Reed F. Beall , Jorge Luis Flores Anato , Adam G. D'Souza , Héctor Alexander Velásquez García , Huiting Ma , Fengjuan Yang , Stefan D. Baral , Jason Cabaj , Elizabeth Cooper , Aidan Hollis , Naveed Zafar Janjua , Alan Katz , Jenine Leal , Mathieu Maheu-Giroux , Elissa Rennert May , Kamil Malikov , Sharmistha Mishra , Gary Moloney , Tyler Williamson
{"title":"A Canadian multi-province study of COVID-19 vaccine coverage along area-level social determinants in 2021","authors":"Reed F. Beall , Jorge Luis Flores Anato , Adam G. D'Souza , Héctor Alexander Velásquez García , Huiting Ma , Fengjuan Yang , Stefan D. Baral , Jason Cabaj , Elizabeth Cooper , Aidan Hollis , Naveed Zafar Janjua , Alan Katz , Jenine Leal , Mathieu Maheu-Giroux , Elissa Rennert May , Kamil Malikov , Sharmistha Mishra , Gary Moloney , Tyler Williamson","doi":"10.1016/j.puhip.2025.100594","DOIUrl":"10.1016/j.puhip.2025.100594","url":null,"abstract":"","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"9 ","pages":"Article 100594"},"PeriodicalIF":2.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joanne E. Porter , Elissa Dabkowski , Warren Smith , Alex Fernando , Liz Seaward
{"title":"An analysis of systemic incident investigation methodologies applied in serious injury or fatality events: A rapid systematic review","authors":"Joanne E. Porter , Elissa Dabkowski , Warren Smith , Alex Fernando , Liz Seaward","doi":"10.1016/j.puhip.2025.100598","DOIUrl":"10.1016/j.puhip.2025.100598","url":null,"abstract":"<div><h3>Objective</h3><div>This rapid review examines studies that have applied an accident causation analysis method building upon the seminal systematic review conducted by Hulme et al. (2019).</div></div><div><h3>Study design</h3><div>A rapid review of the literature.</div></div><div><h3>Methods</h3><div>The following databases, Scopus, EBSCO, Academic Search Compete, CINAHL Complete, MEDLINE, APA PsycArticles, APA PyscINFO, Business Source Ultimate, Business Source Complete, Web of Science and Science Direct were searched for articles that were published from 2019 to June 2023. Eligible studies applied accident analysis modelling to serious injury and fatalities across a variety of industries.</div></div><div><h3>Results</h3><div>A total of five papers met the inclusion criteria of the rapid review. The studies applied a variety of accident causation models from single large-scale accidents to multiple accident analysis originating predominately from manufacturing industries. The data continued to support the evidence of accident causation analysis models focus on errors, malfunctions, and deficiencies rather than a whole of systems approach and remained complex and difficult to interpret. Based upon the core elements of existing models and following the rapid review of the literature, a novel accident causation analysis approach called the SCALE® Process Model was introduced.</div></div><div><h3>Conclusion</h3><div>There is need to further explore research-based incident analysis reporting systems that can be applied across a variety of industries and disciplines. The SCALE® Process Model uses systemic techniques to provide a deeper understanding of how multiple factors contribute to the severity of an event aiding in reducing the incidence of serious injuries and fatalities.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"9 ","pages":"Article 100598"},"PeriodicalIF":2.2,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143521085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Viola Cassetti , María Victoria López-Ruiz , Ana Egea-Ronda , Dory Aviñó Juan Ulpiano , Carmen Belén Benedé Azagra
{"title":"Facilitators and barriers to implement community engagement approaches in health promotion projects: A qualitative study in 13 projects in Spain","authors":"Viola Cassetti , María Victoria López-Ruiz , Ana Egea-Ronda , Dory Aviñó Juan Ulpiano , Carmen Belén Benedé Azagra","doi":"10.1016/j.puhip.2025.100595","DOIUrl":"10.1016/j.puhip.2025.100595","url":null,"abstract":"<div><h3>Objectives</h3><div>Evidence shows that community health promotion projects should be participatory. However, contextual factors affect the ways these projects can be designed and implemented. This article is part of a study to implement evidence-based guidelines to promote community engagement and it describes barriers and facilitators that can influence its implementation.</div></div><div><h3>Study design</h3><div>Qualitative explorative study using semi-structured interviews and interactive workshops in 13 community health promotion projects across Spain.