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Developing Interventions to Address Health Disparities

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (30 October 2021) | Viewed by 60916

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Special Issue Editors

Dr. Maritt Kirst

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Guest Editor

Department of Psychology, Wilfrid Laurier University, 75 University Ave. West, Waterloo, ON N2L 3C5, Canada
Interests: health equity; mental health; addictions; homelessness; evaluation of complex health interventions

Dr. Ketan Shankardass

E-Mail Website
Guest Editor

Department of Health Sciences, Wilfrid Laurier University, 75 University Ave. West, Waterloo, ON N2L 3C5, Canada
Interests: health equity interventions; chronic stress; health in all policies; social epidemiology; health geography

Special Issue Information

Dear Colleagues,

Strong evidence documents persistent inequalities in health outcomes in many countries, with vulnerability often indicated by social class, gender identity, sexual orientation, race, Indigeneity, and other social factors. Health inequalities have been demonstrated for myriad outcomes, including heart disease, diabetes, and poor mental health. There is growing understanding of the role played by the structural and social determinants of health in producing and maintaining these health differences. The distribution of social determinants in a population, such as unequal access to affordable housing, early childhood development, education, job security, and access to healthcare services, are shaped by structural determinants, including the governance and policy actions of governments, as well as culture and societal values. Many consider these inequalities to be avoidable and unfair, and thus, health inequities or disparities.

Globally, there is a growing movement to create opportunities for disadvantaged populations to attain good health, social inclusion, and well-being through programming and policies that facilitate adequate economic, social, and infrastructural environments. This is challenging work, and few programs and interventions exist that effectively address these disparities in a sustained manner. Researchers often play a role in informing or evaluating health equity interventions, such as the implementation of universal basic income programs and increasing accessibility of affordable housing. Recent responses to the COVID-19 pandemic and mobilization against racial injustice are providing opportunities for greater health equity.

In this Special Issue of IJERPH, we invite papers that contribute to the knowledge base on conceptualization, development, implementation, and evaluation of interventions that address health disparities. We are particularly interested in recent action-oriented research that focuses on the development of programs and interventions addressing health disparities related to COVID-19 and mobilization efforts around racial injustice. Papers can also focus on programming related to any social determinant of health (including but not limited to income, gender, race and ethnicity, access to healthcare, housing, social support, employment, education, early childhood experiences, food security) and social inequalities that may be related to health. We are also interested in research supporting efforts to address the structural determinants of health, such as building political will for action on SDOH, integrated governance approaches such as health in all policies, and system integration.

Dr. Maritt Kirst
Dr. Ketan Shankardass
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Health disparities
Health equity
Health of marginalized populations
Social determinants of health
Structural interventions
Program development
Program evaluation

Published Papers (7 papers)

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Research

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15 pages, 947 KiB

Open AccessArticle

Understanding Trustful Relationships between Community Health Workers and Vulnerable Citizens during the COVID-19 Pandemic: A Realist Evaluation

by Dorien Vanden Bossche, Sara Willems and Peter Decat

Int. J. Environ. Res. Public Health 2022, 19(5), 2496; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19052496 - 22 Feb 2022

Cited by 5 | Viewed by 2211

Abstract

(1) Background: Community health workers (CHWs) are an essential public health workforce defined by their trustful relationships with vulnerable citizens. However, how trustful relationships are built remains unclear. This study aimed to understand how and under which circumstances CHWs are likely to build trust with their vulnerable clients during the COVID-19 pandemic. (2) Methods: We developed a program theory using a realist research design. Data were collected through focus groups and in-depth interviews with CHWs and their clients. Using a grounded theory approach, we aimed to unravel mechanisms and contextual factors that determine the trust in a CHW program offering psychosocial support to vulnerable citizens during the COVID-19 pandemic. (3) Results: The trustful relationship between CHWs and their clients is rooted in three mental models: recognition, equality, and reciprocity. Five contextual factors (adopting a client-centered attitude, coordination, temporariness, and link with primary care practice (PCP)) enable the program mechanisms to work. (4) Conclusions: CHWs are a crucial public health outreach strategy for PCP and complement and enhance trust-building by primary care professionals. In the process of building trustful relationships between CHWs and clients, different mechanisms and contextual factors play a role in the trustful relationship between primary care professionals and patients. Future research should assess whether these findings also apply to a non-covid context, to the involvement of CHWs in other facets of primary healthcare (e.g., prevention campaigns, etc.), and to a low- and middle-income country (LMIC) setting. Furthermore, implementation research should elaborate on the integration of CHWs in PCP to support CHWs in developing the mental models leading to build trust with vulnerable citizens and to establish the required conditions. Full article

(This article belongs to the Special Issue Developing Interventions to Address Health Disparities)

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14 pages, 3011 KiB

Open AccessArticle

Piloting the Use of Concept Mapping to Engage Geographic Communities for Stress and Resilience Planning in Toronto, Ontario, Canada

by Martha Ta and Ketan Shankardass

Int. J. Environ. Res. Public Health 2021, 18(20), 10977; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182010977 - 19 Oct 2021

