Decrease Health Inequalities Research Articles

Reevaluating Value-Based Care in Telemedicine: Clinical Opportunities in the Postpandemic Era.

Telehealth during the COVID-19 pandemic became one of the main means for patients to access the health care system. Rules, regulations, and reimbursement policies were loosened, allowing for its expansion into the clinical arena. Since the end of the pandemic, virtual care models have expanded. With a larger emphasis on value-based care, there is a need to understand how telehealth can be utilized to increase value, improve access, enhance the patient experience, improve outcomes, and decrease health inequalities. The article explores the use of telehealth as it relates to a value-based care model, which includes the patient experience, quality of care (access and health equity), provider/clinical practice, and health system/financial. Recommendations for strengthening the use of telehealth to ensure value-based care are provided.

Assessment of Electronic Health Literacy Among Filipino Americans.

Health literacy requires skills of reading, understanding, and analyzing text, numbers, graphs, and diagrams to make well-informed decisions. The increase advancement in technologies has made health information accessible in electronic format. Individuals must apply health literacy in navigating through health information resources on the Internet. Filipino Americans originating from a diverse background are often underreported and underrepresented in health research. The study aim was to examine electronic health literacy among Filipino Americans using the Electronic Health Literacy Scale survey. The descriptive study recruited 103 participants. Overall Filipino Americans are electronic health literate, with a mean of 32.4 ( SD = 4.6). Females ( P = .017), those with graduate or professional degrees ( P = .004) and working in healthcare ( P = .040) tend to have higher electronic health literacy. The study provided valuable insight on electronic health literacy on a population that is underrepresented in research. The descriptive data gained from the study lays foundational work to help decrease health inequities experienced by Filipino Americans.

Impact of screening participation on modelled mortality benefits of a multi-cancer early detection test by socioeconomic group in England

BackgroundCancer burden is higher and cancer screening participation is lower among individuals living in more socioeconomically deprived areas of England, contributing to worse health outcomes and shorter life expectancy. Owing...

Operationalizing strategies for expanding UHC for the vulnerable population in Nigeria

People living in vulnerable conditions have often been neglected or have a low coverage in health insurance which exacerbate poverty, vulnerability and social exclusion. This necessitates building and implementing insurance coverage that fully integrates social protection systems and community-based social care that prioritise the needs of the most vulnerable. To that end, we propose a decentralized system of sustainable financing and management of the vulnerable group fund that is performance driven with multi-stakeholder accountability systems premised on integrated data management. Integrating these elements will ensure that some of the existing gaps in the basic healthcare provision fund implementation in Nigeria are addressed with the following fundamental building blocks for the vulnerable group fund. These recommendations will help governments, resource partners and relevant stakeholders to consider in formulating strategies for operationalizing the vulnerable group funds and decreasing health inequalities among the population. In addition to implementation of this to accelerate universal health coverage and social protection, this will help to mitigate the currents challenges that exacerbate the inequality gaps, and build more resilient health and social protection systems, including the systems within humanitarian crises settings.

2.H. Pro/con workshop: Whether AI will decrease health inequalities or deepen them?