</div></div><div><h3>Methods</h3><div>Data were collected through semi-structured interviews and workshops with 68 participants from core working groups and key stakeholders from 13 community health projects. Descriptive thematic analysis helped identify codes related to barriers and facilitators. Data were then organized in a matrix to identify how each factor influenced each project (content analysis) and to what degree (totally, partially or absent).</div></div><div><h3>Results</h3><div>Fourteen facilitators were identified, related to internal organization and strategies to work effectively; and seven barriers, related to lack of resources, dependence on external factors and not knowing how to evaluate.</div></div><div><h3>Conclusions</h3><div>Most of the factors identified are related to the organisation of the project, with no apparent relation with community engagement. This suggests that organisational structures should be prioritise to ensure the quality of community health promotion projects and their continuity, and to enable engagement of community members throughout a project.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"9 ","pages":"Article 100595"},"PeriodicalIF":2.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lucy McCann , Lucy Johnson , Anna Gkiouleka , Helen Pearce , John Ford
{"title":"EQUALSS GUIDE Multiple: A novel framework for equity-focused evidence synthesis","authors":"Lucy McCann , Lucy Johnson , Anna Gkiouleka , Helen Pearce , John Ford","doi":"10.1016/j.puhip.2025.100600","DOIUrl":"10.1016/j.puhip.2025.100600","url":null,"abstract":"<div><h3>Background</h3><div>Understanding the differential effects of health and care interventions across disadvantaged groups is essential in addressing inequalities and avoiding inadvertently worsening them. Previous research has highlighted limitations with the existing PROGRESS-Plus framework. We aimed to develop a framework to allow researchers to synthesise evidence with an equity perspective.</div></div><div><h3>Methods</h3><div>First, we re-analysed articles from the EQUALISE study, a review of interventions that increase or decrease inequalities in general practice, to explore the various domains of disadvantage examined in the included studies. We then compared these domains of disadvantage with the existing PROGRESS-Plus framework. Finally, we propose a new framework to support equity-focused evidence synthesis.</div></div><div><h3>Findings</h3><div>From the 325 studies included in EQUALISE, the most commonly assessed PROGRESS-Plus domains were sex/gender (53%), ethnicity/race (50%), and age (44%). The PROGRESS-Plus framework did not include explict mention of context-specific groups, those with multiple intersecting disadvantage, and people who experience disability. Building on PROGRESS-Plus, our new framework EQUALSS GUIDE Multiple includes: Ethnicity and race, Qualifications and education, Underserved area, Age, Language and religion, Sex, Sexual orientation, Gender identification, Underrepresented groups (inclusion groups), Income and wealth, Disability (physical, mental and learning), Employment and occupation, and Multiple disadvantage.</div></div><div><h3>Interpretation</h3><div>EQUALSS GUIDE Multiple builds on PROGRESS-Plus to encapsulate key domains of disadvantage while allowing for context-specific flexibility. Examining the effectiveness of policy and practice interventions by disadvantaged groups is paramount to prioritise actions that narrow the health gap and prevent actions which widen inequalities.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"9 ","pages":"Article 100600"},"PeriodicalIF":2.2,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143521084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Suspicion and other feelings about COVID-19 vaccines and mask-wearing among individuals recovering from substance addiction","authors":"Connie Hassett-Walker","doi":"10.1016/j.puhip.2025.100599","DOIUrl":"10.1016/j.puhip.2025.100599","url":null,"abstract":"<div><h3>Objective</h3><div>This study presents findings about vaccination willingness or resistance and mask-wearing among individuals recovering from a substance use disorder during the COVID-19 pandemic period.</div></div><div><h3>Study design</h3><div>Content analysis.</div></div><div><h3>Method</h3><div>Fifty individuals were interviewed. Interviews were transcribed verbatim, and then coded using Atlas Ti qualitative analysis software. A content analysis was conducted, eliciting recurring themes and overarching COVID-19 health behavior dimensions for getting (or not) vaccinated and wearing a mask.