Cited by 1 | Viewed by 1707

Abstract

The physical and social characteristics of urban neighborhoods engender unique stressors and assets, contributing to community-level variation in health over the lifecourse. Actors such as city planners and community organizations can help strengthen resilience in places where chronic stress is endemic, by learning about perceived stressors and assets from neighborhood users themselves (residents, workers, business owners). This study piloted a methodology to identify Toronto neighborhoods experiencing chronic stress and to engage them to identify neighborhood stressors, assets, and solutions. Crescent Town was identified as one neighborhood of interest based on relatively high levels of emotional stress in Twitter Tweets produced over two one-year periods (2013–2014 and 2017–2018) and triangulation using other neighborhood-level data. Using concept mapping, community members (n = 23) created a ten-cluster concept map describing neighborhood stressors and assets, and identified two potential strategies, a Crescent Town Residents’ Association and a community fair to promote neighborhood resources and build social networks. We discuss how this knowledge has circulated through the City of Toronto and community-level organizations to date, and lessons for improving this methodology. Full article

(This article belongs to the Special Issue Developing Interventions to Address Health Disparities)

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13 pages, 330 KiB

Open AccessArticle

Effectiveness of Narrative Messaging Styles about the Social Determinants of Health and Health Inequities in Ontario, Canada

by Emily Churchill, Ketan Shankardass, Andrea M.L. Perrella, Aisha Lofters, Carlos Quiñonez, Louise Brooks, Dana Wilson and Maritt Kirst

Int. J. Environ. Res. Public Health 2021, 18(20), 10881; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182010881 - 16 Oct 2021

Cited by 2 | Viewed by 2128

Abstract

Health inequities are systemic, avoidable, and unjust differences in health between populations. These differences are often determined by social and structural factors, such as income and social status, employment and working conditions, or race/racism, which are referred to as the social determinants of health (SDOH). According to public opinion, health is considered to be largely determined by the choices and behaviours of individuals. However, evidence suggests that social and structural factors are the key determinants of health. There is likely a lack of public understanding of the role that social and structural factors play in determining health and producing health inequities. Public opinion and priorities can drive governmental action, so the aim of this work was to determine the most impactful way to increase knowledge and awareness about the social determinants of health (SDOH) and health inequities in the province of Ontario, Canada. A study to test the effectiveness of four different messaging styles about health inequities and the SDOH was conducted with a sample of 805 adult residents of Ontario. Findings show that messages highlighting the challenges faced by those experiencing the negative effects of the SDOH, while still acknowledging individual responsibility for health, were the most effective for eliciting an empathetic response from Ontarians. These findings can be used to inform public awareness campaigns focused on changing the current public narrative about the SDOH toward a more empathetic response, with the goal of increasing political will to enact policies to address health inequities in Ontario. Full article

(This article belongs to the Special Issue Developing Interventions to Address Health Disparities)

7 pages, 277 KiB

Open AccessArticle

Incarceration and COVID-19: Recommendations to Curb COVID-19 Disease Transmission in Prison Facilities and Surrounding Communities

by Lauren Jeanne Natoli, Kathy Linh Vu, Adam Carl Sukhija-Cohen, Whitney Engeran-Cordova, Gabriel Maldonado, Scott Galvin, William Arroyo and Cynthia Davis

Int. J. Environ. Res. Public Health 2021, 18(18), 9790; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18189790 - 17 Sep 2021

Cited by 12 | Viewed by 2294

Abstract

Overcrowding can increase the risk of disease transmission, such as that of SARS-CoV-2 (COVID-19), within United States prisons. The number of COVID-19 cases among prisoners is higher than that among the general public, and this disparity is further increased for prisoners of color. This report uses the example case of the COVID-19 pandemic to observe prison conditions and preventive efforts, address racial disparities for people of color, and guide structural improvements for sustaining inmate health during a pandemic in four select states: California, New York, Illinois, and Florida. To curb the further spread of COVID-19 among prisoners and their communities, safe public health practices must be implemented including providing personal protective equipment (PPE) and testing of staff and inmates, disseminating culturally and language appropriate information regarding the pandemic and preventive precautions, introducing social distancing measures, and ensuring adequate resources to safely reintegrate released prisoners into their communities. Full article

(This article belongs to the Special Issue Developing Interventions to Address Health Disparities)

18 pages, 378 KiB

Open AccessArticle

Protective Factors That Foster Resilience to HIV/AIDS: Insights and Lived Experiences of Older Gay, Bisexual, and Other Men Who Have Sex with Men

by Renato M. Liboro, Tammy C. Yates, Sherry Bell, Brandon Ranuschio, George Da Silva, Charles Fehr, Francisco Ibañez-Carrasco and Paul A. Shuper

Int. J. Environ. Res. Public Health 2021, 18(16), 8548; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18168548 - 13 Aug 2021