Abstract Reasons for the workshop Every new health technology is hoped to help address leading public health problems. Undoubtedly, AI technologies can be useful in many ways in healthcare systems and health care delivery. For example, AI algorithms can help diagnostic process while reducing waiting times and costs. Virtual health assistants can provide personalised health advice regardless of race or socio-economic status. Telehealth platforms can reduce social inequalities by facilitating healthcare delivery and consumption. Digital health and drones can overcome geographical barriers for certain services. However, it has been shown that AI can also deepen health inequalities. For example, some algorithms were less accurate for ethnic minorities because they had been trained on patients from the population majority. Replacement of healthcare professionals by AI technologies can affect adversely already disadvantaged populations relying on traditional healthcare. For AI to be effectively used in developing countries various barriers need to be overcome, such as health and digital illiteracy, and “digital divide’. Objectives of the workshop 1. To benefit from bringing together in one place highly qualified specialists in the fields of public health ethics and digital health to enable the audience to familiarise themselves with the main sides of the debate around the utility of AI in solving health inequities. 2. Based on the presentations and subsequent discussions, to generate new ideas for further research on the topic. Added value of organising the workshop 1. Provision of platform for high-level professional discussion of AI effects on strategic aims of public health, such as bridging health inequalities, within specialists in both fields public health ethics and digital health. 2. Collecting and responding to immediate audience reactions in view of possible future challenges to EUPHA as organisation to issue an opinion related to particular AI application for public health goals. Format of the workshop The workshop will feature two panelists who will respectively defend opposing claims about the effect of AI on health inequalities. The two chairpersons will present the panelists and guide the discussion. The first chairperson will team with the first panelist and field questions from the audience about the negative effects of AI on health inequalities. The second chairperson will team with the second panelist and field questions about the positive effects of AI on health inequalities. Finally, the audience will make an impromptu vote on which arguments were more convincing. The discussions will be wrapped up towards the conclusion of the workshop. Key messages • The applicability of AI in health care to solve dominant public health problems must be explicitly sought but we must be aware of the dual nature of AI. • When it comes to AI in health care, the precautionary principle must give way to risk mitigation in terms of increasing health inequalities, which should be applied at the development stage. Speakers/Panelists Silviya Yankulovska MU-Pleven, Faculty of Public Health, Pleven, Bulgaria Els Maeckelberghe University Medical Center Groningen, Groningen, Netherlands

Territorial Coordination Centres and Telenursing: innovation and digitalisation of home care in Italy

Abstract Issue After Covid-19, Italy approved the National Recovery and Resilience Plan (NRRP) to boost public health, sustainability and digital innovation, which promotes ecological and digital transition reforms. The strategic health reform redesigned territorial healthcare network by introducing new models of proactive care, as Territorial Coordination Centres (TCCs) and Telenursing. Description of the problem TCC is an innovative organisational model, that coordinates taking care by linking services and professionals involved in different care settings. In TCCs are involved nursing staff, that performs a telemedicine service called Telenursing, a way of delivering nursing care directly to the patient's home, through digital health tools. How will TCCs be implemented, using NRRP funds? How will Telenursing impact on home care? Results By 2024, 600 TCCs are planned to be implemented and fully operational, across the Country, financed by NRRP (280 bln €). The standard set by the NRRP reform is 1 TCC each 100,000 inhabitants, with 4-6 primary nurses involved (2,400-3,600 nationally). TCCs are organised to be interconnected with every healthcare network setting, including home care. Telenursing, within the TCCs, aims to guarantee proactive, personalised and proximity care, enhancing the home as a privileged place of care. Nurses of TCCs perform health monitoring, assessment, promotion, prevention and education by Telenursing, in order to reduce inappropriate hospital admissions and to increase patient satisfaction, safety and empowerment. By 2026, at least 200,000 people will be assisted through telemedicine tools, as planned in NRRP reform (funding 1 bln €). Lessons Italy, pursuing better health outcomes for the population, is investing in strengthening public primary care services and digitalization of services. New strategy aims to improve health of population and decrease health inequalities, while reducing geographical variations. Key messages • Telenursing performed by nurses working in TCCs is aimed at improving proactive, personalised and proximity care, supporting patients and caregivers at home. • By 2024, TCCs will be fully operating to guarantee an innovative system of public primary care, that uses digital tools to manage population in home care, reducing inappropriate hospitalization.

Health behaviour and cardiovascular risk in women living in a disadvantaged region in Hungary

