholders perceptions on strategies to improve persons with disabilities' sexual and reproductive health outcomes in Ghana.","authors":"Abdul-Aziz Seidu, Bunmi S Malau-Aduli, Kristin McBain-Rigg, Aduli E O Malau-Aduli, Theophilus I Emeto","doi":"10.1186/s12939-024-02269-2","DOIUrl":"https://doi.org/10.1186/s12939-024-02269-2","url":null,"abstract":"<p><strong>Background: </strong>Persons with disabilities (PwDs) experience various adverse sexual and reproductive health (SRH) outcomes. However, there is a paucity of evidence on the strategies to improve their SRH outcomes. This study, therefore, used a pluralistic approach to explore PwDs and healthcare providers' (HPs) perspectives on how to improve the SRH of PwDs in Ghana.</p><p><strong>Methods: </strong>In-depth interviews were conducted with 62 purposively selected stakeholders (37 PwDs and 25 HPs) in the Kumasi Metropolis and Offinso North District. The data was subjected to reflexive thematic analysis.</p><p><strong>Results: </strong>Six major themes were generated from the data: Training for disability-sensitive and inclusive healthcare, Healthcare inclusivity - 'nothing about us, without us', Raising awareness for accessibility and equity, Impactful continuous monitoring and evaluation, Vital empowerment for self-reliance and Educating for disability-inclusive healthcare environment. These recommendations were synthesised to develop the THRIVE model-a comprehensive data driven framework from stakeholders that emphasises the importance of factors such as Training for disability-sensitive and inclusive healthcare, Healthcare inclusivity - 'nothing about us, without us', Raising awareness for accessibility and equity, Impactful continuous monitoring and evaluation, Vital empowerment for self-reliance and Enforcement of physical accessibility to improve their SRH outcomes.</p><p><strong>Conclusion: </strong>Using the evidence based THRIVE model could facilitate the development and strengthening of existing interventions and policies including the disability Act 715 to improve the SRH access and outcomes of PwDs in Ghana and other low-and middle-income countries.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"192"},"PeriodicalIF":4.5,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346133","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 equity road ahead for financing non-national immunization program vaccines in China: challenges and opportunities from a qualitative study.","authors":"Mingzhu Jiang, Weixi Jiang, Xuanxuan Yan, Haifeng Ma, Sijuan Zhou, Xiaohua Ying","doi":"10.1186/s12939-024-02282-5","DOIUrl":"https://doi.org/10.1186/s12939-024-02282-5","url":null,"abstract":"<p><strong>Background: </strong>In China, national immunization program (NIP) vaccines benefit from robust financial support and have achieved high coverage. Non-NIP vaccines rely on fragmented funding sources, mostly out-of-pocket payment, and face sub-optimal and inequitable coverage. Sustainable financing needs to be secured for addressing equity in non-NIP vaccine delivery. However, discussion and understanding of this issue remain limited. This study aims to analyze the current situation, comprehensively identify challenges and opportunities in non-NIP vaccine financing, and offer suggestions to enhance vaccine uptake and improve public health.</p><p><strong>Methods: </strong>Between July and December 2023, we conducted a series of semi-structured, in-person interviews with 55 stakeholders from the Health Bureau, Centers for Disease Control and Prevention, Medical Insurance Bureau, and Finance Bureau across five provinces in China. Participants were selected through stratified sampling, and the interviews mainly included their involvement in non-NIP vaccine financing, challenges faced, and strategies for improvement to enhance financing performance. Informed consent was obtained, and thematic analysis was used to analyze the data.</p><p><strong>Results: </strong>Non-NIP vaccine financing sources include out-of-pocket payments, government fiscal, health insurance and other external funds. These four channels differ in vaccine types covered, costs, and target populations, each with unique challenges and opportunities. High out-of-pocket costs remain a significant barrier to equitable vaccine uptake, while market competition has lowered the vaccine price and improved accessibility. Local fiscal support for free vaccination programs faces challenges related to sustainability and regional disparity, though governmental commitment to vaccination is growing. Nevertheless, centralized procurement organized by the government has lowered the price and reduced the financial burden. Despite legal restrictions on using basic health insurance for vaccinations and limited commercial insurance options, private medical savings accounts and mutual-aid mechanisms present new opportunities. Although the scope and impact of external support are limited, it has successfully increased awareness and social attention to vaccination.</p><p><strong>Conclusion: </strong>Relying on individual payments as the main financing channel for non-NIP vaccines is unsustainable and inadequate for ensuring universal vaccine access. A concerted and synergistic approach is essential to ensure sufficient, sustainable resources and enhance public financial management to improve equity in the non-NIP vaccines.