Community health equity research & policy最新文献

{"title":"Small Steps Towards an Inclusive Diabetes Prevention Program: How Small Steps for Big Changes is Improving Program Equity and Inclusion.","authors":"Kaela D Cranston, Megan M MacPherson, Jenna Ap Sim, Mary E Jung","doi":"10.1177/2752535X231189932","DOIUrl":"10.1177/2752535X231189932","url":null,"abstract":"<p><p>Social determinants of health, the effects of colonialism, and systemic injustices result in some groups being at disproportionately higher risk for developing type 2 diabetes (T2D). Many T2D prevention programs have not been designed to provide equitable and inclusive care to everyone. This paper presents an example of the steps taken in an evidence-based community T2D prevention program, Small Steps for Big Changes (SSBC), to improve equitable access and inclusivity based on input from a stakeholder advisory group and the ConNECT Framework. To improve reach to those most at risk for T2D, SSBC has changed both eligibility criteria and program delivery. To ensure that all testing is done in an inclusive manner, changes have been made to measurements, and to training for those delivering the program. This paper also provides actionable recommendations for other researchers to incorporate into their own health programs to promote inclusivity and ensure that they reach those most at risk of T2D.</p>","PeriodicalId":72648,"journal":{"name":"Community health equity research & policy","volume":" ","pages":"227-236"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9853672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of street-based COVID-19 vaccination clinics in Phoenix's homeless population.","authors":"Justin Zeien, Jaime Vieira, Jeffery Hanna, Alma Ramirez, Catherine Miller, Jennifer Hartmark-Hill, Cecilia Rosales","doi":"10.1177/2752535X231196415","DOIUrl":"10.1177/2752535X231196415","url":null,"abstract":"<p><p>The novel Coronavirus (COVID-19) is a highly contagious viral illness that has caused the most significant global health crisis in recent human history. Individuals experiencing homelessness represent one of the more vulnerable populations for COVID-19 infection and morbidity. Amongst individuals experiencing homelessness in Phoenix, a student-led interprofessional organization called Street Medicine Phoenix (SMP) sought to both reduce the risk of COVID-19 transmission and morbidity/mortality related to infection. Through collaborations with the Maricopa County Department of Public Health and various community organizations, SMP developed a format for street-based vaccination clinics. SMP deployed these clinics on numerous occasions to the streets directly surrounding the community homeless shelter, allowing SMP to vaccinate individuals directly in their encampments. Through SMP's efforts starting in February 2021, 400 individuals experiencing homelessness have received at least one COVID-19 vaccine. Challenges encountered included low health literacy, lack of established rapport and trust, low vaccine confidence, difficulty verifying patients' vaccination status, difficulty obtaining sufficient information from patients to create a record in the Arizona State Immunization Information System (ASIIS), monitoring patients post-vaccination, transporting vaccine supplies from encampment to encampment, and lack of patient awareness of the mobile vaccine clinic services. Despite challenges, SMP's outreach efforts have demonstrated the feasibility and importance of mobile public health services to reach homeless encampments, particularly mobile vaccination clinics in response to disease outbreaks, and the necessity of strategic partnerships with community agencies to effectively meet the needs of underserved populations.</p>","PeriodicalId":72648,"journal":{"name":"Community health equity research & policy","volume":" ","pages":"265-273"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10459224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Organizational Capacity to Advance Health Equity: Mixed-Methods Approach at a Local Health Department.","authors":"Shipra Singh, Mounika Polavarapu, Katharine Vallerand, Yashika Bhoge, Krista McCarthy Noviski","doi":"10.1177/2752535X231219297","DOIUrl":"10.1177/2752535X231219297","url":null,"abstract":"<p><p>Local health departments (LHDs) play a leading role in eliminating health inequities as they proactively identify and address barriers to optimal health within the community they serve. This study evaluated a Midwestern County LHD's commitment, collaborations, and capacity to advance health equity in their organization. A total of 81 employees completed the online survey (response rate = 51%) and 12 among randomly selected employees completed the qualitative interviews (31.5%). More than 75% of participants reported that all departments had explicit work plans and 50% had a strong capacity to address social determinants of health. Almost 50% of the participants reported strong internal collaboration, but less than 25% indicated that no external partners were involved during the program planning process. Finally, a few participants identified the need for increased diversity in leadership and expressed the importance of quality training and feedback.