Access to health services
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Research has long focused on the notion of access and the trajectory towards a healthcare encounter but has neglected what happens to patients after these initial encounters. This paper focuses attention on what happens after an initial... more
Research has long focused on the notion of access and the trajectory towards a healthcare encounter but has neglected what happens to patients after these initial encounters. This paper focuses attention on what happens after an initial healthcare encounter leading to a more nuanced understanding of how patients from a diverse range of backgrounds make sense of medical advice, how they mix this knowledge with other forms of information and how they make decisions about what to do next.
Design/methodology/approach-Drawing on 160 in-depth interviews across four European countries the paper problematizes the notion of access; expands the definition of ''decision partners''; and reframes the medical encounter as a journey, where one encounter leads to and informs the next.
Findings-This approach reveals the significant unseen, unrecognised and unacknowledged work that patients undertake to solve their health concerns.
Originality/value-De-centring the professional from the healthcare encounter allows us to understand why patients take particular pathways to care and how resources might be more appropriately leveraged to support both patients and professionals along this journey.
Design/methodology/approach-Drawing on 160 in-depth interviews across four European countries the paper problematizes the notion of access; expands the definition of ''decision partners''; and reframes the medical encounter as a journey, where one encounter leads to and informs the next.
Findings-This approach reveals the significant unseen, unrecognised and unacknowledged work that patients undertake to solve their health concerns.
Originality/value-De-centring the professional from the healthcare encounter allows us to understand why patients take particular pathways to care and how resources might be more appropriately leveraged to support both patients and professionals along this journey.
‘Post-national’ scholars have taken the extension of social rights to migrants that are normally accorded to citizens as evidence of the growing importance of norms of ‘universal personhood’ and the declining importance of the... more
‘Post-national’ scholars have taken the extension of social rights to migrants that are normally accorded to citizens as evidence of the growing importance of norms of ‘universal personhood’ and the declining importance of the nation-state. However, the
distinct approach taken by the state toward another understudied category of noncitizen – stateless people – complicates these theories by demonstrating that the state
makes decisions about groups on different bases than theory would suggest. These findings suggest the need to pay more attention to how the state treats other categories of ‘semi-citizens’. This article examines the differential effects of universal healthcare reforms in Thailand on citizens, migrants, and stateless people and explores their ramifications on theories of citizenship and social rights. While the state has expanded its healthcare obligations toward people living within its borders, it has taken a variegated approach toward different groups. Citizens have been extended ‘differentiated but unambiguous rights’. Migrants have been granted ‘conditional
rights’ to healthcare coverage, dependent on their status as registered workers who pay mandatory contributions. Large numbers of stateless people, however, saw their right to state welfare programs disenfranchised following passage of the new universal healthcare law before later being granted ‘contingent rights’ through a new program.
distinct approach taken by the state toward another understudied category of noncitizen – stateless people – complicates these theories by demonstrating that the state
makes decisions about groups on different bases than theory would suggest. These findings suggest the need to pay more attention to how the state treats other categories of ‘semi-citizens’. This article examines the differential effects of universal healthcare reforms in Thailand on citizens, migrants, and stateless people and explores their ramifications on theories of citizenship and social rights. While the state has expanded its healthcare obligations toward people living within its borders, it has taken a variegated approach toward different groups. Citizens have been extended ‘differentiated but unambiguous rights’. Migrants have been granted ‘conditional
rights’ to healthcare coverage, dependent on their status as registered workers who pay mandatory contributions. Large numbers of stateless people, however, saw their right to state welfare programs disenfranchised following passage of the new universal healthcare law before later being granted ‘contingent rights’ through a new program.
Objective: The lesbian patient population is underserved. Almost no research has examined the knowledge and attitudes of obstetrician-gynecologists toward lesbian health. Our study sought to address this research gap. Methods: All 910... more
Objective: The lesbian patient population is underserved. Almost no research has examined the knowledge and attitudes of obstetrician-gynecologists toward lesbian health. Our study sought to address this research gap. Methods: All 910 obstetrician-gynecologists licensed in Ontario, Canada, were mailed a true-false survey about lesbian health issues, the Homosexuality Attitudes Scale (HAS), and a demographic survey. Results: Of the 910 surveys, 271 were returned. The mean HAS score was 87.6 (standard deviation [SD] 11.5), indicating an overall positive attitude. The mean knowledge score was 76.0% (SD 9.5), indicating that respondents had adequate knowledge about lesbian health; 22% described their lesbian health knowledge-base as unaware. Most respondents reported lack of education on lesbian health in residency (81%) or medical school (78%). The majority reported a desire for formal education pertaining to lesbian health. There was no correlation between HAS and knowledge scores. Conclusions: Although our results indicate overall adequate knowledge about lesbian health issues, important knowledge gaps were identified. Medical school and residency training curricula should include formal education about lesbian health issues, particularly because most obstetrician-gynecologists report a desire to receive this information.
Background. In ensuring access to maternal health services, various strategies toward safer health practices and improved health service delivery are important ingredients to eliminate avoidable maternal deaths. A recent household survey... more
Background. In ensuring access to maternal health services, various strategies toward safer health practices and improved health service delivery are important ingredients to eliminate avoidable maternal deaths. A recent household survey showed that access to antenatal care (ANC) (89%) and facility-based delivery (FBD) (82.4%) in the Eastern Visayas region is significantly high, despite the extensive damage to over 500 health facilities caused by Typhoon Haiyan in November 2013. Postpartum care (PPC), however, was relatively low (37.4%). As these findings needed further elaboration, a qualitative study using focus groups was conducted.
Background: In the United Kingdom and worldwide, there is significant policy interest in improving the quality of care for patients with mental health disorders and distress. Improving quality of care means addressing not only the... more
Background: In the United Kingdom and worldwide, there is significant policy interest in improving the quality of care for patients with mental health disorders and distress. Improving quality of care means addressing not only the effectiveness of interventions but also the issue of limited access to care. Research to date into improving access to mental health care has not been strongly rooted within a conceptual model, nor has it systematically identified the different elements of the patient journey from identification of illness to receipt of care. This paper set out to review core concepts underlying patient access to mental health care, synthesise these to develop a conceptual model of access, and consider the implications of the model for the development and evaluation of interventions for groups with poor access to mental health care such as older people and ethnic minorities. Methods: Narrative review of the literature to identify concepts underlying patient access to mental health care, and synthesis into a conceptual model to support the delivery and evaluation of complex interventions to improve access to mental health care. Results: The narrative review adopted a process model of access to care, incorporating interventions at three levels. The levels comprise (a) community engagement (b) addressing the quality of interactions in primary care and (c) the development and delivery of tailored psychosocial interventions. Conclusions: The model we propose can form the basis for the development and evaluation of complex interventions in access to mental health care. We highlight the key methodological challenges in evaluating the overall impact of access interventions, and assessing the relative contribution of the different elements of the model.
Data from 162 mystery patient visits are shared with health care providers, administrators, and government officials in Douala.
The human right to the highest possible standard of mental and physical health applies to everyone, regardless of immigration status. This right imposes obligations on states to provide access to good quality healthcare, as well as other... more
The human right to the highest possible standard of mental and physical health applies to everyone, regardless of immigration status. This right imposes obligations on states to provide access to good quality healthcare, as well as other areas that affect health, including good housing. Refugees and asylum seekers are considered to be members of a population who are particularly vulnerable and in need of special protection. However, many of those who live in the UK, often find it difficult to exercise their right (EHRC, 2018a; EHRC, 2018b; EHRC, 2018c). This report explores the health experiences of refugees and asylum seekers in the Greater Nottingham area, whilst aiming to identify examples of best practice and areas for improvement.
Mental health in Bangladesh
In this paper, we present the most currently available data on real access to high quality diagnostic and curative and palliative care in Colombia, a middle income country with relatively recent large healthcare reforms. We will focus on... more
In this paper, we present the most currently available data on real access to high quality diagnostic and curative and palliative care in Colombia, a middle income country with relatively recent large healthcare reforms. We will focus on cancer types with a good average prognosis when detected and treated adequately and which are prioritized in national policies and cancer plans: cancers of the breast, cervix, prostate, colorectum and childhood cancers. These cancers have a quite poor prognosis compared to high-income countries. We find that, despite having achieved an almost " universal health coverage " , Colombia suffers serious problems in accessibility to preventative, diagnostic and treatment services for patients with cancer. People living in poverty have lower real access to all types of care, but other problems are due to lack of health literacy, beliefs and knowledge. Much can be gained by early detection, the advanced stages at diagnosis of many cancers can be avoided by increasing awareness amongst both the general public and health care professionals. Delays in diagnosis and treatment can be reduced, changes in legislation and bureaucratic processes, and increases in trained human resources and equipment is needed. The economic impact of getting a cancer diagnosis to patients and their families is understudied but seems to be substantial, as well as studies on quality of life of cancer patients and survivors-providing ample room for improvement.
