International Journal for Equity in Health最新文献

{"title":"Equity challenges in public health responses during the COVID-19 Pandemic: mixed-methods study of Travellers' experiences in Nouvelle-Aquitaine, France.","authors":"Aude Mondeilh, Ana Rivadeneyra-Sicilia, Léa Dallemane, Leila Saboni, Marc Ruello, Stéphanie Vandentorren","doi":"10.1186/s12939-026-02918-8","DOIUrl":"10.1186/s12939-026-02918-8","url":null,"abstract":"<p><strong>Background: </strong>During the COVID-19 pandemic, socially disadvantaged populations in France faced higher risks of infection and severe forms of COVID-19, particularly among marginalized groups such as Travellers, a population predominantly composed of nationals residing in either static or mobile caravans. In France, few studies have investigated Travellers' experiences and preventive behaviours, with existing research limited to a small number of epidemiological outcomes prior to the pandemic. This study addresses this gap by exploring how living conditions and social exclusion shaped Travellers' experiences of the pandemic and their responses to government measures.</p><p><strong>Methods: </strong>We conducted a sequential explanatory mixed-methods study, combining questionnaires and semi-structured interviews among Travellers in the region of Nouvelle-Aquitaine, France. Quantitative data assessed health status, prevention practices including COVID-19 vaccination and living conditions. Qualitative data provided deeper insight into Travellers' experiences, perceptions and attitudes towards the government' handling of the health crisis. Questionnaire data were analysed using descriptive statistics and multivariable logistic regression to identify factors associated with COVID-19 vaccination (≥ 1 dose). Interview data were analysed using Braun and Clarke's six-phase thematic analysis framework.</p><p><strong>Results: </strong>Among 406 participants, 52.6% reported probable COVID-19 infection (based on a positive test or clinical symptoms) since the onset of the pandemic, of whom 9.2% reported to have been hospitalized. 30.0% of participants reported COVID-19 vaccination compared with 85% in the French general population. Vaccination was associated with being a woman, older age, living in stable housing, prior measles-mumps-rubella vaccination, receiving clear information from health authorities, and trust in the French government's pandemic response. Interviewees reported that overcrowded, underserved living conditions hindered adherence to preventive measures, while fear of infection disrupted social interactions, increased feelings of confinement, and heightened psychological distress.</p><p><strong>Conclusions: </strong>The COVID-19 pandemic disproportionately impacted Traveller communities in France, with structural vulnerabilities increasing both exposure and severe outcomes. These findings highlight the need for inclusive public health responses to avoid increasing preexisting health inequalities in future pandemic crisis. Effective strategies should integrate community perspectives, engage healthcare and social professionals, and tailor vaccination approaches to the specific vulnerabilities and socio-historical contexts shaping behaviours in marginalised populations.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community perspectives on access to healthcare for the Rama indigenous people, Nicaragua: the utility of Cultural Safety outside high-income countries.","authors":"Andrew Papworth, Guerry Windell","doi":"10.1186/s12939-026-02920-0","DOIUrl":"10.1186/s12939-026-02920-0","url":null,"abstract":"<p><p>Indigenous Peoples worldwide experience significantly worse health outcomes than people who are non-Indigenous. The challenges they face are generally more severe in low- and middle-income countries, but most research has focused on high-income countries, mainly Australia, Canada, New Zealand and the USA. This study aimed to help redress this imbalance by focusing on access to healthcare for the Rama indigenous people, a community of around 2,000 people who live on the Caribbean Coast of Nicaragua. The data for this study were drawn from face-to-face and online interviews with Rama and non-Rama participants, conducted during two periods: one in spring 2016 and one in January 2024. In total, 49 participants were interviewed, 28 of whom were female. The research found that although government healthcare was nominally free, limited supplies, equipment shortages, and staff constraints pushed many Rama people to rely on expensive private care. This could strain household incomes, which were already under greater pressure than other local, non-indigenous households. Travel to tertiary care centres was costly and difficult because of the distance between Rama communities and where most regional healthcare centres were based. This was one contributory factor that Rama families often took into account when making decisions about when and where to seek healthcare. The language barrier between Rama service users and non-Rama health professionals, perceived discrimination, and non-Rama health professionals' lack of local knowledge further discouraged care-seeking; and there were many barriers for Rama people who wished to train as health professionals. Although Traditional Medicine was valued, its use declined between 2016 and 2024. Progress towards culturally safe healthcare for the Rama will be difficult; supporting more Rama people to become medically trained and promoting longer-term placements in Rama communities for trained health professionals could help in its achievement.