</p>","PeriodicalId":72648,"journal":{"name":"Community health equity research & policy","volume":" ","pages":"305-314"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138464715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Landscape of Health Technology for Equity Deserving Groups in Rural Communities: A Systematic Review.","authors":"Lindsay Burton, Fathi Milad, Robert Janke, Kathy L Rush","doi":"10.1177/2752535X241252208","DOIUrl":"10.1177/2752535X241252208","url":null,"abstract":"<p><strong>Background: </strong>Equity-deserving groups face well-known health disparities that are exacerbated by rural residence. Health technologies have shown promise in reducing disparities among these groups, but there has been no comprehensive evidence synthesis of outcomes.</p><p><strong>Purpose: </strong>The purpose of this systematic review was to examine the patient, healthcare, and economic outcomes of health technology applications with rural living equity-deserving groups.</p><p><strong>Research design: </strong>The databases searched included Medline and Embase. Articles were assessed for bias using the McGill mixed methods appraisal tool.</p><p><strong>Analysis: </strong>Data were synthesized narratively using a convergent integrated approach for qualitative and quantitative findings.</p><p><strong>Results: </strong>This evidence synthesis includes papers (<i>n</i> = 21) that reported on health technologies targeting rural equity-deserving groups. Overall, patient outcomes - knowledge, self-efficacy, weight loss, and clinical indicators - improved. Healthcare access improved with greater convenience, flexibility, time and travel savings, though travel was still occasionally necessary. All studies reported satisfaction with health technologies. Technology challenges reported related to connectivity and infrastructure issues influencing appointment quality and modality options. While some studies reported additional costs, overall, studies indicated cost savings for patients.</p><p><strong>Conclusions: </strong>There is a paucity of research on health technologies targeting rural equity-deserving groups, and the available research has primarily focused on women. While current evidence was primarily of high quality, research is needed inclusive of equity-deserving groups and interventions co-designed with users that integrate culturally sensitive approaches. Review registered with Prospero ID = CRD42021285994.</p>","PeriodicalId":72648,"journal":{"name":"Community health equity research & policy","volume":" ","pages":"315-335"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140878071","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":"Violence Against Lesbian, Gay, and Bisexual Older Adults: Findings From the Brazilian Health System.","authors":"Daniel Canavese, Maurício Polidoro, Sávio Marcelino Gomes, Ariadne Ribeiro Ferreira","doi":"10.1177/2752535X251327537","DOIUrl":"https://doi.org/10.1177/2752535X251327537","url":null,"abstract":"<p><p>The primary objective of this research was to describe the prevalence of violence against older adults according to sexual orientation as documented in the Notifiable Diseases Information System (SINAN) in Brazil. SINAN is a national database that compiles violence-related notifications reported by healthcare services. This ecological study analyzed aggregated data at the population level, focusing on violence notifications involving individuals aged 50 and above from 2017 to 2021. The data underwent descriptive and bivariate statistical analyses, adhering to a significance level of 5%. The completeness percentage of the sexual orientation variable ranged from 70% to 72%. Our analysis detected noteworthy disparities in the distribution of violence notifications based on sexual orientation. Specifically, lesbians had the highest incidence rates of physical violence compared to heterosexual and bisexual women. In a broader context, women demonstrated a higher susceptibility to psychological violence, with bisexual women experiencing a notably elevated prevalence (41.67%). Reports of physical and psychological violence differed based on contextual variables, such as race, education level, and geographic region. We hereby conclude that the disparities found in violence notifications underscore a troubling situation faced by older adults within the LGB community, with a particular emphasis on the challenges encountered by bisexual individuals. Improving cultural competence in health systems is essential to enhancing data collection and understanding the complexities of violence against this population.</p>","PeriodicalId":72648,"journal":{"name":"Community health equity research & policy","volume":" ","pages":"2752535X251327537"},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143635009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community-Engaged Health Communication Strategies During the COVID 19 Pandemic: Experiences From Southern Andean Peru.","authors":"Jeannie Samuel, Carmen J Yon, Ariel Frisancho, Luz Estrada, Milagro Lourdes Valdez Jaén, Domingo P Paucar Pari, Daniel Rojas","doi":"10.1177/2752535X251323637","DOIUrl":"https://doi.org/10.1177/2752535X251323637","url":null,"abstract":"<p><p>This study examines the work of a collective of community-based Indigenous health rights activists in southern Peru who, at the height of the pandemic, designed, recorded, and disseminated seven Quechua language and culturally tailored Public Service Announcements for radio broadcast to provide information