Abstract Background The risk factors for non-communicable diseases more prevalent among socioeconomically disadvantaged (SED) adults. The aim of our study was to investigate monitored health status and health behaviour, including risk factors for cardiovascular disease, among women living in disadvantaged regions of Hungary. Methods In the monitored study, nutritional status was measured by a medical body composition analyser and vascular status by the arterial stiffness parameter (PWVao) measured by arteriograph (ARG), supplemented by a health questionnaire. Descriptive statistical analyses were performed to analyse the database, within a 95% confidence interval (CI). Pearson's χ2 test and analysis of variance (ANOVA) were used to test assumptions. The source population of the study was women living in the Abaúj region, the most disadvantaged regions of Hungary. A total of 150 SED adult women constituted the target population. Results The average age of the study participants was 52.8 (SD:15.9) years. More than half of the participants had at completed 8 years of primary education or less (52.3%; 95% CI: 44-61). They were overweight in terms of Body Mass Index (mean BMI=28.7 SD:6.6), and mean systolic blood pressure was 139 mmHg (SD:21.43). The mean PWVao measured in the population was 10.51m/s (SD:6.9). Elevated BMI was significantly (ANOVA p < 0.011) associated with higher PWVao. 36.2% (95% CI: 48-64) of the target group smoked daily. More than half of smokers (55%; 95%CI:38-76) smoked 11-20 cigarettes per day. Smokers scored an average of 4.82 (SD = 2.3) on the Fagerström Test for Nicotine Dependence (FTND) scale of moderate dependence. Lower educational attainment status (χ2 p < 0.001) significantly increase the proportion of smokers in the sample. Conclusions Obesity, smoking and elevated PWVao, are associated with higher circulatory and vascular risk and higher atherosclerotic organ damage, which may contribute to higher premature mortality among disadvantaged women. Key messages • Examining the association between heath behaviour and cardivascular risk of socioeconomically disadvantaged individuals can enhance the development of interventions to decrease health inequalities. • Targeted community health promotion for disadvantaged women is a priority, because their health behaviour determines the health of their children and families.

Clinical and Educational Training About Diversity, Equity, Inclusion, and Justice for Pediatric Residents

Education and clinical training about diversity, equity, inclusion, and justice (DEIJ) is essential for the personal and professional development of pediatric residents in preparation for a career providing health care to diverse pediatric populations. The ability of pediatric residents to reflect on their lived experiences while gaining perspectives about their patients has the potential to positively affect the health care of patients and decrease health inequities. Clinical rotations were established for students from underrepresented populations in medicine as a pathway for matching and diversifying pediatric residency programs with the potential to help diversify the pediatric workforce. The Accreditation Council for Graduate Medical Education formulated standards about DEIJ in pediatric residency training. Curricula, internships, and mentoring programs have been created by medical institutions and professional medical organizations to provide learning experiences about DEIJ and foster a sense of belonging. This review article highlights the multifactorial approach needed to achieve the goal of diversifying the pediatric workforce through DEIJ instruction in pediatric residency training. [ Pediatr Ann . 2023;52(7):e256–e260.]

Role of men’s sexual and reproductive health clinics in decreasing health inequalities

Role of men’s sexual and reproductive health clinics in decreasing health inequalities

Socio-economic inequalities in body mass index among preschool children: do sports programs in early childhood education and care centers make a difference?

Overweight in childhood is considered to be one of the most serious public health challenges. Many studies have investigated individual-level determinants of children's body mass index (BMI), yet studies exploring determinants at the meso-level are sparse. The aim of our study was to examine how a sports focus at early childhood education and care (ECEC) centers moderates the effect of parental socio-economic position (SEP) on children's BMI. We used data from the German National Educational Panel Study and included 1,891 children (955 boys and 936 girls) from 224 ECEC centers in our analysis. Linear multilevel regressions were used to estimate the main effects of family SEP and the ECEC center sports focus, as well as their interaction, on children's BMI. All analyses were stratified by sex and adjusted for age, migration background, number of siblings, and employment status of parents. Our analysis confirmed the wellknown health inequalities in childhood overweight with a social gradient toward a higher BMI for children from lower SEP families. An interactive effect between family SEP and ECEC center sports focus was found. Boys with low family SEP not attending a sports-focused ECEC center had the highest BMI among all boys. In contrast, boys with low family SEP attending a sports-focused ECEC center had the lowest BMI. For girls, no association regarding ECEC center focus or interactive effects emerged. Girls with a high SEP had the lowest BMI, independent of the ECEC center focus. We provided evidence for the gender-specific relevance of sports-focused ECEC centers for the prevention of overweight. Especially boys from low SEP families benefited from a sports focus, whereas for girls the family's SEP was more relevant. As a consequence, gender differences in determinants for BMI at different levels and their interaction should be considered in further research and preventive measures. Our research indicates that ECEC centers may decrease health inequalities by providing opportunities for physical activity.