Un'indagine antropologica sui percorsi dell'utenza e le esperienze degli operatori Report a cura di Carlotta Bagaglia e Chiara Polcri 2. Dal triage alla sala d'aspetto: punti di vista di utenti, infermieri e medici " 41 2.1 Opinioni sul... more
Un'indagine antropologica sui percorsi dell'utenza e le esperienze degli operatori Report a cura di Carlotta Bagaglia e Chiara Polcri 2. Dal triage alla sala d'aspetto: punti di vista di utenti, infermieri e medici " 41 2.1 Opinioni sul codice ricevuto e percezioni dell'attesa " 41 2.2. Operatori e utenti nella dimensione relazionale e comunicativa " 43 2.3. L'attesa: reazioni degli utenti e dinamiche fra operatori " 48 3. Un focus: la questione del medico di medicina generale " 58 3.1 Una breve premessa " 58 3.2 Le "voci" sul medico di medicina generale " 59 3.3 La "voce" del medico di medicina generale " 66 Conclusioni " 73 (Un breve riassunto / Qualche quesito / Alcune ipotesi di lavoro) Bibliografia " 80 Prologo: brevi storie degli utenti Giuliana è una studentessa fuori sede che arriva in Pronto soccorso con il fidanzato, ha bolle pruriginose sulla schiena. Appena comparso il problema, che imputa allo sfregamento di un nuovo indumento indossato in una giornata estiva molto calda, invia al proprio medico di medicina generale, operante nel comune di residenza della famiglia, alcune foto per chiedergli un consiglio. Il medico, dopo averle detto che probabilmente sono bolle da imputare a punture di insetto, a sudorazione o ad orticaria, le consiglia di comprare una pomata a base antistaminica. Giuliana segue le indicazioni ricevute senza trovare alcun sollievo e, durante la notte, chiama la Guardia Medica che le consiglia due opzioni: o si reca presso il loro servizio autonomamente o esce a comprare in una farmacia notturna antistaminico in gocce da assumere per via orale. Con l'aiuto del fidanzato la ragazza sceglie la seconda opzione ma, sopraggiunta la mattina, dopo avere preso due dosi di farmaco, la sua situazione di salute non è affatto migliorata, anzi, le bolle sono aumentate e il prurito è divenuto insopportabile. Non sapendo cos'altro fare i ragazzi chiamano il 118 che, vista la situazione, gli consiglia di recarsi in Pronto soccorso autonomamente (dove la prestazione, le dicono, sarà gratuita), di aspettare che entri di nuovo in funzione la Guardia Medica o altrimenti, di rivolgersi ad un medico di medicina generale della zona che, privatamente, potrebbe recarsi presso il domicilio. I ragazzi, grazie al passaggio in auto di un amico, decidono di recarsi in Pronto soccorso. Giuliana non si percepisce in ansia, ha necessità però di dare un senso a quello che sta vivendo e risolvere il problema il prima possibile. Mauro, imprenditore di Assisi che lavora a Perugia, arriva in Pronto soccorso con un forte dolore all'orecchio sinistro, dovuto, lui pensa, ad un tappo di cerume che ha fatto infezione e che può aver creato un problema più serio. Durante la mattinata ha chiamato tre volte, senza trovarlo, il suo medico di medicina generale e, nel pomeriggio, come seconda opzione, ha scelto di recarsi in ospedale. Nel descrivere i motivi dell'accesso al Santa Maria della Misericordia Mauro sottolinea la vicinanza dal luogo di lavoro e la consapevolezza di trovare un otorino disponibile, qualora la situazione lo necessiti. Individuare una soluzione rapida al dolore acuto che sta provando è l'obiettivo che si dà; è pronto a pagare la prestazione e a ricevere un ri-orientamento da parte del servizio. Sebastiano è un giovane ragazzo colombiano trasferitosi in Italia da circa quindici anni che giunge in Pronto soccorso per un forte dolore all'orecchio destro dal quale esce materiale purulento. Qualche giorno prima è andato al fiume per trovare refrigerio e, dopo aver fatto molti tuffi, ha iniziato a sentire fastidio all'orecchio. Nei tre o quattro giorni successivi il fastidio è andato aumentando, l'orecchio s'è gonfiato e ha cominciato ad uscire pus. La sera precedente al colloquio, non sapendo più che fare ed essendo aumentato il dolore, ha deciso che all'indomani, con calma ed evitando di passare una notte in ospedale, si sarebbe recato in Pronto soccorso. Nel frattempo, per tamponare la situazione e sulla scorta di un'esperienza precedente, ha assunto un analgesico e una dose di antibiotico. Non contatta né il medico di medicina generale né la Guardia Medica e preferisce recarsi in Pronto soccorso autonomamente, con i mezzi pubblici. Livia giunge in Pronto soccorso molto preoccupata ed in ansia perché avverte un grosso fastidio nella deglutizione che non le permette di respirare bene. La sera precedente, dopo aver mangiato sushi, ha iniziato a soffrire di un forte prurito alle gambe e le si è gonfiata la gola. Ha contattato il medico di medicina generale che, dopo aver tentato di tranquillizzarla, le ha consigliato di recarsi in Pronto soccorso. Livia si auto definisce una persona ipocondriaca che avrebbe preferito essere visitata dal proprio medico, anziché fare la fila in ospedale. Nelle ore precedenti all'accesso avrebbe voluto prendere del cortisone ma, non avendo la prescrizione, non ha potuto comprarlo. Subito dopo il colloquio lascia il Pronto soccorso e decide di recarsi nell'ambulatorio del medico. Maria è una signora sessantaseienne che si reca in Pronto soccorso per un dolore al ginocchio a causa di una caduta del giorno precedente. Il trauma è andato a peggiorare una situazione già precaria che da anni a causa di un'osteoartrite. Si reca in ospedale nel pomeriggio, con calma, dopo aver pranzato, per vedere se può trovare risposta al suo problema. Convinta che esista un Pronto soccorso ortopedico, si dirige direttamente al reparto di ortopedia chiedendo di essere visitata. Con suo grande rammarico viene reindirizzata al Pronto soccorso generale dove dovrà sottoporsi al triage ed attendere il suo turno. Dopo il colloquio non è certa se rimarrà ad attendere perché è molto stanca di aspettare. 2 Gabriel è un uomo adulto originario del Perù che vive a Perugia da circa 18 anni. Arriva in Pronto soccorso con un braccio molto dolorante in seguito ad una caduta da una scala avvenuta una settimana prima. Subito dopo l'incidente, convinto che non fosse nulla di grave, ha applicato del ghiaccio al braccio ed ha lasciato che il dolore si esaurisse nel tempo. Contrariamente alla sua ipotesi il dolore, anziché diminuire, è aumentato, il braccio s'è gonfiato e ha perso la mobilità a due dita. E' molto preoccupato di aver rotto qualcosa e ha deciso di andare direttamente in Pronto soccorso convinto che il medico di medicina generale, che non ha contatto, l'avrebbe inviato in ospedale per fare una radiografia. Elisa è una studentessa fuori sede che vive a Perugia da alcuni anni. Arriva in Pronto soccorso con un'amica dopo essersi svegliata la mattina con un bernoccolo in testa e altre parti del corpo doloranti. La ragazza è molto spaventata perché ha un vuoto di memoria e non ha idea di come possa essersi ferita. L'ultimo ricordo che ha risale alla sera precedente quando, dopo una cena fra amici in pizzeria, è stata accompagnata a pochi passi da casa. Non ha bevuto e non ha assunto droghe e l'amica che era con lei le ha confermato come durante la serata non sia accaduto nulla di particolare. Prima di accedere in Pronto soccorso s'è recata all'Adisu (Agenzia per il diritto allo studio universitario dell'Umbria) in cerca di un medico e, non trovando nessuno disponibile, è andata al Consultorio -suo usuale punto di riferimento -senza riuscire a parlare con nessuno (lo trova chiuso). Non è certa che rimarrà, dopo l'intervista; l'infermiere al triage l'ha molto tranquillizzata e valuta, dunque, di tornare a casa. Rosa è una signora di mezza età che la mattina precedente ha avuto un piccolo infortunio sul lavoro: mentre scendeva da una pedana ha messo male la gamba ed ora sente molto dolore ad un ginocchio. Subito dopo l'incidente, convinta non fosse nulla di importante e che sarebbe bastato un pomeriggio di riposo, è andata a casa e ha applicato del ghiaccio sulla parte dolorante. La mattina seguente ha contattato il suo medico di medicina generale che le ha vivamente consigliato di andare al Pronto soccorso così da permettergli di aprire una pratica Inail per infortunio. Secondo il parere del medico, infatti, in questo modo sarebbe stata maggiormente tutelata rispetto alle eventuali complicazioni future. La signora, in disaccordo con il medico e non volendo creare problemi all'azienda nella quale è impiegata, ha proposto di risolvere la questione andando privatamente a fare una radiografia, per decidere in un secondo momento l'eventuale denuncia all'ente preposto. Persuasa, infine, dal suo medico ad andare in ospedale, è giunta in Pronto soccorso accompagnata in auto dalla figlia. Neide è una pittrice brasiliana in Italia dal 2007; è separata da qualche tempo dal marito (italiano) e vive sola a Perugia. Il giorno prima mentre era in centro a piedi è caduta, inciampando in una buca, e sbattendo la testa, l'addome, i seni e il ginocchio. Il dolore acuto alla testa e specialmente ad uno dei due seni la tiene sveglia tutta la notte e la mattina, subito dopo essersi svegliata, sviene. Decide così di recarsi in farmacia dove le danno garze e disinfettante per le numerose escoriazioni che presenta. Con la speranza che il dolore passi, torna a casa ma, sempre più dolorante e preoccupata che la caduta possa aver creato un danno importante al capo e ai seni, recanti protesi, decide di chiamare un conoscente e, in serata, si fa accompagnare in Pronto soccorso. In ospedale, dice, le fanno una puntura di Voltaren e la rimandano a casa con l'indicazione di tornare, qualora il dolore non fosse diminuito. Ma, trascorsa un'altra notte insonne e sempre più preoccupata per il dolore alla testa che la riporta all'esperienza del padre, morto in Brasile a seguito di un trauma cranico, torna in ospedale con la speranza che possano farle esami diagnostici più approfonditi. Mentre si sta recando al lavoro Dalia, originaria della Romania, ha un'incidente stradale. In seguito ad una brusca frenata subisce un tamponamento che le provoca un forte mal di testa, dolore al collo e nausea. E' impiegata come personale di servizio presso una famiglia...