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148329048","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":"Heterogeneous income gradients in early motherhood in Mexico: a population-based multi-method study, 2000-2020.","authors":"Edson Serván-Mori, Alejandro Zamudio-Sosa, Lucio Esposito, Gabriela Sandoval-Moreno, H Xavier Jara, Daniella Medeiros Cavalcanti, Ana L Moncayo, Davide Rasella, Carlos Chivardi","doi":"10.1186/s12939-026-02908-w","DOIUrl":"10.1186/s12939-026-02908-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Early motherhood remains a major public health and equity challenge in low- and middle-income countries, especially in Latin America. While poverty, education, gender norms, and barriers to sexual and reproductive health are well-established determinants, how household income translates into (or fails to translate into) delayed childbearing remains insufficiently understood-particularly in highly unequal settings marked by informality and fragmented social protection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine the association between household income and early motherhood in Mexico, and to disentangle direct and indirect socioeconomic pathways linking income to early childbearing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a population-based, multi-method analysis using harmonised municipal microdata from the 2000, 2010, and 2020 Mexican Population and Housing Censuses (n = 3.05 million women aged 12-24 years, representing 30.6 million individuals). Total household income was imputed using Quantile Random Forests trained on nationally representative income-expenditure surveys. Our analytical strategy combined: (1) machine learning models to identify key correlates and non-linear individual-level patterns of early motherhood; (2) Bayesian spatial models (INLA) to quantify subnational clustering and contextual heterogeneity; and (3) dynamic structural equation modelling to assess direct and lagged relationships among income, schooling-related indicators, union formation, and early motherhood outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Early motherhood prevalence declined modestly from 21.46% (2000) to 19.31% (2020) and remained concentrated in socioeconomically disadvantaged households. In individual-level models, marital status, age, household structure, and dependency ratio were the dominant correlates; income ranked eighth in feature importance. Partial dependence plots indicated a non-linear inverse L-shaped association: predicted risk increased up to approximately Int$ 1,760 (2018 PPP) per adult equivalent, then plateaued and declined slightly. Parity-specific models showed that income's predictive relevance weakened with higher parity, with U-shaped patterns at the lowest income levels for second and ≥third births. Municipal analyses revealed persistent spatial clustering after adjustment for key predictors, and residual \"place\" effects consistent with unmeasured contextual constraints shaping early motherhood. In dynamic models, the direct income-early motherhood path was not statistically significant. Overall patterns were consistent with predominantly indirect linkages operating through schooling- and union-related indicators and reinforcing disadvantage dynamics at the municipal level.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In Mexico, early motherhood remains strongly shaped by intersecting social and territorial inequalities. Income gradients are modest and appear to operate mainly through schooling lag and ","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148328994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indigenous-non-Indigenous inequalities in oral health prevention among children and adolescents in Ecuador: a cross-sectional study.","authors":"Edy Quizhpe, Miguel San Sebastián","doi":"10.1186/s12939-026-02928-6","DOIUrl":"10.1186/s12939-026-02928-6","url":null,"abstract":"<p><strong>Background: </strong>Although oral diseases are among the most prevalent chronic conditions affecting children and adolescents globally, access to preventive and treatment services remains uneven. These disparities are particularly pronounced among Indigenous populations and reflect long-standing structural and social inequities. This study examined the prevalence of, and ethnic inequalities in, refraining from dental care and inadequate toothbrushing frequency among Indigenous and non-Indigenous children and adolescents in Ecuador.</p><p><strong>Methods: </strong>A cross-sectional study was conducted using a nationally representative data from the ENSANUT 2018 demographic survey. Two preventive oral health outcomes were included: refraining from dental care in the previous 12 months and inadequate toothbrushing frequency (< 2 times/day). Ethnicity was self-reported and categorized as Indigenous or non-Indigenous (Afro-Ecuadorian, Mestizo, White, and Montubio). Survey weighted prevalence and absolute risk differences between ethnic groups were estimated to assess inequalities in the outcomes, with adjustment for sex, place of residence and region, and stratified by age group.