about COVID-19 vaccines. The activists took initiative amid a dysfunctional vaccine roll-out, when vaccination rates in their region were among the lowest in the country, and when mortality rates from COVID-19 were very high. The experiences of the activist collective, including their participatory, community-based approach and their connections with health workers, demonstrate the importance of pre-existing, strong, respectful relationships between communities and health systems in times of public health crisis. This is not an easy task given that relationships between communities and Peru's government-run health system are complex and shaped by dynamics of power, including colonial legacies and contemporary injustices. This case critically reflects on the notion of resilience and provides insights into the enduring struggles by Indigenous activists to decolonize and strengthen the public health system by pushing for forms of community participation based on substantive partnerships with community-based actors that genuinely integrate their knowledge and expertise.</p>","PeriodicalId":72648,"journal":{"name":"Community health equity research & policy","volume":" ","pages":"2752535X251323637"},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143635008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Food Systems, Indigenous Knowledge and Systems Thinking: A Case Study in Regional New Zealand.","authors":"Rachael Glassey, David Tipene-Leach, David Rees, Boyd Swinburn","doi":"10.1177/2752535X251324808","DOIUrl":"https://doi.org/10.1177/2752535X251324808","url":null,"abstract":"<p><strong>Background: </strong>The nutritional health of tamariki (children) in Aotearoa New Zealand (NZ) is poor. Nourishing Hawke's Bay (NHB) began as an initiative to address this problem in low advantage regions of Hawke's Bay (HB) and evolved into the evaluation of Ka Ora. Ka Ako the free, healthy school lunch programme, and the scoping of wider improvements in the regional food ecosystem.</p><p><strong>Purpose: </strong>The aim of this paper is to describe how NHB co-designed and evaluated food interventions incorporating systems thinking and mātauranga Māori (traditional knowledge), as lenses through which to view the initiative.</p><p><strong>Study sample and research design: </strong>Cognitive mapping interviews (n = 11) with community health and education leaders identified six key co-design principles or Pou (metaphorical posts) for NHB.</p><p><strong>Data collection: </strong>Further systems methods, such as group model building and system dynamics modelling, and mātauranga Māori methods, such as wānanga (Māori learning forums), involved the community in food systems mapping and intervention co-design and prioritisation.</p><p><strong>Results: </strong>Three Pou, 'food security,' 'mātauranga Māori' and 'children's hauora' (wellbeing), set the research agenda for NHB. the other three Pou, 'work with community,' 'cohesion and integration' and 'start with schools,' determined the subsequent research processes. Along with standard population evaluation methods (including quantitative and qualitative assessments of changes in student health and wellbeing), a participatory Value for Investment (VFI) analysis assessed return on investment.</p><p><strong>Conclusions: </strong>Combining systems thinking and mātauranga Māori is a novel, participatory approach co-creating pathways to improved nutrition and food security for tamariki and holds promise for wider food system changes in regional NZ.</p>","PeriodicalId":72648,"journal":{"name":"Community health equity research & policy","volume":" ","pages":"2752535X251324808"},"PeriodicalIF":0.0,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racially Equitable Homeless Services: Exploring Organizational Characteristics.","authors":"Whitney Thurman, Elizabeth Heitkemper, Tara Hutson, Summer Wright, Amy Patten, Andrea Kaltz","doi":"10.1177/2752535X251321535","DOIUrl":"https://doi.org/10.1177/2752535X251321535","url":null,"abstract":"<p><strong>Purpose: </strong>Racial disparities in homelessness are pervasive and necessitate sustained effort on improving racial equity in homeless services. This study used a community-engaged approach and qualitative methods to describe the role of informal organizations identified by Black adults with lived experience of homelessness as preferred locations for accessing services and to explore the values and beliefs of these informal organizations. The study included representatives (<i>N =</i> 19) of community organizations (<i>N</i> = 17) in one southern city. Most participants (<i>n</i> = 14, 73.6%) worked in paid positions and included executive directors as well as volunteers.</p><p><strong>Findings: </strong>Thematic analysis identified three themes that characterized values and the ways in which these organizations interface with one another and with the formal homelessness response system (HRS): <i>boots-on-the-ground, the homelessness response system is inequitable,</i> and <i>cautious collaboration.</i> Findings reveal avenues through which local collaboration can be improved and potential policies to improve racial equity in homeless services.