Introduction: Patients and the public are beginning to use digital health tools to assist in managing chronic illness, support independent living and self-care, and remain connected to health and care providers. However, engaging with and... more
Introduction: Patients and the public are beginning
to use digital health tools to assist in managing
chronic illness, support independent living and
self-care, and remain connected to health and care
providers. However, engaging with and enrolling in
digital health interventions, such as telehealth
systems, mobile health applications, patient portals
and personal health records, in order to use them
varies considerably. Many factors affect people’s
ability to engage with and sign up to digital health
platforms.
Objectives: The primary aim is to identify the
barriers and facilitators patients and the public
experience to engagement and recruitment to digital
health interventions. The secondary aim is to identify
engagement and enrolment strategies, leading if
possible to a taxonomy of such approaches, and a
conceptual framework of digital health engagement
and recruitment processes.
Methods: A systematic review of qualitative studies
will be conducted by searching six databases:
MEDLINE, CINAHL, PubMed, EMBASE, Scopus and
the ACM Digital Library for papers published between
2000 and 2015. Titles and abstracts along with
full-text papers will be screened by two independent
reviewers against predetermined inclusion and
exclusion criteria. A data extraction form will be used
to provide details of the included studies. Quality
assessment will be conducted using the Consolidated
Criteria for Reporting Qualitative Research checklist.
Any disagreements will be resolved through
discussion with an independent third reviewer.
Analysis will be guided by framework synthesis and
informed by normalization process theory and
burden of treatment theory, to aid conceptualisation
of digital health engagement and recruitment
processes.
Discussion: This systematic review of qualitative
studies will explore factors affecting engagement and
enrolment in digital health interventions. It will
advance our understanding of readiness for digital
health by examining the complex factors that affect
patients’ and the public’s ability to take part.
to use digital health tools to assist in managing
chronic illness, support independent living and
self-care, and remain connected to health and care
providers. However, engaging with and enrolling in
digital health interventions, such as telehealth
systems, mobile health applications, patient portals
and personal health records, in order to use them
varies considerably. Many factors affect people’s
ability to engage with and sign up to digital health
platforms.
Objectives: The primary aim is to identify the
barriers and facilitators patients and the public
experience to engagement and recruitment to digital
health interventions. The secondary aim is to identify
engagement and enrolment strategies, leading if
possible to a taxonomy of such approaches, and a
conceptual framework of digital health engagement
and recruitment processes.
Methods: A systematic review of qualitative studies
will be conducted by searching six databases:
MEDLINE, CINAHL, PubMed, EMBASE, Scopus and
the ACM Digital Library for papers published between
2000 and 2015. Titles and abstracts along with
full-text papers will be screened by two independent
reviewers against predetermined inclusion and
exclusion criteria. A data extraction form will be used
to provide details of the included studies. Quality
assessment will be conducted using the Consolidated
Criteria for Reporting Qualitative Research checklist.
Any disagreements will be resolved through
discussion with an independent third reviewer.
Analysis will be guided by framework synthesis and
informed by normalization process theory and
burden of treatment theory, to aid conceptualisation
of digital health engagement and recruitment
processes.
Discussion: This systematic review of qualitative
studies will explore factors affecting engagement and
enrolment in digital health interventions. It will
advance our understanding of readiness for digital
health by examining the complex factors that affect
patients’ and the public’s ability to take part.
Introduction: There are different dimensions of access to healthcare services – availability, accessibility, accommodation, affordability, and acceptability. The aim of the study is to analyze these different dimensions of access to... more
Introduction: There are different dimensions of access to healthcare services – availability, accessibility, accommodation, affordability, and acceptability. The aim of the study is to analyze these different dimensions of access to healthcare services in Northeast region in Bulgaria.
Material and Methods: Data from inquiry are used to analyse the access to healthcare services. The inquiry is conducted in 2014 among 618 citizens of Northeast region in Bulgaria.
Results and discussion: Access to healthcare services depends largely on the domicile of the respondents. There are barriers even with primary care, which create restrictions on the use of other types of healthcare services. Half of the respondents living in villages declares that their access to general practitioner is limited. In addition to the financial burden, a barrier to access to specialized medical care is also the lack of referrals for examinations or diagnostic tests. The barriers to physical accessibility lead to financial and time restrictions, which turn in reasons for postponing the usage of medical care.
Conclusion: The findings show that there are differences in access to the healthcare system, depending both on the place of residence and on the income of respondents, which are an example of health inequities. The „construction“ of the regional healthcare system affects the access of the population to healthcare, which in turn is a prerequisite for reducing or exacerbating the inequity.
Material and Methods: Data from inquiry are used to analyse the access to healthcare services. The inquiry is conducted in 2014 among 618 citizens of Northeast region in Bulgaria.
Results and discussion: Access to healthcare services depends largely on the domicile of the respondents. There are barriers even with primary care, which create restrictions on the use of other types of healthcare services. Half of the respondents living in villages declares that their access to general practitioner is limited. In addition to the financial burden, a barrier to access to specialized medical care is also the lack of referrals for examinations or diagnostic tests. The barriers to physical accessibility lead to financial and time restrictions, which turn in reasons for postponing the usage of medical care.
Conclusion: The findings show that there are differences in access to the healthcare system, depending both on the place of residence and on the income of respondents, which are an example of health inequities. The „construction“ of the regional healthcare system affects the access of the population to healthcare, which in turn is a prerequisite for reducing or exacerbating the inequity.
- by Maria Rohova and +2
- •
- Access to health services
People in midlife and later life are enjoying diverse types of intimate relationships and sexual expression outside hetero-monogamy, yet these relationships are largely invisible and not recognised in planning, policy or health care. In a... more
People in midlife and later life are enjoying diverse types of intimate relationships and sexual expression outside hetero-monogamy, yet these relationships are largely invisible and not recognised in planning, policy or health care. In a climate of social and demographic changes, relationship types and ways of living intimate citizenship in Australia are expanding. The focus of this research is rural Australians in midlife: past research on friends-with-benefits relationships (FWBR) has been mostly conducted in North America using convenience college student populations.
The experience of 22 Australian rural baby boomers in FWBR is explored using in-depth interviews to identify the effect of the relationships on their wellbeing, their beliefs about sexual health risks, and use of sexual health services. Thematic analysis of interview transcripts provides empirical evidence about midlife relationships. The FWBR was a positive experience with participants reporting independence, increased agency and more enjoyable sexual experiences in midlife. Participants’ beliefs about sexual health risk varied, as did their access to sexual health services. Living in a rural location has implications for privacy, confidentiality and fear of stigma from having a non-traditional relationship, and for some participants health service access is limited. Findings are located in wider fields of social change in relationships, including intimate citizenship; and midlife and older adult sexuality and sexual health.