Design of a community-based, Hybrid Type II effectiveness-implementation asthma intervention study: The Rhode Island Asthma Integrated Response (RI-AIR) program

BackgroundPediatric asthma is among the most common health conditions and disproportionately impacts Black and Latino children. Gaps in asthma care exist and may contribute to racial and ethnic inequities. The Rhode Island Asthma Integrated Response (RI-AIR) program was developed to address current limitations in care. The aims of the RI-AIR Hybrid Type II effectiveness-implementation trial were to: a) simultaneously evaluate the effectiveness of RI-AIR on individual-level and community-level outcomes; b) evaluate implementation strategies used to increase uptake of RI-AIR. In this manuscript, we outline the design and methods used to implement RI-AIR. MethodsSchool-based areas (polygons) with the highest asthma-related urgent healthcare utilization in Greater Providence, R.I., were identified using geospatial mapping. Families with eligible children (2–12 years) living in one of the polygons received evidence-based school- and/or home-based asthma management interventions, based on asthma control level. School-based interventions included child and caregiver education programs and school staff trainings. Home-based interventions included individualized asthma education, home-environmental assessments, and strategies and supplies for trigger remediation. Implementation strategies included engaging school nurse teachers as champions, tailoring interventions to school preferences, and engaging families for input. ResultsA total of 6420 children were screened throughout the study period, 811 were identified as eligible, and 433 children were enrolled between November 2018 and December 2021. ConclusionsEffective implementation of pediatric asthma interventions is essential to decrease health inequities and improve asthma management. The RI-AIR study serves as an example of a multi-level intervention to improve outcomes and reduce disparities in pediatric chronic disease.Clinical Trials Registration Number: NCT03583814.

Strategic Thinking for Bold Goals

Strategic Thinking for Bold Goals

Impact of health insurance on adult mortality in rural areas: Evidence of Seguro Popular in Mexico using panel data

At the beginning of the 21st century, longstanding health inequality existing in developing countries prompted the adoption of public policies focused on increasing health insurance coverage (HIC). The adoption of these policies was based on the assumption that by expanding coverage, health outcomes of the uninsured population would improve, thus decreasing health inequalities. Yet, evidence from developing countries on the effect of HIC on health outcomes is scant. This paper contributes to this literature by studying the impact of health insurance on adult mortality in a developing country setting characterized by high income and health inequalities (Mexico). We examined Seguro Popular (SP) a public health intervention targeted towards workers in informal sector employment. We used longitudinal data from the Mexican Family Life Survey (MxFLS), a nationally representative survey of the Mexican population, that covered three important periods for the roll-out of SP: the year prior to the program’s implementation, the years of expansion, and the years when the program was approaching universal coverage. We merged SP administrative data to the MxFLS and exploited program coverage heterogeneity over time and across municipalities in the implementation of SP to examine its impact on mortality. Our findings demonstrate that SP decreased mortality among the population of adults above the age of 50 residing in rural areas with no preprogram access to medical benefits. We also showed that SP had larger effects for households not receiving benefits from Prospera, Mexico's well-known anti-poverty cash transfer program.

1105. A Matched-Group Comparison of Interventions for COVID-19 During the First and Second Waves of the COVID-19 Pandemic in a County Hospital in Chicago.

Abstract Background The COVID-19 pandemic continually challenges the scientific community to develop and evaluate viable treatments. In May 2020, remdesivir became the first medication to receive emergency use authorization for the treatment of COVID-19, while dexamethasone became standard of care for patients requiring supplementary oxygen in late 2020. Methods This was a retrospective observational study of hospitalized adult patients with confirmed coronavirus disease 2019 (COVID-19) admitted in the first wave (3/2020-7/2020) and second wave (10/2020-1/2021) at Cook County Hospital. Variables on demographic, clinical data and outcomes were extracted from the EMR. The measured intervention was use of dexamethasone with remdesivir during the second wave; patients were matched by age and diabetic status to patients in the first wave who had received only remdesivir. The primary outcome was mortality; secondary outcomes were ICU admission and intubation. Conditional logistic regression was used to examine associations between use of dexamethasone and each outcome, controlling for glucose levels, use of remdesivir and severity of disease. Results 621 patients were admitted in the first wave (3/2020-7/2020) versus 355 in the second wave (12/2020-1/2021). Median age was 55 years and 56 years, respectively. Most patients were Hispanic and Black. In the first wave, 296 patients (48%) were admitted with severe COVID-19 (defined as oxygen saturation on room air at or below 94%) versus 163 patients (46%) in the second wave. Logistic regression showed no association between use of dexamethasone and ICU admission, mortality or intubation. Use of remdesivir showed no association with any of the outcomes. Glucose and severe/critical disease were strongly associated with ICU admission (p=0.01 and p=0.003) and mortality (p=0.06 for both). Conclusion Despite promising medications, in this study the mortality and disease severity of COVID-19 was very similar to that seen in the first wave. This could be due to patients presenting with more advanced disease and undiagnosed or poorly-controlled comorbidities that may offset the potential benefit of these treatments. Enhancing access to care and decreasing health inequalities may be more worthwhile than finding a “miracle drug”. Disclosures All Authors: No reported disclosures.

