Equity Of Services Research Articles

Gender and ethnic equity in Aotearoa New Zealand's public service before and since Covid‐19: Toward intersectional inclusion?

AbstractSince its bi‐cultural foundation with Te Tiriti o Waitangi (the Treaty of Waitangi, signed in 1840 by Māori, the indigenous Polynesian people of Aotearoa New Zealand (NZ), chiefs and representatives of the British Crown), cultural identities have expanded through immigration. While Aotearoa NZ's government seeks to encourage workplace diversity in public service agencies, developments are being disrupted by Covid‐19. Using a typology of equality approaches, this study appraises the “ambition” of equity progress in Aotearoa NZ public service agencies based on content analysis of interviews with sector experts, agency staff and managers. In terms of equity discourses, workplace inequities emerge as more pronounced for Māori and Pasifika (the indigenous peoples of the Pacific), indicating that more “ambitious” equality initiatives, including those which aim for intersectional inclusion, are needed. The study thereby contributes a more nuanced understanding of equity approaches that could meaningfully inform workplace initiatives designed to recognize, value and empower gender diversity. Its relevance for Aotearoa NZ, which has one of the most diverse working‐age populations in the world, is likely to resonate in other countries where workforce diversity is yet to translate into equitable engagement in and experiences of work organizations by all.

Health promotion through collaborative health: a Tuscan model

Abstract Background chronic diseases affect in Italy about 39.1% of the total population and 85.3% of the over 75 years. A new experimental approach has been studied that, through the communities, activate collaborative processes to improve the health and well-being of population. The ASL Toscana Sudest for the three years 2017-2020 has acquired from the Self-management Resource Center (SMRC, University of Stanford California) licenses for implementing self-management programs for chronically ill people. The training process is subject to quality control by SMRC with annual report. Objectives the goal is to train participants in the solution of problems, to make decisions, to set objectives and define priorities, to undertake actions for clinical-emotional management and its social role. The self-management education processes carried out have been addressed primarily to the diabetes program. Results 57 conductors were trained through the administration of 30 hours of frontal lessons to nurses and lay people. Subsequently, the conductors implemented 77 programs in which a total of 750 people participated. Of these, 90% took part in at least four of the six seminars provided for in the program. In addition, a specific program has been launched for a group of 13 Bengali citizens resident in Italy with particular attention to the risk of development of dysmetabolic diseases and the possible correlation with Ramadan. Conclusions the engagement of the citizen in terms of Public Health manifests itself with a cumulative impact of small behavioral changes at the level of individuals, communities, and the population. Main message: the project aims to introduce the concept of ‘Collaborative Health' offering concrete examples of experiences already present in the Tuscan context, formulating possible recommendations for stakeholders for the innovation of the system and stimulating greater sustainability, appropriateness and equity of services and health models in Italy. Key messages Collaborative health is a winning strategy for health promotion. Chronic diseases are a main topic for health promotion.

Weaving Diversity into LIS Instruction: Equity Behaviors to Create the Tapestry of Inclusive Library Practice

Libraries should be inclusive spaces for all patrons. It is imperative today’s librarians are equipped to infuse diversity, equity, and inclusion (DEI) theory with best practice when establishing policy and procedure. Library preparation programs must prepare the next generation of librarians to meet the needs of a diverse population, however, there are no established protocols in LIS education for training pre-service librarians in DEI. This exploratory study examines how one class used a culturally responsive pedagogy (CRP) framework to study issues of diversity, equity, and inclusion in library services. Findings suggest LIS students who interrogate their own bias and integrate thoughtful equity behaviors adopt greater empathy and DEI strategies

Approaching a New Normal: Lessons Learned Transitioning Family Education Programming to a Virtual Environment.

The COVID-19 pandemic is highlighting deep-rooted health inequities. While the virus itself does not discriminate, gaps in access to services and disparities in health outcomes are prevalent. Concerns over worsening mental health outcomes and increases in family violence exist. Thus, service organizations have faced an unprecedented call to rethink services, with many transitioning to virtual programming to ensure the needs of their clients can be met. This brief highlights lessons learned as one organization pivoted to meet critical client needs during the COVID-19 pandemic. Evidence suggests atypically high engagement and retention in family education and family violence reduction programming under Safer at Home orders when compared with pre-COVID engagement. Findings suggest key tenants for program success are tied to strong programming, staff engagement, and participation retention and satisfaction. Program adaptations create opportunities for increasing service equity, improving engagement and satisfaction, and improving family and mental health outcomes by maintaining connections, while providing a model for delivering services to reduce child maltreatment during times of social isolation and increased hardship.

Prehabilitation services for people diagnosed with cancer in Scotland – Current practice, barriers and challenges to implementation

BackgroundPrehabilitation is the practice of enhancing a patient's functional and psychological capacity before treatment commences. It is of interest in the cancer context because of the impact of treatments on quality of life and cancer survivorship. This work aims to document current practice, barriers and challenges to implementing prehabilitation to inform the development of a national framework. MethodsA mixed-methods approach was applied: an on-line survey was sent to stakeholders in cancer care across Scotland, supplemented by in-depth interviews. Key domains explored were the perceived importance of prehabilitation, availability, delivery and content of services, outcome measures, referral processes and funding. FindingsA total of 295 survey responses were obtained and 11 interviews completed. Perceived importance of prehabilitation was rated highly. There was uncertainty over the definition of prehabilitation and most respondents did not know if local services were available. Where services were described, a range of health professionals were involved, different outcome measures were utilised and frequency of referrals varied. Respondents highlighted short time frames between referral and treatment, concerns about patient engagement, the evidence base for action and funding priorities. Respondents also commented on which context a referral should be made and to whom, and the need for equity of service across the country. ConclusionsThe current work found clear evidence of the perceived importance of prehabilitation in cancer patients. However, issues and key gaps were identified within current services (including issues arising from COVID-19) which must be addressed to enable wide-spread development and implementation of equitable programmes.