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"193"},"PeriodicalIF":4.5,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11429117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346142","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":"Correction: A realist impact evaluation of a tool to strengthen equity in local government policy-making.","authors":"Sally Schultz, Felicity Beissmann, Christina Zorbas, Serene Yoong, Anna Peeters, Kathryn Backholer","doi":"10.1186/s12939-024-02277-2","DOIUrl":"https://doi.org/10.1186/s12939-024-02277-2","url":null,"abstract":"","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"191"},"PeriodicalIF":4.5,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11425987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346134","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":"Un/met: a mixed-methods study on primary healthcare needs of the poorest population in Khyber Pakhtunkhwa province, Pakistan.","authors":"Maira Shaukat, Alina Imping, Lisa Rogge, Fatima Khalid, Safat Ullah, Fayaz Ahmad, Zeeshan Kibria, Andreas Landmann, Zohaib Khan, Manuela De Allegri","doi":"10.1186/s12939-024-02274-5","DOIUrl":"10.1186/s12939-024-02274-5","url":null,"abstract":"<p><strong>Background: </strong>Access of all people to the healthcare they need, without financial hardship is the goal of Universal Health Coverage (UHC). As UHC initiatives expand, assessing the needs of vulnerable populations can reveal gaps in the system which may be covered by relevant policies. In this study we (i) identify the met and unmet primary healthcare needs of the poorest population of Khyber Pakhtunkhwa province (KP), Pakistan, and (ii) explore why the gaps exist.</p><p><strong>Methods: </strong>We used Leveque's Framework of Patient-centred Access to Healthcare to examine unmet primary healthcare (PHC) needs and their underlying causes for the poorest population in four districts of Khyber Pakhtunkhwa province, Pakistan. Using a triangulation mixed methods design, we analysed data from a quantitative household survey of744 households, 17 focus group discussions with household members and, 11 interviews with healthcare providers.</p><p><strong>Results: </strong>Our results show that indicate that despite service utilization, PHC needs were not met, primarily due to prohibitively high costs at each stage of access. Furthermore, gaps in outreach and information (approachability), and varying availability of medicines and diagnostics at facilities (appropriateness) the supply side as well as difficulties in navigating the system (inability to perceive) and adhering to prescriptions (inability to engage) on the demand side, also led to unmet PHC needs. Going beyond utilization, our findings highlight that engagement with care is an important determinant of met needs for vulnerable populations.</p><p><strong>Conclusion: </strong>Social health protection policies can contribute to advancing UHC for primary care. However, in our setting, enhancing communication and outreach, addressing gender and age disparities, and improving quality of care and health infrastructure are necessary to fully meet the needs of the poorest populations.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"190"},"PeriodicalIF":4.5,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11421121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307723","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":"Challenges and strategies for navigating Australian healthcare access: experience from Chinese international students","authors":"Qinglin Men, Wen Li, Asaduzzaman Khan, Robyn M. Gillies","doi":"10.1186/s12939-024-02273-6","DOIUrl":"https://doi.org/10.1186/s12939-024-02273-6","url":null,"abstract":"Australia hosts over 680,000 international students, contributing $47.8 billion to the Australian economy in 2023, and Chinese students rank first among all nationalities. However, despite their considerable numbers, research focusing on their access to healthcare services is scant. This study aimed to explore barriers and supports regarding the utilisation of healthcare services among Chinese international students studying in Australia. Semi-structured interviews were conducted in Chinese between October and December 2023 with 25 Chinese international students (age range, 19–30; female/male, n = 18/7; undergraduate/postgraduate/doctoral, n = 1/18/6) enrolled in three Australian universities to understand the healthcare challenges they encountered and the coping strategies they recommended. These interviews were recorded, and thematic analysis was applied to the interview data. An adapted social-ecological model was used to identify barriers and pragmatic strategies to deal with the challenges at different levels. Chinese international students in Australia faced healthcare barriers at different levels. Individual barriers included language and cultural disparities, lack of knowledge about the healthcare system, and reluctance to seek help. Institutional barriers involved high costs, difficulties regarding appointments, and procedures related to the referral system. Policy barriers included insurance coverage and reimbursement issues. The students interviewed for this study proposed individual-level strategies, such as trying various methods to reduce language barriers, seeking information online, and using online resources and consultations. A central appointment platform and multilingual medical service were recommended from students to medical institutions, while medical service guidance and psychological support were suggested to education institutions. Higher-level strategies were also reported, which were mainly pertaining to insurance terms and coverage for overseas students and improving the accessibility of medical information. Our study identifies barriers to healthcare access for Chinese international students in Australia, including culture-specific challenges. To mitigate these issues, we recommend self-directed health promotion, targeted support by education institutions, enhanced cross-cultural communication and expanded telemedicine by hospitals, and attention to insurance coverage. Future research should explore optimising these approaches to improve support systems and policy frameworks.","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"54 1","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}