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Measuring Health Inequities among Vulnerable Populations

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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 Care Sciences & Services".

Deadline for manuscript submissions: closed (30 March 2022) | Viewed by 34810

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Special Issue Editors

Prof. Dr. Godfred O. Boateng

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Guest Editor

Department of Kinesiology, College of Nursing and Health Innovations, The University of Texas at Arlington, 500 West Nedderman Dr., Arlington, TX, USA
Interests: health inequities; measurement theory; global health; environmental health; mental health; aging and health; noncommunicable diseases; health systems; behavioral sciences; research methods; social science statistics

Prof. Dr. Torsten B. Neilands

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Guest Editor

Division of Prevention Science, University of California, San Francisco, CA 94158, USA
Interests: HIV/AIDS; tobacco research; clinical research; behavioral sciences; mental health; substance use; reproductive health; mentoring; research methods; social science statistics (including latent variable modeling); survey scale development
Special Issues, Collections and Topics in MDPI journals

Dr. John Sauceda

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Guest Editor

Division of Prevention Science, University of California, San Francisco, CA 94158, USA
Interests: health disparities affecting Latinx communities impacted by HIV; measurement of psychological constructs and social factors; comparing outcomes across diverse populations; using multiphase optimization strategies (MOST) to improve HIV care engagement; social and behavioral sciences aspects of HIV cure research; mentoring
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The WHO defines health inequities as avoidable inequalities in health between groups of people within countries and between countries. These inequities are driven by environmental, social, and economic conditions, which increase the risk of illness, disease, and the inability to prevent them at the individual, household, community, national, and international levels. This culminates in a health continuum, with the poor and non-poor at the extreme ends. Health inequities are rooted in social injustices that make some population groups more vulnerable to poor health than other groups. The ability of health practitioners, academics, researchers, governments, and agencies to quantify health inequities has been found to facilitate the estimation of prevalence and identify hotspots, target appropriate resources to vulnerable populations, and develop interventions in bridging health inequities. For example, the HWISE (Household Water Insecurity Experiences Scale), a tool for assessing water insecurity across low- and middle-income countries, has enabled the assessment of the prevalence of water insecurity, identification of water insecure hotspots, and the appropriate targeting of resources to populations that are prone to water insecurity.

This Special Issue calls for studies on the measurement of health inequities among vulnerable populations and developing tools/constructs/indicators that facilitate the study of environmental, global, and public health research targets. It also focuses on best practices, guidelines, strategies, principles, critical analysis, high-quality reviews, and new techniques or technologies that facilitate the assessment or quantification of health inequities in improving population health. For this Special Issue, vulnerable populations include the economically disadvantaged, racial and ethnic minorities, the uninsured, low-income children, women, children and infants in low-income countries, the elderly, the homeless, those with human immunodeficiency virus (HIV), and those with chronic health conditions. This collection of articles that measure or provide systems to assess health inequities will be a boon to the field of public health research aimed at bridging health inequity and improving population health.

Prof. Dr. Godfred O. Boateng
Prof. Dr. Torsten B. Neilands
Prof. Dr. John Sauceda
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 inequities
Measurement
Tools/Metrics
Indicators
Guidelines
Global health
Environmental health
Maternal health
Child health
Reproductive health
Vulnerable populations
HIV/AIDS
Noncommunicable diseases
Public health
Mental health

Related Special Issue

Measuring Health Inequities among Vulnerable Populations (2nd Edition) in International Journal of Environmental Research and Public Health (2 articles)

Published Papers (9 papers)

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Research

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15 pages, 786 KiB

Open AccessArticle

Development and Initial Evaluation of a Nurse-Led Healthcare Clinic for Homeless and At-Risk Populations in Tasmania, Australia: A Collaborative Initiative

by Grace Bennett-Daly, Maria Unwin, Ha Dinh, Michele Dowlman, Leigh Harkness, Jane Laidlaw and Kathleen Tori

Int. J. Environ. Res. Public Health 2021, 18(23), 12770; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph182312770 - 03 Dec 2021