This research contributes empirical evidence that reveals the diversity and complexity of midlife FWBR, and is the basis for policy, practice and research recommendations. Midlife and older adults are expected to contribute to the community and economy well into later life. To ensure optimal wellness, sexual health must be considered in their overall health care and there is a need for community awareness of, and respect for, diverse relationships.
The experience of 22 Australian rural baby boomers in FWBR is explored using in-depth interviews to identify the effect of the relationships on their wellbeing, their beliefs about sexual health risks, and use of sexual health services. Thematic analysis of interview transcripts provides empirical evidence about midlife relationships. The FWBR was a positive experience with participants reporting independence, increased agency and more enjoyable sexual experiences in midlife. Participants’ beliefs about sexual health risk varied, as did their access to sexual health services. Living in a rural location has implications for privacy, confidentiality and fear of stigma from having a non-traditional relationship, and for some participants health service access is limited. Findings are located in wider fields of social change in relationships, including intimate citizenship; and midlife and older adult sexuality and sexual health.
This research contributes empirical evidence that reveals the diversity and complexity of midlife FWBR, and is the basis for policy, practice and research recommendations. Midlife and older adults are expected to contribute to the community and economy well into later life. To ensure optimal wellness, sexual health must be considered in their overall health care and there is a need for community awareness of, and respect for, diverse relationships.
This dissertation examines the ways in which a specific social and linguistic field around the sex trade shapes access to and experiences with health and social services for transgender and cisgender women and non-binary sex workers and... more
This dissertation examines the ways in which a specific social and linguistic field around the sex trade shapes access to and experiences with health and social services for transgender and cisgender women and non-binary sex workers and experiential people in Winnipeg, the capital city of the Midwestern Canadian province, Manitoba, on Treaty One. It is the result of over 5 years of ethnographic engagement with sex worker rights activists, services providers, stakeholders and public and private events, meetings and discussions focused on sex trade political action and reform, and 52 in-depth interviews with workers, experiential people and stakeholders. The sex workers and experiential people I spoke to asked plainly for service providers to do better in terms of caring for them and meeting them where they are, highlighting the need for specialized services that are tailored to participants’ priorities and lived realities. The findings also call for the general training of service providers that addresses the complexity of the sex trade, the principles of harm reduction, and anti-racism. Beyond strict and sometimes mandatory categories of experiences in sex work and the sex trade, there is a need to recognize individual experiences, goals, and the harms they might identify in their lives. Grounded in extensive ethnographic field data, my results also reveal the complex field of power relations that play out in the sex trade industry in Winnipeg, and how these power relations get enacted through various linguistic deployments to structure the conditions of access to social and political support networks and resources. I argue that the redeployment of linguistic signifiers, such as “sex worker”, “sex trade worker”, “sexually exploited person”, “prostituted women”, “human trafficking survivor”, open up a polarizing moral field that people have to navigate to get their health and social services needs met. This turbulent and irreconcilable social field is an effect of what I refer to as deliberative identities. I use this concept to go beyond dominating and restrictive dichotomies—as either ‘empowered’ or ‘victims’—that too often populate public health, health policy and media representations of sex workers, their bodies, their agentive capacities, and their social positionings.
Background: While numerous studies have shown the positive impact of free healthcare policies, the ethical issues raised by these policies in low-income countries have received little attention. In Burkina Faso, in July 2016, user fees... more
Background: While numerous studies have shown the positive impact of free healthcare policies, the ethical issues raised by these policies in low-income countries have received little attention. In Burkina Faso, in July 2016, user fees were removed at healthcare facilities for children under 59 months of age and for “mothers”, i.e., for reproductive care. These eligibility criteria are, reportedly, sometimes difficult to comprehend or to enforce. The purpose of this study is twofold: 1) to understand the perceptions and practices of health workers and beneficiaries regarding compliance with eligibility criteria for free care and 2) to explore the ethical tensions that have arisen and possible ways of resolving them. Methodology: In late 2018, a crosssectional qualitative study was conducted in five rural communities in Boulsa, Burkina Faso. Semi-directed individual interviews were conducted with healthcare personnel (n=10) and mothers of young children (n=10) who were purposefully selected with the assistance of community health workers. Interviews were recorded and transcribed. A thematic content analysis was conducted on all materials. Themes were identified, discussed and reformulated between team members. Results: The study reveals the presence of practices to circumvent strict compliance with the eligibility criteria for free access. Common circumventing practices include hiding the exact age of children aged 60 months or older and using eligible persons for stockpiling drugs or for receiving a free consultation for the benefit of other household members. These practices result from ethical and economic tensions experienced by the beneficiaries. But they also raise ethical dilemmas for healthcare providers since they have to enforce compliance with the eligibility criteria while realizing the financially precarious position of the households. Informal mechanisms are introduced at the community level to reconcile the healthcare providers’ dissonance. Conclusion: The implementation of the user fee abolition policy in Burkina Faso is being carried out through local reinvention mechanisms to overcome ethical tensions related to the compliance with the eligibility criteria.
Together these stories, from healthcare providers and community members paint a picture of not only a community facing many barriers to care, including racial discrimination, but one that has a clear vision for healing and reconciliation.... more
Together these stories, from healthcare providers and community members paint a picture of not only a community facing many barriers to care, including racial discrimination, but one that has a clear vision for healing and reconciliation. To overcome harmful stereotypes, misinformation, mistaken assumptions, and indifference, many are working to build stronger patient-provider relationships, mutual understanding, and respect. This study highlights the importance of addressing racial discrimination, cultural beliefs, and community assets when working towards health and healthcare equity for the Chuukese. Lessons learned may be relevant for other Micronesian, Pacific Islander, and indigenous communities.
In virtually all rural areas in Ontario the limited transportation alternatives means that rural residents without access to a personal vehicle are at great risk of transportation disadvantage. The primary research method for this... more
In virtually all rural areas in Ontario the limited transportation alternatives means that rural residents without access to a personal vehicle are at great risk of transportation disadvantage. The primary research method for this research involved testing a transportation disadvantage framework using fourteen Key Informant Interviews undertaken with service providers operating within the case study of Huron County. The research found that residents within five demographic groups are at risk of transportation disadvantage within Huron County: older adults, those with physical or mental disabilities, youth, low-income households, and women. The research confirmed that transportation disadvantage exists on a continuum with some groups more disadvantaged than others, but also within groups with some accessibility needs more attainable than others. The research concludes with suggestions for a public transportation system to improve unmet transportation needs in Huron County along with recommendations for improving transportation access within the county.
This article contributes new insights into how refugees, asylum seekers and undocumented migrants experience access to healthcare in the UK from both the perspective of caseworker volunteers and the assessment of policy regulations that... more
This article contributes new insights into how refugees, asylum seekers and undocumented migrants experience access to healthcare in the UK from both the perspective of caseworker volunteers and the assessment of policy regulations that influence such experiences. Drawing on material taken from qualitative interviews conducted with Doctors of the World caseworkers and Freedom of Information documents from NHS trusts, we reveal the various complexities faced by refugees, asylum seekers and undocumented migrants when trying to access vital health care. These issues include, charging regulations, the refusal to register patients at GP practices without proof of ID, language barriers and complications navigating the healthcare system. We found that such deterrents lead to risky help and health seeking, lack of or inadequate healthcare, and worse health outcomes among these populations. DOTW caseworkers perceived policies such as charging regulations, to be unjust as they plunge patients into significant debt, which is reported to the Home Office and can lead to the detainment or deportation of patients and their families. Study participants called on the UK government to recognise health as a fundamental human right, to develop inclusive social policy and to create an empathetic health system that allows refugees, asylum seekers and undocumented migrants equitable access to health and social services. To achieve health for all, they argued the need for clearer guidelines regarding access to healthcare and charging regulations, with some suggesting the importance of revising current Department of Health and Social Care policies and Home Office measures. Our article concludes that there is a need to tackle the underlying causes of ill health, including discriminatory policies, racism, and exclusion; addressing the social and economic determinants of health; and providing meaningful and culturally sensitive healthcare and social support.
"The purpose of this paper is to organize and summarize existing information on delayed medical attention for women with breast cancer and identify research needs in this area. This review is organized in six parts: I) origins and... more
"The purpose of this paper is to organize and summarize
existing information on delayed medical attention for women
with breast cancer and identify research needs in this area.