</div></div><div><h3>Results</h3><div>While most subjects were willing to get vaccinated and wear mask, a small minority were not. Both formal (mandates) and informal (pressure from others) mechanisms played a role in getting participants to mask-up and get vaccinated, even when they did not want to. Concern for others motivated some individuals to both get vaccinated and wear a mask. Fear and ambivalence emerged as emotional themes, as did suspicion particularly among vaccine-refusing subjects. Reasons for not getting vaccinated included lack of trust in the government, as well as the vaccine-development process.</div></div><div><h3>Conclusions</h3><div>The results suggest that many COVID-19 prevention initiatives have gone right in terms of reaching individuals recovering from substance addiction. Public health officials may consider alternative ways of reaching individuals whose frame of reference regarding vaccines, public health, and government outreach is one of suspicion and distrust of facts. Future research should examine sources of health and medical information, and how these contribute to individuals’ vaccination hesitancy.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"9 ","pages":"Article 100599"},"PeriodicalIF":2.2,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143428161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kelly L. Budge , Sameeha Shaikh , Mirai Mikhail , Cassandra Bakus , Sabrina LaRosa , Chinwe Ogedegebe , Antonia F. Oladipo
{"title":"The imperative for universal screening of domestic violence: Social determinants of health disparities during COVID-19 within New Jersey","authors":"Kelly L. Budge , Sameeha Shaikh , Mirai Mikhail , Cassandra Bakus , Sabrina LaRosa , Chinwe Ogedegebe , Antonia F. Oladipo","doi":"10.1016/j.puhip.2025.100597","DOIUrl":"10.1016/j.puhip.2025.100597","url":null,"abstract":"<div><h3>Background</h3><div>It is recognized that stressors encountered during the COVID-19 pandemic created an environment that exacerbated DV. COVID disproportionately impacted at-risk populations, but it is unclear if these social determinants of health disparities similarly impact the incidence of DV. This study aimed to identify and highlight affected communities within the state of New Jersey (NJ) that were disproportionately affected by domestic violence (DV) during the COVID-19 pandemic.</div></div><div><h3>Study design</h3><div>The study design was retrospective cross-sectional.</div></div><div><h3>Methods</h3><div>Public data from the NJ Department of Health, Department of Law and Public Safety, and US Census were compared. Community factors, DV incidence, and COVID rates were analyzed using a <em>t</em>-test and Spearman correlation.</div></div><div><h3>Results</h3><div>NJ COVID-19 Incidence rates significantly correlated with varied populations based on socioeconomic status, race, and ethnicity. The median incidence of DV per county population significantly increased from 0.55 % in 2019 to 0.63 % in 2020 (p = 0.03). However, DV incidence was not correlated with rates of COVID-19 per county (p = 0.25). Race and ethnicity did not correlate with DV rates (White, p = 0.06; Black, p = 0.11; 2+ races, 0.14; Hispanic, p = 0.55) except for Asian populations (p = 0.01). Some socioeconomic factors did correlate with DV (unemployment, p = 0.04; median household income, p = 0.003); poverty did not (p = 0.11).</div></div><div><h3>Conclusion</h3><div>NJ experienced a surge in DV rates during the pandemic that cut across communities of all racial and ethnic backgrounds, in contrast to the more unequal impact of COVID-19 incidence. Findings highlight the importance of screening for DV in times of societal distress to clinicians, researchers, and policymakers.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"9 ","pages":"Article 100597"},"PeriodicalIF":2.2,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143474938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Feasibility study of the implementation of health promoting processes in a secondary school and ways to capture its impact on adolescent lifestyle choices","authors":"C.A. Forbes , A.J. Williams , K. Wyatt","doi":"10.1016/j.puhip.2025.100591","DOIUrl":"10.1016/j.puhip.2025.100591","url":null,"abstract":"<div><h3>Objectives</h3><div>Schools are environments that influence adolescent health choices; understanding schools as complex adaptive systems, we have developed a series of processes that are adaptive to the school context, to support schools to create the conditions for health promotion. The aim of this study was to determine the feasibility and acceptability of capturing the impact of implementing the health promoting school (HPS) process.