Cited by 5 | Viewed by 2965

Abstract

People who are homeless experience significantly poorer health than the general population and often face multifaceted challenges engaging with public healthcare services. Mission Health Nurse-led Clinic (MHNC) was established in 2019 to meet the healthcare needs of this marginalised population in Launceston, Tasmania. This study examines barriers to healthcare access amongst individuals who experience homelessness, client and staff perceptions of the MHNC services and explored opportunities for service expansion. Descriptive statistics were drawn from administrative data, and all interviews were thematically analysed. A total of 426 presentations were reported for 174 individuals experiencing homelessness over 26 months. The median client age was 42 years and 60.9% were male; A total of 38.5% were homeless or lived in a supported accommodation. The predominant reasons for clinic visits included prescription requests (25.3%) and immunisations (20.1%). A total of 10 clients and 5 City Mission staff were interviewed with three themes emerging from the findings: personal vulnerability, disconnectedness and acceptability of the MHNC. The MHNC services were reported to be highly appreciated by all clients. Mental health and allied health, extra operating hours and maintaining the flexibility of walk-in appointments were suggested as expansion areas for the service and were highlighted as ways to increase engagement for improved health outcomes. Continued partnerships with interprofessional primary healthcare providers would contribute to addressing unmet healthcare needs in this vulnerable population. Full article

(This article belongs to the Special Issue Measuring Health Inequities among Vulnerable Populations)

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16 pages, 361 KiB

Open AccessArticle

Assessing Self-Efficacy and Communication Regarding Sexual Agreements among Men Who Have Sex with Men in the USA: Development and Validation of Two Novel Scales

by Torsten B. Neilands, Deepalika Chakravarty, Lynae A. Darbes, Nathan P. O’Brien, Ilse S. Gonzalez and Colleen C. Hoff

Int. J. Environ. Res. Public Health 2021, 18(18), 9727; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18189727 - 15 Sep 2021

Viewed by 1693

Abstract

HIV disproportionately impacts men who have sex with men (MSM) in the USA. Building upon research on relationship constructs unique to MSM couples’ HIV-prevention needs, we developed two new scales measuring sexual agreement self-efficacy (SASE) and importance of sexual agreement communication (ISAC). Following qualitative item development, we used two large independent samples of MSM couples (N1 = 441, N2 = 388) to conduct scale validation. Exploratory factor analyses indicated both SASE and ISAC to be unidimensional with 7 and 5 items (eigenvalues = 5.68 and 3.50), respectively, with strong factor loadings. Confirmatory factor analyses yielded satisfactory model fit for SASE (CFI = 0.99; SRMR = 0.03) and ISAC (CFI = 0.99; SRMR = 0.05). Reliability was high for SASE (ω = 0.92) and ISAC (ω = 0.84). Predictive validity analysis revealed a protective association between higher scores on both scales and the outcomes of sexual risk behavior and agreement breaks. Convergent and discriminant validity analyses demonstrated associations in the expected directions between these scales and multiple measures of relationship quality. Therefore, SASE and ISAC are two brief, valid, and reliable scales that can facilitate more in-depth explorations of sexual agreements in MSM and thereby contribute greatly to improving our understanding of and ability to intervene on sexual agreements to improve health and relationship outcomes. Full article

(This article belongs to the Special Issue Measuring Health Inequities among Vulnerable Populations)

12 pages, 1143 KiB

Open AccessArticle

Improving Social Justice in COVID-19 Health Research: Interim Guidelines for Reporting Health Equity in Observational Studies

by Alba Antequera, Daeria O. Lawson, Stephen G. Noorduyn, Omar Dewidar, Marc Avey, Zulfiqar A. Bhutta, Catherine Chamberlain, Holly Ellingwood, Damian Francis, Sarah Funnell, Elizabeth Ghogomu, Regina Greer-Smith, Tanya Horsley, Clara Juando-Prats, Janet Jull, Elizabeth Kristjansson, Julian Little, Stuart G. Nicholls, Miriam Nkangu, Mark Petticrew, Gabriel Rada, Anita Rizvi, Larissa Shamseer, Melissa K. Sharp, Janice Tufte, Peter Tugwell, Francisca Verdugo-Paiva, Harry Wang, Xiaoqin Wang, Lawrence Mbuagbaw and Vivian Welch Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2021, 18(17), 9357; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18179357 - 04 Sep 2021

Cited by 13 | Viewed by 6437

Abstract

The COVID-19 pandemic has highlighted the global imperative to address health inequities. Observational studies are a valuable source of evidence for real-world effects and impacts of implementing COVID-19 policies on the redistribution of inequities. We assembled a diverse global multi-disciplinary team to develop interim guidance for improving transparency in reporting health equity in COVID-19 observational studies. We identified 14 areas in the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist that need additional detail to encourage transparent reporting of health equity. We searched for examples of COVID-19 observational studies that analysed and reported health equity analysis across one or more social determinants of health. We engaged with Indigenous stakeholders and others groups experiencing health inequities to co-produce this guidance and to bring an intersectional lens. Taking health equity and social determinants of health into account contributes to the clinical and epidemiological understanding of the disease, identifying specific needs and supporting decision-making processes. Stakeholders are encouraged to consider using this guidance on observational research to help provide evidence to close the inequitable gaps in health outcomes. Full article