This review is organized in six parts: I) origins and permanence
of the message “do not delay” medical attention for potential
cancer symptoms; II) definition and classification of breast
cancer delay; III) impact of delay on breast cancer prognosis;
IV) factors related to breast cancer delay and the ways these
have been studied; V) the study of breast cancer delay in
Mexico; and VI) directions for future research in developing
countries, with a special focus on Mexico. We point out the
need of a more integral study of delay that takes into account
socio-structural and health services factors, in order to find
modifiable factors towards which political actions should
be directed to improve breast cancer medical attention in
underdeveloped countries."
existing information on delayed medical attention for women
with breast cancer and identify research needs in this area.
This review is organized in six parts: I) origins and permanence
of the message “do not delay” medical attention for potential
cancer symptoms; II) definition and classification of breast
cancer delay; III) impact of delay on breast cancer prognosis;
IV) factors related to breast cancer delay and the ways these
have been studied; V) the study of breast cancer delay in
Mexico; and VI) directions for future research in developing
countries, with a special focus on Mexico. We point out the
need of a more integral study of delay that takes into account
socio-structural and health services factors, in order to find
modifiable factors towards which political actions should
be directed to improve breast cancer medical attention in
underdeveloped countries."
Trade- Related Aspects of Intellectual Property Rights (TRIPS) Agreement, 1995 established synergy with human rights laws in realization of right to health, and access to medicine and sustainable development. The Doha Declaration on... more
Trade- Related Aspects of Intellectual Property Rights (TRIPS) Agreement, 1995 established synergy with human rights laws in realization of right to health, and access to medicine and sustainable development. The Doha Declaration on Public Health, 2001; Sustainable Development Goals, 2015-2030 and United Nations Secretary- General’s High- Level Panel on Access to Medicines Report, 2016 promote innovation of health technologies in developing countries. It is estimated that 75 per cent of the world’s population is health deficient and medicine starved due to patenting requirement of pharmaceutical industries. India passed Patents (Amendment) Act, 2005 dealing with exclusive marketing right, product patent and process patent to protect the interest of the generic drugs in compliance of TRIPS Agreement, 1995 under public interest. In post Patents (Amendment) Act, 2005 phase India faced formidable challenge of the Swiss drug maker Novartis’ patent application for Gleevec in Madras High Court, 2006; Intellectual Property Appellate Board (IPAB) in 2009 and Supreme Court in 2013. The judicial exuberance struck a balance between patent right, health right and access to medicine in Indian socio-economic context. It is followed by spelling out of the National Intellectual Property Right (IPR) Policy, 2016 focused on enhancing access to healthcare as human right.
This qualitative study looked at the availability and adequacy of reproductive health services for young people during and post conflict settings. Four (4) Focus Group Discussions with both in and out- of school youths were carried out as... more
This qualitative study looked at the availability and adequacy of reproductive health services for young people during and post conflict settings. Four (4) Focus Group Discussions with both in and out- of school youths were carried out as well as nine (9) key informant interviews with service providers and policy makers. The study was carried out in both rural and semi-urban settings to provide the dynamics between these two settings and a holistic approach to understanding their different scenario.
This study provided an overview of the various proportions of barriers to access to reproductive health care during and post conflict settings in Amuru district, Northern Uganda using “the Access Model” (availability, access, affordability, acceptability and accommodation) and highlight existing interventions designed to overcome these barriers. There was no distinct difference from the perspective of in-school and out-of school youths to availability and adequacy of youth friendly and gender sensitive reproductive health services. Young people felt they have been neglected in participating in issues affecting them especially as it relates to their sexuality. The findings imply that a blend of interventions is required to tackle specific access barriers but that their effectiveness and efficiency can be influenced by related factors.
This study provided an overview of the various proportions of barriers to access to reproductive health care during and post conflict settings in Amuru district, Northern Uganda using “the Access Model” (availability, access, affordability, acceptability and accommodation) and highlight existing interventions designed to overcome these barriers. There was no distinct difference from the perspective of in-school and out-of school youths to availability and adequacy of youth friendly and gender sensitive reproductive health services. Young people felt they have been neglected in participating in issues affecting them especially as it relates to their sexuality. The findings imply that a blend of interventions is required to tackle specific access barriers but that their effectiveness and efficiency can be influenced by related factors.
Objective : To describe sexual and reproductive health (SRH) needs of female sex workers (FSWs) to inform the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention in this population. Design and setting : The ANRS... more
Objective : To describe sexual and reproductive health (SRH) needs of female sex workers (FSWs) to inform the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention in this population.
Design and setting : The ANRS 12361 PrEP-CI cross-sectional and mixed-methods study was designed and implemented with two community-based organisations in Côte d’Ivoire.
Participants : A convenience sample of 1000 FSWs aged ≥18, not known as HIV-positive, completed a standardised questionnaire assessing sociodemographic characteristics, sexual practices, use of community health services and a priori acceptability of PrEP. Twenty-two indepth interviews and eight focus group discussions were also conducted to document FSWs’ risky practices and sexual behaviours, experiences with violence and discrimination, attitudes regarding HIV and sexually transmitted infections (STIs), and barriers to SRH services.
Results : Although 87% described consistent condom use with clients, more than 22% declared accepting condomless sexual intercourse for a large sum of money. Furthermore, condom use with their steady partner and knowledge of their partner’s HIV status were low despite their acknowledged concurrent sexual partnerships. While inconsistent condom use exposed FSWs to STIs and undesired pregnancies, the prevalence of contraceptive strategies other than condoms was low (39%) due to fear of contraception causing sterility. FSWs faced obstacles to accessing SRH care and preferred advice from their peers or self-medication.
Conclusions : Despite adoption of preventive behaviour in most cases, FSWs are still highly exposed to HIV. Furthermore, FSWs seem to face several barriers to accessing SRH. Implementing PrEP among FSWs in West Africa, such as in Côte d’Ivoire, constitutes an opportunity to consider the regular follow-up of HIV-negative FSWs. PrEP initiation should not condition access to SRH services; conversely, SRH services could be a way to attract FSWs into HIV prevention. Our results highlight the importance of developing a people-focused approach that integrates all SRH needs when transitioning from PrEP efficacy trials to implementation.
Design and setting : The ANRS 12361 PrEP-CI cross-sectional and mixed-methods study was designed and implemented with two community-based organisations in Côte d’Ivoire.
Participants : A convenience sample of 1000 FSWs aged ≥18, not known as HIV-positive, completed a standardised questionnaire assessing sociodemographic characteristics, sexual practices, use of community health services and a priori acceptability of PrEP. Twenty-two indepth interviews and eight focus group discussions were also conducted to document FSWs’ risky practices and sexual behaviours, experiences with violence and discrimination, attitudes regarding HIV and sexually transmitted infections (STIs), and barriers to SRH services.
Results : Although 87% described consistent condom use with clients, more than 22% declared accepting condomless sexual intercourse for a large sum of money. Furthermore, condom use with their steady partner and knowledge of their partner’s HIV status were low despite their acknowledged concurrent sexual partnerships. While inconsistent condom use exposed FSWs to STIs and undesired pregnancies, the prevalence of contraceptive strategies other than condoms was low (39%) due to fear of contraception causing sterility. FSWs faced obstacles to accessing SRH care and preferred advice from their peers or self-medication.
Conclusions : Despite adoption of preventive behaviour in most cases, FSWs are still highly exposed to HIV. Furthermore, FSWs seem to face several barriers to accessing SRH. Implementing PrEP among FSWs in West Africa, such as in Côte d’Ivoire, constitutes an opportunity to consider the regular follow-up of HIV-negative FSWs. PrEP initiation should not condition access to SRH services; conversely, SRH services could be a way to attract FSWs into HIV prevention. Our results highlight the importance of developing a people-focused approach that integrates all SRH needs when transitioning from PrEP efficacy trials to implementation.
Thematic report on the situation of Roma This report summarises the results of the large-scale survey conducted as part of the project 'Novel Approaches to Generating Data on hard-to-reach populations at risk of violation of their... more
Thematic report on the situation of Roma This report summarises the results of the large-scale survey conducted as part of the project 'Novel Approaches to Generating Data on hard-to-reach populations at risk of violation of their rights'. The project was funded under the European Economic Area Financial Mechanism 2014-2021 (EEA FM) under call BGLD-3.001, programme 'Local development, poverty reduction and enhanced inclusion of vulnerable groups'.