Impact of social deprivation on clinical outcomes of adults hospitalised with community-acquired pneumonia in England: a retrospective cohort study

IntroductionSocioeconomic deprivation has been associated with an increased incidence of infection and poorer clinical outcomes during influenza pandemics and the COVID-19 pandemic. The aim of this study was to determine...

Practical Strategies for Health Equity Researchers to Enhance Analytic Rigor and Generate Meaningful Insights From Qualitative Data.

Researchers and public health practitioners increasingly need to leverage diverse methodologic approaches in health equity research that will lead to innovations in the assessment of health inequities and development of interventions to decrease health inequities. One well-suited approach is the use of robust qualitative methods (alone or in combination with quantitative methods). As more health equity researchers employ qualitative methods in their study designs, additional guidance is needed on how to conduct robust and rigorous qualitative data analyses. We share a 4-step analytic strategy for health equity researchers and practitioners - particularly those with limited training in qualitative data analysis - that can be used to effectively execute qualitative analysis to inform health equity-driven efforts. These strategies will guide those less experienced in qualitative methodology to employ a pragmatic approach to analysis that is sound, reasonable, and produces meaningful insight that can be used to inform efforts to advance health equity for communities with the greatest needs.

Individual and food environment factors associated with the diet of disadvantaged adults in Flanders

Abstract Background Health inequalities partially remain due to differences in diet between socioeconomic groups. Examining the association between socio-ecological factors and the diet of socioeconomically disadvantaged (SED) individuals can enhance the development of interventions to decrease health inequalities. Methods In total, 278 SED adults residing in two Flemish municipalities completed a survey addressing sociodemographics, diet, health and their perceptions of the food environment. The objective food environment was examined by assessing food retailer information in street network-based buffers of 500m and 1000m around participants’ addresses. Linear regression was used to test assumptions. Results Individual factors such as poor subjective health (OR0.58;CI 0.34-0.97), food insecurity (OR0.60;CI 0.38-0.94) and living alone (OR0.86;CI 0.75-0.98) were negatively associated with healthy dietary habits such as daily fruit and vegetable (FV) consumption. Positive perceptions on the availability of FV were positively associated (OR1.09;CI 1.02-1.17) with daily FV consumption. Objective food environmental factors showed a stronger association with unhealthy dietary habits. A greater amount of retailers within 1000m walking distance was negatively associated with fast-food (OR0.96;CI 0.94-0.99) and sugar-sweetened beverages (SSB) consumption (OR0.93; CI 0.88-0.98). More supermarkets within 500m distance was negatively associated (OR0.77;CI 0.58-0.97) with SSB consumption, while more convenience stores within a 1000m distance was positively associated (OR1.48;CI 1.17-1.88) with SSB consumption. Conclusions Our findings suggest that factors associated with the diet of SED adults differ according to food and drink items. Interventions focused on this population should take these differences into account. Key messages

Enhancing American Indians'/Alaska Natives' Knowledge, Confidence, and Community During the Medical School Application Process: Findings From the Northwest Native American Center of Excellence.