(This article belongs to the Special Issue Measuring Health Inequities among Vulnerable Populations)

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13 pages, 368 KiB

Open AccessArticle

Urban-Rural Inequality of Opportunity in Health Care: Evidence from China

by Chao Ma, Ze Song and Qingqing Zong

Int. J. Environ. Res. Public Health 2021, 18(15), 7792; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18157792 - 22 Jul 2021

Cited by 29 | Viewed by 2762

Abstract

(1) Background: We aim to measure the urban-rural inequality of opportunity in healthcare in China based on the theory of Equality of Opportunity (EOp). (2) Methods: Following the compensation principle, we establish a decomposition strategy for the fairness gap, which we use for the measurement of the inequality of opportunity in urban-rural healthcare utilization. We then use China Health and Nutrition Survey (CHNS) data from 1997 to 2006 to calculate the fairness gap. (3) Results: Empirical analysis using CHNS data shows that the ratio of the fairness gap to the directly observed average urban-rural difference in healthcare was 1.167 for 1997–2000 and 1.744 for 2004–2006. The average urban-rural difference observed directly from original statistical data may have underestimated the degree of this essential inequity. (4) Conclusions: Our findings suggest that upgrading urban-rural reimbursement ratios may not be sufficient in eliminating the inequality of opportunity in healthcare utilization between urban and rural residents. Within the context of an urban-rural dualistic social structure and widening of the urban-rural income gap, a shift to a pro-disadvantaged policy will be a more effective approach in promoting equality of opportunity in healthcare. Full article

(This article belongs to the Special Issue Measuring Health Inequities among Vulnerable Populations)

7 pages, 294 KiB

Open AccessArticle

Development of the Mobile Technology Vulnerability Scale among Youth and Young Adults Living with HIV

by Nadra E. Lisha, Torsten B. Neilands, Xavier A. Erguera and Parya Saberi

Int. J. Environ. Res. Public Health 2021, 18(8), 4170; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18084170 - 15 Apr 2021

Cited by 3 | Viewed by 1588

Abstract

Introduction: Youth and young adults living with HIV (YLWH) in the US have the lowest viral suppression percentage. Lack of sufficient technology access may be correlated with HIV health outcomes in this population. Methods: We developed a Mobile Technology Vulnerability Scale (MTVS; 18 items) among 18–29-year-olds. Exploratory factor analysis (EFA) was performed on baseline data (N = 79), followed by a confirmatory factor analysis (CFA) of 6-month follow-up data (N = 69). Cronbach’s alpha for internal consistency and test-retest reliability were examined. We also correlated the scale with self-report antiretroviral therapy (ART) adherence. Results: EFA yielded a single-factor solution at baseline after dropping one item. CFA at follow-up corroborated the single-factor. Cronbach’s alpha was high and MTVS was correlated with ART adherence at both time points. MTVS at baseline and 6 months were correlated. Conclusion: The 17-item MTVS scale was found to be valid and reliable and related to ART adherence. Full article

(This article belongs to the Special Issue Measuring Health Inequities among Vulnerable Populations)

13 pages, 355 KiB

Open AccessArticle

Measuring Satisfaction and Comfort with Gender Identity and Gender Expression among Transgender Women: Development and Validation of the Psychological Gender Affirmation Scale

by Jae M. Sevelius, Deepalika Chakravarty, Samantha E. Dilworth, Greg Rebchook and Torsten B. Neilands

Int. J. Environ. Res. Public Health 2021, 18(6), 3298; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063298 - 23 Mar 2021

Cited by 8 | Viewed by 4027

Abstract

Among transgender and gender diverse people, psychological gender affirmation is an internal sense of valuing oneself as a transgender or gender diverse person, being comfortable with one’s gender identity, and feeling satisfied with one’s body and gender expression. Gender affirmation can reduce gender dysphoria and mitigate deleterious health effects of marginalization. We sought to create an instrument to measure psychological gender affirmation among transgender women. Following initial item development using qualitative interviews, we used self-administered survey data from two distinct samples (N1 = 278; N2 = 368) of transgender women living with HIV in the USA. We used data from Study 1 to perform exploratory factor analysis (EFA) and data from Study 2 to perform confirmatory factor analysis (CFA), yielding the five-item single-factor Psychological Gender Affirmation (PGA) scale with high reliability (α = 0.88). This scale is psychometrically sound as demonstrated by its convergent and discriminant validity via correlations with select measures and by its predictive validity through associations in hypothesized directions with measures of mental health and substance use. The PGA scale will aid research on psychological gender affirmation that can in turn inform interventions as well as gender-affirming clinical and social practices to promote the health and well-being of transgender and gender diverse people. Full article