Background: Low back pain (LBP) is a common cause of disability and is ranked as the most burdensome health condition globally. Self-management, including components on increased knowledge, monitoring of symptoms, and physical activity,... more
Background: Low back pain (LBP) is a common cause of disability and is ranked as the most burdensome health condition globally. Self-management, including components on increased knowledge, monitoring of symptoms, and physical activity, are consistently recommended in clinical guidelines as cost-effective strategies for LBP management and there is increasing interest in the potential role of digital health.
In recent years, the attention in transportation planning has shifted from the analysis of congestion to the analysis of accessibility. Among others, this change draws the attention to the classical distributive question in... more
In recent years, the attention in transportation planning has shifted from the analysis of congestion to the analysis of accessibility. Among others, this change draws the attention to the classical distributive question in transportation: who reaps the accessibility benefits from investments in the transport system? The answer to this question will in part depend on the accessibility measure that is chosen. Hence, a careful consideration of the accessibility measure(s) to be used in the evaluation of transport policies and projects is of the utmost importance. This paper contributes to this search for sound accessibility measures by delving into the vast literature on social justice. Starting from the classical debate on ‘equality of welfare’ versus ‘equality of resources’, the paper critically reflects on the usefulness of a variety of accessibility measures. This search results in the elimination of a number of widely used measures, which, based on the philosophical arguments presented in the paper, are considered unsuitable as an indicator for the analysis of the distribution of accessibility benefits over population groups or geographical areas.
The interpretation of access has been a subject of debate in health care as well as a major concern in health policy formulation especially in the area of health care reform. Access to health care studies had focused mainly on limited... more
The interpretation of access has been a subject of debate in health care as well as a major concern in health policy formulation especially in the area of health care reform. Access to health care studies had focused mainly on limited elements of geographic access and financial access, and many used health care utilization as proxy of access. Scarce studies had examined access per se. This review aims to examine the concept of access within health care financing through a conceptual framework that views access as empowerment and a multidimensional concept of affordability, availability and acceptability resulting from the interaction of health system and the client. Review of 40 original and review articles on access to health care within health care financing was conducted. The review reveals that most studies agree on both financial and non-financial factors affecting access within health care financing but showed a wide non-recognition of the interaction of affordability, acceptability and availability dimensions that determines access. Some evidence of empowerment, resulting from this interaction were reported but an elaboration of its relation to community participation is suggested. Recognition of the multi-dimensional concept and its interaction is suggested as basis of conceptualization of access that inform health policy change for better health care access.
Στην Έκθεση αυτή του έργου "Συμμετοχική Προσέγγιση για την Ευαισθητοποίηση και Καταπολέμηση των Διακρίσεων βάσει του Σεξουαλικού Προσανατολισμού και της Ταυτότητας Φύλου στον τομέα της υγείας - PARADISO" (με χρηματοδότηση της Γ.Γ. Έρευνας... more
Στην Έκθεση αυτή του έργου "Συμμετοχική Προσέγγιση για την Ευαισθητοποίηση και Καταπολέμηση των Διακρίσεων βάσει του Σεξουαλικού Προσανατολισμού και της Ταυτότητας Φύλου στον τομέα της υγείας - PARADISO" (με χρηματοδότηση της Γ.Γ. Έρευνας & Καινοτομίας, Κ/Ε 81012), επιχειρώ - μέσω ποιοτικής κοινωνιολογικής έρευνας πεδίου - να αναδείξω τις πιθανές προκλήσεις και τα εμπόδια που αντιμετώπισαν και αντιμετωπίζουν τα ΛΟΑΤΚΙ+ άτομα στην Ελλάδα όσον αφορά την πρόσβασή τους στο εθνικό σύστημα υγείας και τη λήψη των υπηρεσιών υγείας κατά την περίοδο της πανδημίας του κορωνοϊού Covid-19, καθώς και η ανάπτυξη ολοκληρωμένων προτάσεων πολιτικής προς τους αρμόδιους θεσμικούς φορείς για τη διασφάλιση της ισότιμης και απρόσκοπτης πρόσβασης τους σε ποιοτικές υπηρεσίες υγείας.
Ειδικότερα, στόχοι της έρευνας είναι, πρωτίστως μέσα από την διεξαγωγή ποιοτικής κοινωνιολογικής έρευνας και, δευτερευόντως, μέσω βιβλιογραφικής επισκόπησης:
- η διερεύνηση των αναγκών υγείας των ΛΟΑΤΚΙ+ ανθρώπων σε συνάρτηση με τον σεξουαλικό προσανατολισμό, την ταυτότητα ή τα χαρακτηριστικά φύλου τους και της πιθανής αλλαγής /μεταβολής αυτών κατά την διάρκεια της πανδημίας
- η διερεύνηση της πρόσβασης των ΛΟΑΤΚΙ+ ανθρώπων στο εθνικό σύστημα υγείας και στη χρήση των υπηρεσιών του πριν και κατά τη διάρκεια της πανδημίας, ο εντοπισμός πιθανών διαφορών στην προπανδημική και στην πανδημική περίοδο, καθώς και των πιθανών κενών και προκλήσεων στην πρόσβαση των ΛΟΑΤΚΙ+ ανθρώπων σε υπηρεσίες υγείας κατά την πανδημική περίοδο
- η διερεύνηση της ανταπόκρισης του ελληνικού κράτους (αλλά και φορέων της κοινωνίας των πολιτών και του ιδιωτικού τομέα υγείας) στην κρίση δημόσιας υγείας, εστιάζοντας στην κάλυψη των αναγκών υγείας των ΛΟΑΤΚΙ+ ατόμων και η συλλογή βέλτιστων πρακτικών, θετικών μέτρων ή πρωτοβουλιών (αν υπάρχουν) - τόσο από το κράτος όσο και από φορείς της κοινωνίας των πολιτών και τον ιδιωτικό τομέα – αναφορικά με την παροχή υπηρεσιών υγείας σε ΛΟΑΤΚΙ+ άτομα κατά τη διάρκεια της πανδημίας στην Ελλάδα
- η ανάπτυξη στοχευμένων προτάσεων πολιτικής με βάση τα ευρήματα της έρευνας πεδίου, για την διασφάλιση της απρόσκοπτής και ισότιμης πρόσβασης και μεταχείρισης των ΛΟΑΤΚΙ+ ανθρώπων στο εθνικό σύστημα υγείας - και, ευρύτερα, σε υπηρεσίες υγείας - τόσο κατά την περίοδο της πανδημίας όσο και όταν αυτή θα έχει πλέον τελειώσει.
Ειδικότερα, στόχοι της έρευνας είναι, πρωτίστως μέσα από την διεξαγωγή ποιοτικής κοινωνιολογικής έρευνας και, δευτερευόντως, μέσω βιβλιογραφικής επισκόπησης:
- η διερεύνηση των αναγκών υγείας των ΛΟΑΤΚΙ+ ανθρώπων σε συνάρτηση με τον σεξουαλικό προσανατολισμό, την ταυτότητα ή τα χαρακτηριστικά φύλου τους και της πιθανής αλλαγής /μεταβολής αυτών κατά την διάρκεια της πανδημίας
- η διερεύνηση της πρόσβασης των ΛΟΑΤΚΙ+ ανθρώπων στο εθνικό σύστημα υγείας και στη χρήση των υπηρεσιών του πριν και κατά τη διάρκεια της πανδημίας, ο εντοπισμός πιθανών διαφορών στην προπανδημική και στην πανδημική περίοδο, καθώς και των πιθανών κενών και προκλήσεων στην πρόσβαση των ΛΟΑΤΚΙ+ ανθρώπων σε υπηρεσίες υγείας κατά την πανδημική περίοδο
- η διερεύνηση της ανταπόκρισης του ελληνικού κράτους (αλλά και φορέων της κοινωνίας των πολιτών και του ιδιωτικού τομέα υγείας) στην κρίση δημόσιας υγείας, εστιάζοντας στην κάλυψη των αναγκών υγείας των ΛΟΑΤΚΙ+ ατόμων και η συλλογή βέλτιστων πρακτικών, θετικών μέτρων ή πρωτοβουλιών (αν υπάρχουν) - τόσο από το κράτος όσο και από φορείς της κοινωνίας των πολιτών και τον ιδιωτικό τομέα – αναφορικά με την παροχή υπηρεσιών υγείας σε ΛΟΑΤΚΙ+ άτομα κατά τη διάρκεια της πανδημίας στην Ελλάδα
- η ανάπτυξη στοχευμένων προτάσεων πολιτικής με βάση τα ευρήματα της έρευνας πεδίου, για την διασφάλιση της απρόσκοπτής και ισότιμης πρόσβασης και μεταχείρισης των ΛΟΑΤΚΙ+ ανθρώπων στο εθνικό σύστημα υγείας - και, ευρύτερα, σε υπηρεσίες υγείας - τόσο κατά την περίοδο της πανδημίας όσο και όταν αυτή θα έχει πλέον τελειώσει.