</p><p><strong>Conclusions: </strong>Informal organizations fill critical gaps in services and can reach people experiencing homelessness who are unable or unwilling to access formal services. However, informal organizations often remain disconnected from the larger HRS which can exacerbate racial inequities. Community care hubs are a promising solution to incorporating smaller organizations and building a more integrated and equitable HRS.</p>","PeriodicalId":72648,"journal":{"name":"Community health equity research & policy","volume":" ","pages":"2752535X251321535"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community Perspectives on Inequalities in the Provision of Basic Healthcare Services for the Most Vulnerable Populations in the Eastern Congo: A Qualitative Study.","authors":"Dieudonné Bwirire, Rik Crutzen, Rianne Letschert, Edmond Ntabe Namegabe, Bonfils Cheruga, Juliette Mukwege, Trésor Amisi Kasaya, Nanne de Vries","doi":"10.1177/2752535X251321286","DOIUrl":"https://doi.org/10.1177/2752535X251321286","url":null,"abstract":"<p><strong>Background: </strong>There is a notable lack of evidence regarding the factors that shape the provision of essential healthcare services in post-conflict settings.</p><p><strong>Purpose: </strong>This study aimed to explore and describe the factors influencing the provision of basic health care services for the most vulnerable populations in the Eastern Congo.</p><p><strong>Method: </strong>Employing a qualitative research approach, twenty individual interviews with community members and thirteen focus group discussions were conducted. Participants were drawn from three geographically and demographically diverse locations with a history of decades-long armed conflicts in the Congo. Inductive thematic coding used the Health System Dynamics Framework categories (i.e. goals and outcomes, values and principles; service delivery; the population; the context; leadership & governance; and the organization of resources (finances; human resources; infrastructure and supplies; knowledge and information), while allowing for additional themes.</p><p><strong>Results: </strong>Our findings are presented thematically according to these ten categories. The following factors were perceived as key areas enabling or hindering healthcare provision to the community: (1) the context for organizing basic healthcare service delivery is complex and challenging; (2) the population plays a crucial role as an active producer of health and potential change agents; (3) there is a poor strategic policy framework to guide local-level communities in the provision of basic healthcare services; (4) several critical barriers and facilitators related to effective healthcare service delivery were identified; (5) the classification of basic health service delivery methods to meet the healthcare needs of the vulnerable population; (6) the healthcare system is pluralistic and consists of multiple overlapping systems and providers; and (7) service providers and potential service users still consider access to basic healthcare services challenging, potentially resulting in reduced coverage.</p><p><strong>Conclusion: </strong>These findings suggest that substantial changes in the factors contributing to the provision of basic healthcare services are necessary to ensure the delivery of basic healthcare services to the most vulnerable populations in the Eastern Congo. Consequently, there is a critical need to reconsider the healthcare delivery system, specifically addressing these contributing factors in the context of the Eastern Congo.</p>","PeriodicalId":72648,"journal":{"name":"Community health equity research & policy","volume":" ","pages":"2752535X251321286"},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>'We're More Prepared than Before</i>: Understanding the Strategies Used by a Non-governmental Organization During the COVID-19 Pandemic in Sub-Saharan Africa.","authors":"Satveer Dhillon, Isaac Luginaah, Susan J Elliott, Justine Nagawa, Ronah Agaba Niwagaba","doi":"10.1177/2752535X251317651","DOIUrl":"10.1177/2752535X251317651","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic had a negative impact on populations worldwide, particularly on older adults residing in low - and middle-income countries. Due to these negative impacts, non-governmental organizations (NGOs) provided extensive support, which affected their operations.</p><p><strong>Methods: </strong>Using the social resilience framework, the purpose of this study was to better understand what strategies NGOs used to support vulnerable populations and how they are building back stronger from the COVID-19 pandemic. In the fall of 2022, 26 (virtual) in-depth interviews were conducted with staff and volunteers from an NGO supporting older adults in Uganda.</p><p><strong>Results: </strong>Several key themes emerged including using existing resources to better support older adults and staff and the importance of having multiple sources of revenue to support organizational operations.</p><p><strong>Discussion: </strong>The key lessons learned by NGO staff and volunteers can be utilized to enact policy and practice change to help strengthen NGOs' social resilience. This would allow them to continue implementing innovative strategies to support vulnerable populations during times of crisis.</p>","PeriodicalId":72648,"journal":{"name":"Community health equity research & policy","volume":" ","pages":"2752535X251317651"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143071272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}