</div></div><div><h3>Study design</h3><div>feasibility study.</div></div><div><h3>Methods</h3><div>A purposefully selected secondary school in England, with high Free School Meal (FSM) allocation, was recruited to implement the HPS processes, which includes an annual school audit. We developed a questionnaire, to capture lifestyle behaviours and school culture, completed before the audit and 9 months after. Descriptive analysis analysed the questionnaire responses to understand whether it captured similar responses to the audit. Post intervention interviews with staff and a focus group with students assessed the acceptability and practicality of the intervention and study design.</div></div><div><h3>Results</h3><div>The HPS processes were implemented September 2022–September 2023. Students (n = 337), families (n = 49) and staff (n = 22) completed the school audit in November 2022 and November 2023. 237 students completed The Lifestyle and School Questionnaire at baseline (September 2022) and 210 at follow-up (June 2022). Following the initial school audit, the need to improve the school food was identified and became the school focus; results from the second audit reflected a small positive shift in students’ opinion of food provision. It was feasible to capture lifestyle and school culture data using the questionnaire and the same food related priority was captured by the initial questionnaire. However, the timing of the implementation of the changes to the school context meant that this was not captured in the follow up questionnaire results.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that it is possible to administer questionnaires regarding adolescent lifestyle choices in schools. These findings also suggest that it is feasible and acceptable to implement a set of HPS processes. More research is needed to demonstrate an impact on individual health behaviours.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"9 ","pages":"Article 100591"},"PeriodicalIF":2.2,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Santina Corona , Maria Luisa Ianni , Eleonora Cimino , Mario Muselli
{"title":"Trends in public interest and vaccination coverage for Herpes Zoster","authors":"Santina Corona , Maria Luisa Ianni , Eleonora Cimino , Mario Muselli","doi":"10.1016/j.puhip.2025.100592","DOIUrl":"10.1016/j.puhip.2025.100592","url":null,"abstract":"<div><h3>Background</h3><div>Varicella-zoster virus (VZV) causes varicella (chickenpox) and herpes zoster (HZ), a painful and potentially debilitating disease. Vaccines are available to prevent HZ, but vaccination coverage remains low. This study aims to measure the impact of an awareness campaign on public interest and vaccination coverage for HZ in Italy.</div></div><div><h3>Study design</h3><div>Cross-sectional ecological study.</div></div><div><h3>Methods</h3><div>Google Trends data and anti-zoster vaccination records were analyzed. Joinpoint regression models were used to identify trends and joinpoints. Correlation analyses were performed to assess the relationship between public interest and vaccination rates.</div></div><div><h3>Results</h3><div>The search trends for \"Herpes Zoster\" and \"Zoster Vaccine\" showed a similar increasing trend from 2016 to 2022, with a peak in July 2022 coinciding with the start of the awareness campaign. The search volumes for \"Herpes Zoster\" were consistently higher than those for \"Zoster Vaccine\" before 2021. The vaccination coverage significantly increased after the campaign. A correlation was found between public interest and vaccination rates.</div></div><div><h3>Conclusions</h3><div>The results of this study suggest that public awareness campaigns can be an effective way to increase vaccination coverage for HZ. The awareness campaign increased public interest and translated into increased vaccination uptake. Google Trends data proved useful in assessing public awareness. Public awareness campaigns can effectively increase vaccination coverage for HZ. Google Trends data can be utilized to monitor public interest in vaccination-related topics. These findings can inform strategies to promote zoster vaccination and reduce the burden of HZ-related complications.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"9 ","pages":"Article 100592"},"PeriodicalIF":2.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143428159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah Overgaard Slater , Lauren Arundell , Anders Grøntved , Jo Salmon