Background: Health systems are faced with different needs, conditions and expectations concerning health and healthcare delivery. The most vulnerable groups risk receiving poorer care due to barriers and inequities in health service... more
Background: Health systems are faced with different needs, conditions and expectations concerning health and healthcare delivery. The most vulnerable groups risk receiving poorer care due to barriers and inequities in health service provision and utilisation. However health care organisations are often not sufficiently equipped to effectively recognise and respond to the diverse needs of the population served. To this end, the Task Force Migration, Equity and Diversity (TF MED) developed a set of standards that allow health care organisations to evaluate equity in service provision and implement improvements. A test was conducted in 52 pilot organisations from sixteen countries to assess compliance with the standards, as well as to explore challenges and opportunities for the effective uptake of equity measures.
This paper describes the way in which a mixed methods approach might provide a knowledge base to understand some of the factors involved in access to paediatric healthcare. The paper addresses the potential for this approach to start to... more
This paper describes the way in which a mixed methods approach might provide a knowledge base to understand some of the factors involved in access to paediatric healthcare. The paper addresses the potential for this approach to start to build an evidence-informed understanding of a public policy issue. Our research tracked the increase in paediatric presentations at the Woman’s and Children’s Health Service Emergency Department in South Australia for illness events that might more appropriately have been dealt with through primary care services such as general practice. The mixed methods used the Hospital Admission Status(HAS), Paediatric ED data, analysis of the South Australian Social Health Atlas for demographic and epidemiological data, and triage priority information. This quantitative analysis informed the use of interviews with parents, community health providers and emergency health professionals. Sequencing allowed the researcher to integrate the question over time and revealed policy deficits in health access in Australia.
Problem: Over 40% of those with mental illness are untreated since the supply of psychiatrists does not meet the demand. The psychiatric mental health nurse practitioner (PMHNP) may be an adjunct in providing those services. The purpose... more
Problem: Over 40% of those with mental illness are untreated since the supply of psychiatrists does not meet the demand. The psychiatric mental health nurse practitioner (PMHNP) may be an adjunct in providing those services. The purpose of this quality assurance study was to evaluate outcomes of care between a PMHNP and a psychiatrist (medical doctor [MD]).
Methods: An observational, descriptive design with a retrospective medical record review of adult patients over a six-month period in a suburban, Midwestern, privately owned psychiatric practice.
Results: A total of 787 individual patients encountered at least one visit (N=787) although 3,679 visits were reviewed. The PMHNP was more likely to care for younger patients while the MD cared for more older patients (p<.001). The PMHNPs cared for a more diverse gender spectrum than the MD (p = .031). The MD was more likely to care for Caucasian patients; whereas, the PHMNPs cared for a more diverse racial or ethnic population (p <.001). The MD was more likely to care for the self-pay patient than the PMHNP who cared for those with a larger range of payor types (p< .001). The rate of emergency department (ED) visits and hospitalizations between providers was essentially the same (p=0.40) and (p=0.31) respectively.
Implications: No determination could be made in the key outcome measures of ED visits or hospitalizations between the PMHNPs and MD due to lack of documentation in the record. However, 450 more patients per month were treated for mental healthcare needs when PMHNPs were utilized.
Methods: An observational, descriptive design with a retrospective medical record review of adult patients over a six-month period in a suburban, Midwestern, privately owned psychiatric practice.
Results: A total of 787 individual patients encountered at least one visit (N=787) although 3,679 visits were reviewed. The PMHNP was more likely to care for younger patients while the MD cared for more older patients (p<.001). The PMHNPs cared for a more diverse gender spectrum than the MD (p = .031). The MD was more likely to care for Caucasian patients; whereas, the PHMNPs cared for a more diverse racial or ethnic population (p <.001). The MD was more likely to care for the self-pay patient than the PMHNP who cared for those with a larger range of payor types (p< .001). The rate of emergency department (ED) visits and hospitalizations between providers was essentially the same (p=0.40) and (p=0.31) respectively.
Implications: No determination could be made in the key outcome measures of ED visits or hospitalizations between the PMHNPs and MD due to lack of documentation in the record. However, 450 more patients per month were treated for mental healthcare needs when PMHNPs were utilized.
Con base en datos cualitativos de seis grupos focalizados, realizados durante los años 2015 y 2016, con mujeres de 18 a 60 años residentes en un barrio de sectores populares del conurbano norte bonaerense, analizamos las lógicas de... more
Con base en datos cualitativos de seis grupos focalizados, realizados durante los años 2015 y 2016, con mujeres de 18 a 60 años residentes en un barrio de sectores populares del conurbano norte bonaerense, analizamos las lógicas de utilización y sus experiencias con los servicios de salud públicos. Nos centramos en las barreras que las participantes identifican para acceder a la infraestructura sanitaria pública del barrio (Centro de Salud y postas sanitarias) y en los establecimientos hospitalarios de la localidad, considerando las necesidades, expectativas y demandas de cuidado médico, no sólo curativo, sino también preventivo y de salud mental. Observamos las consecuencias de las barreras en el acceso a la atención, cómo reaccionan frente a ellas y los recursos que algunas mujeres y sus grupos familiares movilizan para sortearlas (contar con medios para desplazarse a otras localidades, el pago de bolsillo para consultas y tratamientos privados, contar con cobertura de obra social, etc.).
(with Chhea, C. and Warren, N.) A decade after health sector reform, public health services in rural Cambodia remain under-utilised for multiple reasons related to financial, structural and personnel factors. Ineffectiveness of rural... more
(with Chhea, C. and Warren, N.) A decade after health sector reform, public health services in rural Cambodia remain under-utilised for multiple reasons related to financial, structural and personnel factors. Ineffectiveness of rural public health services has led to a significant increase in private providers, often the same people who staff public facilities. Public health clinics are often portrayed as low quality, with long waiting times and unexpected costs; in contrast, private clinics are seen to provide more convenient health care. Several strategies, including contract management and health equity funds, have been introduced to improve public sector performance and encourage utilization; these efforts are ongoing. However, the feasibility of these strategies remains in question, particularly in terms of cost-effectiveness and sustainability.
Methods: In this article the strategies of and barriers met by health workers who remain in rural areas and deliver public health services are elucidated. Ethnographic research conducted in 2008 with health providers involved in treating tuberculosis patients in Kampong Speu Province, Cambodia is drawn on. Participants were recruited from the provincial health department, provincial hospital and four health centres. Data collection involved in-depth interviews, participation in meetings and workshops aimed at health workers, and observation of daily activities at the health facilities. Data were transcribed verbatim, imported into NVivo software (www.qsrinternational.com) for management, and analysed using a grounded theory approach.
Results: Primary healthcare service delivery in rural Cambodia was reliant on the retention of mid-level of health staff, primarily midwives and nurses. Its performance was influenced by institutional characteristics relating to the structure of the health system. Personal factors were impacted on by these structural issues and affected the performance of health staff. Institutional factors worked against the provision of high-quality public health services, and included the fragmentation of service delivery and structure, limited capacity and shortage of high-qualified health staff, competition with the private sector, and shortage of medical supplies. These factors all de-motivated health staff, and undermined their performance in public service positions. Personal factors were paramount for staff retention. These included: optimism and appreciation of work responsibilities and position, the personal ability to cope with financial barriers, and institutional benefits such as opportunities for professional development, job security, financial opportunities (via performance-based allowances), and status in society. Individual financial coping strategies were the dominant factor underlying retention, but alone were often de-motivating: clients were diverted from the public services, which led to distrust, and thus undermined the capacity of public system. There was significant interaction between institutional and personal factors, which impacted on the effectiveness of health staff retention in rural areas. Health workers tended to remain in their government positions for prolonged periods of time because they experienced personal rewards. At the same time, however, their job performance in the public health services were hindered by challenges related to the institutional factors.
Conclusions: The interaction between institutional factors and personal factors was crucial for effectiveness of health staff retention in rural Cambodia. Efforts aimed at ensuring quality of care and encouraging health staff retention should attempt to remove the institutional barriers that discourage the use of rural public health services.
Methods: In this article the strategies of and barriers met by health workers who remain in rural areas and deliver public health services are elucidated. Ethnographic research conducted in 2008 with health providers involved in treating tuberculosis patients in Kampong Speu Province, Cambodia is drawn on. Participants were recruited from the provincial health department, provincial hospital and four health centres. Data collection involved in-depth interviews, participation in meetings and workshops aimed at health workers, and observation of daily activities at the health facilities. Data were transcribed verbatim, imported into NVivo software (www.qsrinternational.com) for management, and analysed using a grounded theory approach.