To describe a Medical School Applicant Workshop (MSAW); present lessons learned about its impact on American Indian/Alaska Native (AIAN) participants' knowledge, confidence, and sense of community; and report on participants' medical school application progress 1 year after workshop completion. The Northwest Native American Center of Excellence at Oregon Health & Science University developed and implemented an annual 1-day AIAN MSAW in 2018. The main objectives of the workshop are for participants to gain insights into the medical school application process; learn strategies to competitively apply; receive feedback on their personal statement and mock interviews; and discuss the medical school application process with AIAN faculty, admissions deans, and peer-mentors. Recruitment of AIAN participants occurred via email; social media; text messaging; medical association contacts; and AIAN and science, technology, engineering, and mathematics organizations. Two surveys were administered: one immediately after and another 1-year after the workshop. Forty AIAN MSAW participants were accepted in 2018-2020. Findings indicate statistically significant increases in participants' self-reported knowledge of the medical school application process and in their self-reported confidence. Participants reported meeting other AIAN students was highly beneficial and feeling connected to a community of AIAN health professionals after attending the workshop. Among the 25 participants who completed the 1-year follow-up survey, 12 (48.0%) indicated applying to medical school; all 12 of these participants were invited to interview, and 11 were offered acceptance to at least one medical school. Completing the MSAW increased participants' knowledge, confidence, and sense of community. If other programs and institutions were to consider using the MSAW model to reduce barriers and provide supports specifically designed for AIANs before and during the medical school application process, medical schools may stand to further increase AIAN representation in the physician workforce and ultimately to decrease health inequities among AIANs.

270 Code De-Escalation: Effectiveness and Feasibility Pilot Study of Intervention to Decrease Restraint Use and Health Inequities in Agitation Management in a Community Hospital Emergency Department

Restraint use in the emergency department (ED) has been shown to pose significant physical, psychological, and medicolegal risk to both patients and health care workers. Recent studies have demonstrated racial disparities in restraint application in the ED setting. This study aimed to evaluate the effectiveness of Code De-escalation, a standardized team-based approach for agitation management and assessment of perception of threatening behaviors, in reducing restraint use and racial disparities in restraint application in a community hospital emergency department.

Reducing New Chlamydia Infection Among Young Men by Promoting Correct and Consistent Condom Use: Protocol for a Randomized Controlled Trial

BackgroundThe health, social, and economic costs of sexually transmitted infections (STIs) represent a major public health concern. Young people are considered one of the groups most at risk for acquiring and transmitting STIs. Correct and consistent condom use has been shown to be the most effective method for reducing STIs; however, condoms are often not used properly. Evidence shows that brief behavior change interventions that focus on skills, communication, and motivation to acquire safe sex practices should be adopted into routine care to reduce STIs. Funding for sexual health services in England has declined dramatically, so novel ways of reducing clinic attendance are being sought. The home-based intervention strategy (HIS-UK) to promote condom use among young men has shown promise in feasibility and pilot studies by demonstrating high acceptability of the intervention in participant and health professional feedback, including aiding men to find condoms they like and feel more confident when using condoms.ObjectiveThe aim of this study is to determine the effectiveness and cost-effectiveness of HIS-UK when compared to usual condom distribution care among young men.MethodsThe 3 trial arms consisting of “e-HIS” (HIS-UK delivered digitally), “ProHIS” (HIS-UK delivered face-to-face), and control condition (usual National Health Service [NHS] care) will be compared against the following 3 primary outcomes: the extent to which correct and consistent condom use is increased; improvement of condom use experiences (pleasure as well as fit and feel); and decrease in chlamydia test positivity. Eligibility criteria include men aged 16-25 years at risk of STIs through reporting of condom use errors (ie, breakage or slippage) or condomless penile-vaginal or penile-anal intercourse with casual or new sexual partners during the previous 3 months. Prospective participants will be recruited through targeted advertisements and an opportunistic direct approach at selected sexual health and genitourinary medicine services and university-associated health centers and general practitioner practices. Community and educational establishments will be used to further advertise the study and signpost men to recruitment sites. Participants will be randomly allocated to 1 of 3 trial arms. A repeated measures design will assess the parallel arms with baseline and 12 monthly follow-up questionnaires after intervention and 3 chlamydia screening points (baseline, 6, and 12 months).ResultsRecruitment commenced in March 2020. Due to the COVID-19 pandemic, the study was halted and has since reopened for recruitment in Summer 2021. A 30-month recruitment period is planned.ConclusionsIf effective and cost-effective, HIS-UK can be scaled up into routine NHS usual care to reduce both STI transmission in young people and pressure on NHS resources. This intervention may further encourage sexual health services to adopt digital technologies, allowing for them to become more widely available to young people while decreasing health inequalities and fear of stigmatization.Trial RegistrationISRCTN Registry ISRCTN11400820; https://www.isrctn.com/ISRCTN11400820