(This article belongs to the Special Issue Measuring Health Inequities among Vulnerable Populations)

13 pages, 314 KiB

Open AccessArticle

Gender Affirmation through Correct Pronoun Usage: Development and Validation of the Transgender Women’s Importance of Pronouns (TW-IP) Scale

by Jae M. Sevelius, Deepalika Chakravarty, Samantha E. Dilworth, Greg Rebchook and Torsten B. Neilands

Int. J. Environ. Res. Public Health 2020, 17(24), 9525; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17249525 - 19 Dec 2020

Cited by 8 | Viewed by 5230

Abstract

Social interactions where a person is addressed by their correct name and pronouns, consistent with their gender identity, are widely recognized as a basic and yet critical aspect of gender affirmation for transgender people. Informed by the Model of Gender Affirmation, we developed a self-report measure of the importance of social gender affirmation, the Transgender Women’s Importance of Pronouns (TW-IP) scale, which measures gender affirmation through the usage of correct pronoun by others. Data were from self-administered surveys in two independent samples of transgender women living with HIV in the US (N1 = 278; N2 = 369). Using exploratory factor analysis with data from Study 1 and confirmatory factor analysis with data from Study 2, we obtained a four-item scale with a single-factor structure and strong reliability (α = 0.95). We present evidence of TW-IP’s convergent and discriminant validity through its correlations with select mental health and HIV-related measures. Further, scores on TW-IP were linked in expected directions to several hypothesized mental health and HIV care outcomes, demonstrating its predictive validity. The resulting brief measure of importance of pronouns among transgender women shows strong psychometric properties. Validation evidence offers highly promising opportunities for use of the measure in clinical and research settings. Full article

(This article belongs to the Special Issue Measuring Health Inequities among Vulnerable Populations)

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9 pages, 706 KiB

Open AccessCommentary

“Sehat Sahulat Program”: A Leap into the Universal Health Coverage in Pakistan

by Syed Shahzad Hasan, Zia Ul Mustafa, Chia Siang Kow and Hamid A. Merchant

Int. J. Environ. Res. Public Health 2022, 19(12), 6998; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19126998 - 07 Jun 2022

Cited by 10 | Viewed by 4688

Abstract

Universal Health Coverage (UHC), initiative from the World Health Organization (WHO), is a means to provide the human right to health by providing essential health services to everyone, enabling disease prevention, treatment, rehabilitation, and palliative care. In line with the WHO recommendations, the UHC was first introduced in Pakistan in Khyber Pakhtunkhwa (KP) province under the name ‘Sehat Sahulat Programme’ (SSP), literally ‘Health Facility Program’ in 2015. The provincial Government in Punjab approved a similar initiative in Punjab, the largest province (by population) of the country, and the program was later rolled out in Islamabad Capital Territory (ICT), Azad and Jammu Kashmir (AJK), Gilgit Baltistan (GB), Sindh, and Baluchistan provinces leaping into the nation-wide coverage. This article provides a current overview of the UHC initiative in Pakistan, analyses its progress in appraising key milestones, and makes recommendations to achieve a robust universal health coverage across Pakistan. Full article

(This article belongs to the Special Issue Measuring Health Inequities among Vulnerable Populations)

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11 pages, 356 KiB

Open AccessCommentary

Participatory Approaches to Addressing Missing COVID-19 Race and Ethnicity Data

by Farah Kader and Clyde Lanford Smith

Int. J. Environ. Res. Public Health 2021, 18(12), 6559; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18126559 - 18 Jun 2021

Cited by 8 | Viewed by 3328

Abstract

Varying dimensions of social, environmental, and economic vulnerability can lead to drastically different health outcomes. The novel coronavirus (SARS-CoV-19) pandemic exposes how the intersection of these vulnerabilities with individual behavior, healthcare access, and pre-existing conditions can lead to disproportionate risks of morbidity and mortality from the virus-induced illness, COVID-19. The available data shows that those who are black, indigenous, and people of color (BIPOC) bear the brunt of this risk; however, missing data on race/ethnicity from federal, state, and local agencies impedes nuanced understanding of health disparities. In this commentary, we summarize the link between racism and COVID-19 disparities and the extent of missing data on race/ethnicity in critical COVID-19 reporting. In addition, we provide an overview of the current literature on missing demographic data in the US and hypothesize how racism contributes to nonresponse in health reporting broadly. Finally, we argue that health departments and healthcare systems must engage communities of color to co-develop race/ethnicity data collection processes as part of a comprehensive strategy for achieving health equity. Full article

(This article belongs to the Special Issue Measuring Health Inequities among Vulnerable Populations)

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