Cited by 11 | Viewed by 3076

Abstract

Since the beginning of the HIV/AIDS epidemic, gay, bisexual, and other men who have sex with men (gbMSM) have been disproportionately impacted by HIV/AIDS health disparities. Research showed that resilience to HIV/AIDS is associated with increased use of relevant health services, lower sexual health risks, and improved mental health outcomes among racially and ethnically diverse gbMSM. As the subpopulation that has historically been impacted by HIV/AIDS the longest, older gbMSM living with HIV/AIDS have inarguably exhibited resilience to HIV/AIDS the most. The qualitative study described in this paper sought to identify and examine protective factors that fostered resilience to HIV/AIDS based on the insights and lived experiences of racially and ethnically diverse, older gbMSM. Applying a community-based participatory research approach that included the meaningful involvement of older gbMSM living with HIV/AIDS in different roles (i.e., advisory committee member, collaborator, peer researcher, and participant), the study recruited and included forty-one older gbMSM living with HIV/AIDS from Ontario, Canada, in confidential, semi-structured interviews. Utilizing thematic analysis, we identified three major themes from the participant interviews as factors that fostered the resilience of older gbMSM to HIV/AIDS and helped to address HIV/AIDS health disparities: (1) established protective factors, (2) behavioral protective factors, and (3) controversial protective factors. This paper argues for the importance of valuing and capitalizing on these protective factors in the conceptualization and development of interventions, services, and programs that are dedicated to fostering resilience to HIV/AIDS. Full article

(This article belongs to the Special Issue Developing Interventions to Address Health Disparities)

Review

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15 pages, 491 KiB

Open AccessReview

Implementing Anti-Racism Interventions in Healthcare Settings: A Scoping Review

by Nadha Hassen, Aisha Lofters, Sinit Michael, Amita Mall, Andrew D. Pinto and Julia Rackal

Int. J. Environ. Res. Public Health 2021, 18(6), 2993; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18062993 - 15 Mar 2021

Cited by 108 | Viewed by 45379

Abstract

Racism towards Black, Indigenous and people of colour continues to exist in the healthcare system. This leads to profound harm for people who use and work within these settings. This is a scoping review to identify anti-racism interventions in outpatient healthcare settings. Searching the peer-reviewed and grey literature, articles were screened for inclusion by at least two independent reviewers. Synthesizing the socio-ecological levels of interventions with inductively identifying themes, a conceptual model for implementing anti-racism interventions in healthcare settings is presented. In total, 37 peer-reviewed articles were included in the review, with 12 empirical studies and 25 theoretical or conceptual papers. Six grey literature documents were also included. Healthcare institutions need to incorporate an explicit, shared language of anti-racism. Anti-racism action should incorporate leadership buy-in and commitment with dedicated resources, support and funding; a multi-level approach beginning with policy and organizational interventions; transparent accountability mechanisms for sustainable change; long-term meaningful partnerships with Black, Indigenous, and people of colour (i.e., racialized communities); and ongoing, mandatory, tailored staff education and training. Decision-makers and staff in healthcare settings have a responsibility to take anti-racism action and may improve the success and sustainability of their efforts by incorporating the foundational principles and strategies identified in this paper. Full article

(This article belongs to the Special Issue Developing Interventions to Address Health Disparities)

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Other

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11 pages, 606 KiB

Open AccessStudy Protocol

Understanding the Acceptability and Uptake of HPV Self-Sampling Amongst Women Under- or Never-Screened for Cervical Cancer in Toronto (Ontario, Canada): An Intervention Study Protocol

by Aisha Lofters, Kimberly Devotta, Vijayshree Prakash and Mandana Vahabi

Int. J. Environ. Res. Public Health 2021, 18(17), 9114; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18179114 - 29 Aug 2021

Cited by 6 | Viewed by 2671

Abstract

Cervical cancer remains a global public health concern, even though scientific advancements have made the disease almost entirely preventable. With the link between human papillomavirus (HPV) and cervical cancer, and the subsequent improvement in screening technology, there is potential to improve access and coverage of cervical screening with the introduction of HPV self-sampling. In Ontario, Canada, a province with a cytology-based screening program (i.e., Pap test), women who identify as South Asian, West Asian, Middle Eastern and North African have some of the lowest rates of screening, and research suggests they have a higher burden of cervical cancer. In this study, we will use both quantitative and qualitative methods to understand the acceptability and uptake of a take-home HPV self-sampling kit. Working with community champions—people with pre-existing connections with local groups—we will recruit women from these groups who are under- or never-screened for cervical cancer. Women will self-select whether they are in the group that tries HPV self-sampling or in the group that does not. We will aim for 100 women in each group. All participants will provide feedback on the feasibility, acceptability and preferences for cervical screening through a survey and phone follow-up. Women who self-select the HPV self-sampling group, will be followed up to find out if they followed through with self-sampling and to understand their experience using the device. Women who do not want to try self-sampling will be followed up to see if they went on to get a Pap test. The qualitative phase of this study consists of five focus groups with participants and semi-structured interviews with key informants in the community. Full article

(This article belongs to the Special Issue Developing Interventions to Address Health Disparities)

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