{"title":"Age of first digital device use and screen media use at age 15: A cross-sectional analysis of 384,591 participants from 55 countries","authors":"Sarah Overgaard Slater , Lauren Arundell , Anders Grøntved , Jo Salmon","doi":"10.1016/j.puhip.2025.100596","DOIUrl":"10.1016/j.puhip.2025.100596","url":null,"abstract":"<div><h3>Objectives</h3><div>We investigated the associations between age of first digital device use and screen media use at age 15.</div></div><div><h3>Study design and methods</h3><div>Utilizing cross-sectional data from the 2018 Program for International Student Assessment, we analyzed responses from 384,591 fifteen-year-olds (50 % girls) from 55 countries on their age of first device use and current frequency of 12 screen behaviours. Behaviors were categorized as social, gaming, recreational, educational/practical (grouped into regular [every day; almost every day] and non-regular users [once or twice a week; once or twice a month; never or hardly ever]. Generalized linear regression, adjusted for highest level of schooling of mother/father and with student sampling and replicate weights to account for the sampling design was used to estimate prevalence ratios (PR) for regular use of each screen activity per additional year of age when first using devices.</div></div><div><h3>Results</h3><div>Higher age of first device use was associated with lower prevalence of being a regular user for nine screen behaviours at age 15, with some sex differences. The strongest association was found for using email’ (PR per increasing year of first device use for total sample: 0.956 [95%CI 0.935; 0.977]; boys: 0.956 [95%CI 0.928; 0.986]) and playing collaborative online games (girls: 0.947 [95%CI 0.905; 0.991]). Later first use of devices was associated with decreased prevalence of regular use for social purposes at age 15.</div></div><div><h3>Conclusion</h3><div>The later children start using digital devices, the less likely they are to be regular users at 15 years, especially social use. Delaying children's introduction to digital devices may decrease future use.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"9 ","pages":"Article 100596"},"PeriodicalIF":2.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wehrli Susanne , Dwyer Andrew A , Matthias Baumgartner R , Landolt Markus A
{"title":"Exploring network relations between healthcare access and utilisation in individuals with rare diseases","authors":"Wehrli Susanne , Dwyer Andrew A , Matthias Baumgartner R , Landolt Markus A","doi":"10.1016/j.puhip.2025.100593","DOIUrl":"10.1016/j.puhip.2025.100593","url":null,"abstract":"<div><h3>Background</h3><div>Rare diseases affect fewer than one in 2000 people and impact approximately 400 million individuals globally. High costs, uncoordinated care, and inadequate provider knowledge pose challenges to rare disease care. We aimed to examine the relationship between healthcare access and utilisation among rare disease patients in Switzerland.</div></div><div><h3>Study design</h3><div>A cross-sectional survey was conducted with 314 individuals with a rare disease.</div></div><div><h3>Methods</h3><div>Participants completed the Perception of Access to Healthcare Questionnaire (PAHQ) and provided data on healthcare utilisation (institutional and provider levels). Network analysis assessed nodes were based on expected influence (EI), predictability, and bridge centrality (BC).</div></div><div><h3>Results</h3><div>Four PAHQ subscales (acceptability, availability, adequacy, and awareness) exhibited higher EI and predictability. Conversely, accessibility and affordability of healthcare services had lower EI and predictability scores. In terms of healthcare utilisation, hospitals, private practices, general practictioners (GPs), mental health professionals, and emergency services demonstrated elevated EI and predictability. Specialists and holistic healthcare providers exhibited lower EI and predictability. Affordability, disease course, as well as hospital, and GP utilisation had elevated BC values and emerged as key connectors between access and utilisation.</div></div><div><h3>Conclusion</h3><div>This study illuminates the intricate dynamics of healthcare experiences for patients with rare diseases. This work validates network analysis as a valuable tool for examining healthcare systems. Findings can inform policies that address challenges faced by this vulnerable population, namely care integration for individuals with an unstable disease course.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"9 ","pages":"Article 100593"},"PeriodicalIF":2.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}