</p><p><strong>Results: </strong>Refraining from dental care was more prevalent among Indigenous than non-Indigenous children (50.6% vs. 37.3%), corresponding to an adjusted absolute risk difference of 9.2% points (95% CI: 4.4 ̶ 13.9). Inadequate toothbrushing was consistently higher among Indigenous children and adolescents, with an adjusted absolute difference of 12.8; 95% CI: (9.8 ̶ 15.9) and 11; 95% CI: (7.8 ̶ 14.3) percentage points, respectively.</p><p><strong>Conclusions: </strong>Substantial ethnic inequities in access to dental care services and preventive oral health behaviour persist among children and adolescents in Ecuador. These findings underscore the need for equity-oriented and culturally appropriate oral health policies targeting Indigenous populations.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316914","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":"Evaluating fifteen years of national policy in Israel to overcome socio-geographic health disparities in Israel's Northern District: a mixed-methods study.","authors":"Nurit Dessau, Marganit Ofir Gutler, Beth G Zalcman, Sivan Spitzer","doi":"10.1186/s12939-026-02919-7","DOIUrl":"10.1186/s12939-026-02919-7","url":null,"abstract":"<p><strong>Background: </strong>Geographic location impacts health. Despite Ministry of Health policies, Israel's northern district continues to lag behind in health outcomes. This study examined geographic health inequities in Israel (2009-2024), alongside policies intended to reduce them, through the Policy Networks framework to analyze Ministry of Health policymaking on health equity.</p><p><strong>Methods: </strong>This mixed-methods study evaluated Ministry of Health initiatives between 2009 and 2024. A quantitative analysis compared health infrastructure and workforce rates in Israel's Northern District compared to national rates from 2009 to 2024. Qualitative analysis involved a content analysis of policy documents to identify key stakeholders, roles, and policy shifts over time.</p><p><strong>Results: </strong>Quantitative analysis found persistent healthcare disparities in the north, including hospital bed, physician, and paramedical personnel rates. Qualitative analysis of the ten policy documents issued between 2009 and 2024 showed varying focus to socio-geographic disparities, with only four addressing the Northern District. Three factors were identified as contributing to the persistence of disparities: lack of robust representation, centralized decision-making, and decreased focus on geographic disparities.</p><p><strong>Conclusion: </strong>Health disparities between Israel's northern district and central regions persist due to inequities in healthcare access and outcomes and lack of sufficient policies. Centralized decision-making and the exclusion of peripheral stakeholders in the policy network hinder implementation of equity-focused solutions.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316952","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":"From inclusion to control: structural racism in medical organization governance.","authors":"Sonya C Faber, Robyn Wong-Lee, Daniel Zalewa, NiCole T Buchanan, Diana Quinn, Monnica T Williams","doi":"10.1186/s12939-026-02910-2","DOIUrl":"10.1186/s12939-026-02910-2","url":null,"abstract":"<p><strong>Purpose: </strong>This study examines organizational racial power dynamics through a case study of the interactions between a Diversity, Equity, and Inclusion (DEI) Committee and the Board of Directors at an organization specializing in health care practitioner training. We explore how power-defined as control over resources by certain individuals while others lack such control-can be utilized constructively or destructively. Understanding the hoarding of power to maintain hierarchies, rather than fostering equitable systems, is crucial for driving proactive organizational change.</p><p><strong>Design: </strong>Employing a case study methodology, we analyze the division of power within an organization and elucidate behaviors that led to the concentration of power, highlighting its detrimental use. We also examine how organizational leadership systematically undermined the DEI Committee's efforts to establish an accountable, transparently governed organization committed to justice, equity, diversity, and inclusion.</p><p><strong>Findings: </strong>Our analysis reveals that when existing power structures are threatened, they adapt to defend their dominance, often at the expense of the organization's mission. A failure to integrate DEI principles resulted in the loss of relationships with field experts and inflicted harm on its members, ultimately leading to the organization's collapse. Harm included symptoms of racial stress and trauma in racialized board members. In addition to exposing governance failures, this study illuminates the psychological and racial trauma experienced by affected members, linking structural exclusion to cumulative harm. This analysis is contextualized within current events, where similar patterns of dismantling equity-focused initiatives are observed at national levels.</p><p><strong>Originality: </strong>This paper offers a unique and timely perspective on advancing organizational equity, particularly relevant for diversity consultants tasked with analyzing and resolving problematic organizational dynamics. We provide guidelines for distinguishing between appropriate Board governance and detrimental power hoarding, contributing to the broader discourse on fostering equitable organizational practice.