Results: Primary healthcare service delivery in rural Cambodia was reliant on the retention of mid-level of health staff, primarily midwives and nurses. Its performance was influenced by institutional characteristics relating to the structure of the health system. Personal factors were impacted on by these structural issues and affected the performance of health staff. Institutional factors worked against the provision of high-quality public health services, and included the fragmentation of service delivery and structure, limited capacity and shortage of high-qualified health staff, competition with the private sector, and shortage of medical supplies. These factors all de-motivated health staff, and undermined their performance in public service positions. Personal factors were paramount for staff retention. These included: optimism and appreciation of work responsibilities and position, the personal ability to cope with financial barriers, and institutional benefits such as opportunities for professional development, job security, financial opportunities (via performance-based allowances), and status in society. Individual financial coping strategies were the dominant factor underlying retention, but alone were often de-motivating: clients were diverted from the public services, which led to distrust, and thus undermined the capacity of public system. There was significant interaction between institutional and personal factors, which impacted on the effectiveness of health staff retention in rural areas. Health workers tended to remain in their government positions for prolonged periods of time because they experienced personal rewards. At the same time, however, their job performance in the public health services were hindered by challenges related to the institutional factors.
Conclusions: The interaction between institutional factors and personal factors was crucial for effectiveness of health staff retention in rural Cambodia. Efforts aimed at ensuring quality of care and encouraging health staff retention should attempt to remove the institutional barriers that discourage the use of rural public health services.
Overall prevalence of hepatitis B (HBV) in the UK is low. However, among migrants from endemic areas, prevalence has been shown to be high. Furthermore, timely diagnosis and/or referral are required prevent serious health consequences... more
Overall prevalence of hepatitis B (HBV) in the UK is low. However, among migrants from endemic areas, prevalence has been shown to be high. Furthermore, timely diagnosis and/or referral are required prevent serious health consequences through early institution of treatment.
Methods: We identified locations that would be familiar to Chinese members of the community with the objective of facilitating testing. Dried blood spot samples were collected from 229 Chinese subjects and tested for HBV and also for hepatitis C virus (HCV) infection – offering complete chronic viral hepatitis screening.
Results: HBsAg was positive in 20/229 (8.7 %) participants, (10F, 10M). Five women and one man were aware of their condition, but only one man and none of the women were under specialist care. The average length of residence in the UK for positive patients was 15 years (range 2-40).
Evidence of HBV past infection, HBcAb(+)/HBsAg(-), was seen in 28/229 participants (12.2%).
HCV antibody testing produced negative results in all participants.
The methodology of testing was well accepted, 139/144 (95%) responded to a feedback questionnaire declaring no discomfort and 100% finding the information session useful.
Conclusion: This model of outreach testing is helpful for addressing health inequalities afflicting the UK’s Chinese community.
Methods: We identified locations that would be familiar to Chinese members of the community with the objective of facilitating testing. Dried blood spot samples were collected from 229 Chinese subjects and tested for HBV and also for hepatitis C virus (HCV) infection – offering complete chronic viral hepatitis screening.
Results: HBsAg was positive in 20/229 (8.7 %) participants, (10F, 10M). Five women and one man were aware of their condition, but only one man and none of the women were under specialist care. The average length of residence in the UK for positive patients was 15 years (range 2-40).
Evidence of HBV past infection, HBcAb(+)/HBsAg(-), was seen in 28/229 participants (12.2%).
HCV antibody testing produced negative results in all participants.
The methodology of testing was well accepted, 139/144 (95%) responded to a feedback questionnaire declaring no discomfort and 100% finding the information session useful.
Conclusion: This model of outreach testing is helpful for addressing health inequalities afflicting the UK’s Chinese community.
This commentary outlines the health insurance disparities of Compact of Free Association (COFA) migrants living in the United States. Compact of Free Association migrants are citizens of the Republic of the Marshall Islands, the Federated... more
This commentary outlines the health insurance disparities of Compact of Free Association (COFA) migrants living in the United States. Compact of Free Association migrants are citizens of the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau who can live, work, and study in the United States without a visa. Compact of Free Association migrants make up a significant proportion of the rapidly growing Pacific Islander population in the United States. This article describes the historical and current relationships between the United States and the Compact nations and examines national policy barriers constraining health insurance access for COFA migrants. In addition, the commentary describes the state-level health policies of Arkansas, Hawai'i, and Oregon, which are the states where the majority of COFA migrants reside. Finally, policy recommendations are provided to improve health equity for COFA migrants. What do we already know about this topic? Compact of Free Association migrants experience barriers in accessing health insurance in the United States. How does your research contribute to the field? The manuscript provides a synthesis of the national policy barriers and describes state-level health policies in the 3 states where the majority of COFA migrants reside. What are your research's implications toward theory, practice, or policy? The manuscript provides policy recommendations to improve health equity for COFA migrants.
Physical, emotional and sexual child abuse are major problems in South Africa. This study investigates whether children know about post-abuse services, if they disclose and seek services, and what the outcomes of help-seeking behaviour... more
Physical, emotional and sexual child abuse are major problems in South Africa. This study investigates whether children know about post-abuse services, if they disclose and seek services, and what the outcomes of help-seeking behaviour are. It also examines factors associated with request and receipt of services. Confidential self-report questionnaires were completed by adolescents in South Africa as part of a community-based study of children aged 10-17 (n=3515) in two provinces. Child abuse, disclosure and outcomes of help-seeking were measured using internationally recognized measures. Prevalence of frequent (>weekly) physical abuse was 7.4%, frequent emotional abuse 12.4%, and lifetime contact sexual abuse 9.0%. 98.6% of children could name one suitable confidante or formal service for abuse disclosure, but only 20.1% of abuse victims disclosed. Of those, 72% received help. Most common confidantes were caregivers and teachers. Of all abuse victims, 85.6% did not receive help due to non-disclosure or inactivity of services, and 14.4% received help: 4.9% from formal health or social services and 7.1% through community vigilante action. Emotional abuse, sexual abuse and female gender were associated with higher odds of help-seeking. While children in South Africa showed high knowledge of available services, access to formal services among abused children was low and not all those requesting services received them. Notably fewer children received help from formal services than through community vigilante action. Urgent action is needed to improve service access for child abuse victims.
Since late 2009, Greece has been dealing with the effects of a debt crisis. The neoliberal principles embedded in the three structural adjustment programmes that the country accepted have required radical cuts in health care funding,... more
Since late 2009, Greece has been dealing with the effects of a debt crisis. The neoliberal principles embedded in the three structural adjustment programmes that the country accepted have required radical cuts in health care funding, which in turn have led to widening inequalities in health. This article focuses on access to health care for people with disabilities in Greece in the context of these structural adjustments. We investigate possible differences in unmet health care needs between people with and without disabilities, using de-identified cross-sectional data from the European Health Interview Survey. The sample included 5400 communitydwelling men and women aged 15 years and over. The results of the logistic regressions showed that people with disabilities report higher unmet health care needs, with cost, transportation, and long waiting lists being significant barriers; experience of all barriers was positively associated with low socioeconomic status. These findings suggest that a section of the population who may have higher health care needs face greater barriers in accessing services. Austerity policies impact on access to health care in both direct and indirect ways, producing long-term disadvantage for disabled people. Social policies and comprehensive anti-discrimination legislation might help to address some of the barriers this population faces.
Rapid point-of-care (POC) testing for HIV has been shown to increase the uptake of testing, rates of clients receiving test results, numbers of individuals aware of their status and timely access to care for those who test positive. In... more
Rapid point-of-care (POC) testing for HIV has been shown to increase the uptake of testing, rates of clients receiving test results, numbers of individuals aware of their status and timely access to care for those who test positive. In addition, several studies have shown that rapid POC testing for HIV is highly acceptable to clients in a variety of clinical and community-based health care settings. Most acceptability studies conducted in North America, however, have been conducted in large, urban environments where concentrations of HIV testing sites and testing innovations are greatest. Using a survey of client preferences at a sexual health clinic in Halifax, Nova Scotia, we suggest that HIV test seekers living in a region outside of Canada’s major urban HIV epicentres find rapid POC testing highly acceptable. We compare the results of the Halifax survey with existing acceptability studies of rapid POC HIV testing in North America and suggest ways in which it might be of particular benefit to testing clients and potential clients in Nova Scotia and other regions of Canada that currently have few opportunities for anonymous or rapid testing. Overall, we found that rapid POC HIV testing was highly desirable at this study site and may serve to overcome many of the challenges associated with HIV prevention and testing outside of well-resourced metropolitan environments.
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