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283519","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":"Strengthening women's leadership in health systems through innovation and intersectionality.","authors":"Augustus Osborne, Morie Vandi","doi":"10.1186/s12939-026-02926-8","DOIUrl":"10.1186/s12939-026-02926-8","url":null,"abstract":"<p><p>Women comprise most of the global health and care workforce, yet they remain underrepresented in leadership across health systems, including in ministries of health, hospitals, academic institutions, humanitarian agencies, and health financing bodies. This imbalance is not only a matter of fairness; it shapes whose expertise is recognised, which priorities are funded, and how health systems respond to inequity, crisis, and exclusion. The problem is particularly acute in fragile and conflict-affected settings, where insecurity, displacement, interrupted education, shrinking civic space, and institutional breakdown further narrow women's pathways into leadership. This viewpoint argues that strengthening women's leadership should be treated as a core component of health systems strengthening rather than as a peripheral diversity agenda. It further argues that leadership initiatives must move beyond numerical inclusion to address how authority, legitimacy, and opportunity are distributed across institutions and communities. Drawing on an intersectional lens, the paper examines how gender interacts with ethnicity, caste, class, disability, age, geography, and displacement status to shape who is excluded from leadership pathways and why. It then outlines four practical and adaptable strategies for change: digital mentorship and leadership training platforms, community-based leadership incubators, policy and institutional reform fellowships, and participatory research and advocacy networks. The paper emphasises that leadership development will remain limited unless it is accompanied by reforms to workplace culture, sponsorship, promotion systems, safety, and institutional accountability. Strengthening women's leadership in health systems is therefore essential not only for representation, but also for building more equitable, trusted, and resilient systems capable of advancing universal health coverage and responding effectively to diverse community needs.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13277078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148277370","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 and geographic inequalities in unmet healthcare needs in Cambodia: evidence from a national cross-sectional study.","authors":"Khin Thiri Maung, Monica Hunsberger, Heng Sopheab, Nawi Ng, Ailiana Santosa","doi":"10.1186/s12939-026-02922-y","DOIUrl":"10.1186/s12939-026-02922-y","url":null,"abstract":"<p><strong>Introduction: </strong>Despite economic growth and health system improvements in Cambodia, inequalities in access to healthcare services persist. Unmet healthcare needs provide a key indicator of equity in health service access. This study examined the association between socioeconomic position (SEP) and unmet healthcare needs among Cambodian adults and assessed whether these associations differed by residential area.</p><p><strong>Method: </strong>We conducted a cross-sectional analysis of nationally representative data from 5,001 adults aged ≥ 18 years in Cambodia who participated in the 2023 World Health Survey Plus (WHS+). Unmet healthcare need was defined using three specifications: (1) not receiving healthcare despite reported need; (2) not receiving healthcare or receiving care from a non-medical facility; and (3) not receiving healthcare or receiving care from a non-medical facility or private pharmacy. SEP was derived using principal component analysis conducted separately for urban and rural households and categorized into tertiles. Survey-weighted multivariable logistic regression examined associations between SEP and unmet healthcare needs stratified by residential area.</p><p><strong>Results: </strong>The prevalence of unmet healthcare needs ranged from 7.6% to 42.8%, depending on the definition used. In urban areas, no statistically significant associations between SEP and unmet healthcare needs were observed across specifications. In rural areas, low-SEP individuals had significantly higher odds of unmet healthcare needs under Specification 2 (aOR = 2.40, 95% CI: 1.06-5.41), while middle-SEP individuals had lower odds under Specification 3 (aOR = 0.63, 95% CI: 0.41-0.96). Predicted probabilities varied across SEP and residential area, with patterns differing depending on outcome specifications, particularly in the urban area.</p><p><strong>Conclusion: </strong>Unmet healthcare needs in Cambodia show persistent socioeconomic and geographic inequalities, which are more evident when defined by access to formal providers. Self-reported measures may underestimate these disparities. Policies should prioritize strengthening affordable rural primary care, regulating private pharmacies, and improving financial protection for disadvantaged populations.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13285095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148277402","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 political economy of health reforms and out-of-pocket spending in Türkiye: evidence from household microdata, 2014-2023.","authors":"Sinem Cece, Abuzer Pınar, Lamiha Öztürk, Dilara Şenay","doi":"10.1186/s12939-026-02929-5","DOIUrl":"10.1186/s12939-026-02929-5","url":null,"abstract":"<p><strong>Background: </strong>Out-of-pocket (OOP) health spending remains a major challenge to financial protection and health equity in many middle-income countries, even in contexts where insurance coverage has expanded. Türkiye represents a salient case, as large-scale health reforms over the past two decades have coincided with persistent OOP burdens and increasing macroeconomic volatility.</p><p><strong>Methods: </strong>This study analyzes nationally representative microdata from the Turkish Household Budget Survey covering the period 2014-2023. Log-linear regression models were used to examine the socio-demographic determinants of individual-level out-of-pocket (OOP) health expenditures. To assess equity and financial protection, both the OOP-to-income ratio and a World Health Organization-referenced 10% threshold were employed as descriptive benchmarks, rather than to estimate full population-level catastrophic health expenditure incidence.</p><p><strong>Results: </strong>OOP health expenditures increased over the study period and remained above OECD averages. While higher-income groups incurred greater absolute spending, the relative financial burden was disproportionately concentrated among lower-income households. After 2018, the concentration of high OOP-to-income burdens increased, particularly among disadvantaged groups, suggesting a weakening of financial protection during periods of economic turbulence and structural reform.</p><p><strong>Conclusions: </strong>The findings indicate that health reforms in Türkiye expanded access to services but did not prevent the unequal distribution of financial risk across income groups. From a health equity perspective, modernization strategies that rely on public-private partnerships and digital expansion may unintentionally shift cost pressures onto households. Strengthening financial protection mechanisms and systematically monitoring distributional effects are essential for advancing equity-oriented health reform.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148277411","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":"Healthcare providers' approaches to sexual function in women with migration histories: a qualitative study using Andersen's behavioural model.","authors":"Negin Mirzaei Damabi, Mumtaz Begum, Jodie C Avery, Salima Meherali, Zohra S Lassi","doi":"10.1186/s12939-026-02917-9","DOIUrl":"10.1186/s12939-026-02917-9","url":null,"abstract":"<p><strong>Background: </strong>Sexual function (SF) remains a critically neglected dimension of Sexual and Reproductive Health (SRH), particularly for Women with Migration Histories (WMH), who face intersecting cultural, institutional, and systemic barriers to care. Despite global health frameworks positioning sexual wellbeing as integral to holistic health, SF is rarely integrated into routine SRH practice. This study examines healthcare providers' approaches to SF in the clinical care of WMH in South Australia (SA).</p><p><strong>Methods: </strong>An exploratory qualitative design was employed, using semi-structured interviews with ten SRH providers in SA, including nurses, allied health professionals, and a gynaecologist. Participants were purposively sampled for their experience in caring for WMH. Data were analysed thematically using NVivo. An adapted version of the Andersen Behavioural Model of Health Services Use (ABMHSU) was applied to guide the development of the interview guide and structure the analysis across three domains: predisposing factors, enabling resources, and need-related factors.</p><p><strong>Results: </strong>Providers described limited engagement with SF in routine clinical care, which remained focused on reproductive control. They identified predisposing barriers operating within the clinical encounter, including taboos and stigma surrounding sexual health, marginalisation, mistrust, and communication difficulties shaped by cultural and linguistic distance. Enabling resources were undermined by Medicare ineligibility, financial hardship, interpreter-related concerns, and fragmented care pathways. Need-related barriers included system strain limiting timely responses and restricted access to culturally appropriate sexual therapy. Together, these interconnected barriers were perceived to reinforce the marginalisation of SF in SRH care for WMH.</p><p><strong>Conclusions: </strong>Incorporating SF into routine SRH care for WMH requires coordinated improvements at both the service and provider levels. At the service level, modifiable strategies include culturally tailored SRH literacy, interpreter-sensitive communication, system navigation support, and Medicare-funded, culturally adapted sexual therapy. At the provider level, addressing personal discomfort, insufficient training, and concerns about cultural appropriateness requires comprehensive, mandatory training in trauma-informed and culturally safe care, supported by centralised and accessible resources. Together, these interventions are critical to improving SRH service provision and utilisation, sexual autonomy, health literacy, consumer satisfaction, and overall quality of life for WMH.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148277364","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}