Pragmatic evaluation of transdisciplinary research on gender equity in the New Zealand public service

PurposeDespite the need for such, little scholarly attention has been paid to transdisciplinary enquiry into gender inequities in workplaces. The authors provide a pragmatic evaluation of the transdisciplinary research (TDR) model by Hall et al. (2012) for framing the study of this societal issue, shedding light on the challenges, principles and values that could usefully inform subsequent TDR in organisational settings.Design/methodology/approachThis paper evaluates the model in relation to TDR on gender inequities in New Zealand's public service by Hall et al. (2012) Content analysis on our reflective narratives from research team meetings, email exchanges, informal discussions and a workshop reveals TDR study insights. Findings show support for the model and its four broad phases and surface principles and values for applied TDR enquiry that addresses societal challenges in the organisational context.FindingsThe adoption of a TDR model to examine a study of equity in the public service revealed practical and conceptual challenges, encouraging ongoing reflection and adaptive behaviour on the researchers' part. The pragmatic evaluation also highlighted environmental constraints on undertaking TDR, with implications for the ambition of future studies.Research limitations/implicationsThis evaluative enquiry encourages similar research in other organisational and national settings to validate the use of TDR to gain insightful, contextualised understandings of social challenges centred in the organisational setting.Practical implicationsThis pragmatic evaluation of a TDR model's capacity to approximate the approach and phases of our applied enquiry lays the groundwork to refining TDR approaches used in subsequent studies aimed at addressing societal issues in the organisational setting.Social implicationsThis paper can potentially promote greater collaboration between research scholars and other stakeholders wanting to develop TDR paradigms and applied enquiry that can meaningfully inform workplace and societal impacts.Originality/valueThis pragmatic evaluation of a TDR approach involves its initial application to the study of equity at work and develops principles and values that could inform TDR paradigms and methodologies of subsequent enquiries in the field.

Human rights and equity in mental health services

Human rights and equity in mental health services

A clustering method for measuring accessibility and equity in public transportation service: Case study of Melbourne

This paper proposes a Modified Cumulative Accessibility (MCA) measure incorporating actual travel demand information (Origin-Destination trip patterns) to improve the accuracy of the measure as a reliable proxy for equity evaluation and amelioration in accessing Public Transportation (PT) services. The travel demand information is reflected into the MCA measure by evaluating and clustering PT and Private Vehicle Transportation (PVT) trip diaries. Both vertical and horizontal equities are measured for the network's Transportation Analysis Zones (TAZs). To redress the inequities, a priority list of operational recommendations for each TAZ is identified. The proposed method is tested with the Greater Melbourne area datasets and the TAZs with the highest inequity along with prescribed operational recommendations are identified. In terms of equitable distribution of public transportation service, a major observation from the case study model was that the outer suburban areas located in the eastern side of the the Melbourne metropolitan area are relatively underserved as compared to the inner and western suburbs.

Strategies and indicators to address health equity in health service and delivery systems: a scoping review protocol.

The purpose of this review is to describe how health service and delivery systems support health equity, and to identify strategies and indicators being used to measure health equity. It is widely acknowledged that a population health and equity approach is needed to improve the overall health of the population. The health service and delivery system plays an important role in this approach. Despite this, system transformation to address health inequities has been slow. This is due, in part, to the lack of evidence-based guidance on how health service and delivery systems can address and measure health equity integration. Most studies focus on health equity integration in the public health sector at a provincial or national level, but less is known about integration within the health service and delivery system. More information is needed to understand how that transformation is occurring, or could occur, to make a meaningful contribution toward improving population health outcomes. This scoping review will identify studies that describe the strategies and indicators that health service and delivery systems are using to integrate health equity and how progress is measured. Evidence from qualitative, quantitative, mixed method studies, and gray literature will be included. This review will be conducted in accordance with JBI methodology for scoping reviews. A comprehensive search strategy, developed with a librarian scientist, will be used to identify relevant sources. Titles, abstracts, and full texts will be evaluated against inclusion criteria. Information will be extracted by two independent reviewers. Data will be synthesized and presented narratively, with tables and figures where appropriate.

Survey Design on the Perceptions of Automated Vehicles: Face and Content Validity

Abstract Date Presented 04/13/21 Automated vehicles (AVs) may provide many societal benefits, including reducing road fatalities, improving participation, and increasing equity of transportation services. However, societal benefits will not occur if individuals do not accept and adopt this technology. The aim of this study was to design a survey that would assess users' perceptions of AVs after exposure to the technology. Although further validation is required, this survey provides insight into users' perceptions of AVs. Primary Author and Speaker: Justin Mason Additional Authors and Speakers: Linda Olson

Can health service equity alleviate the health expenditure poverty of Chinese patients? Evidence from the CFPS and China health statistics yearbook

ObjectivesTo comprehend the relationship between various indicators of health service equity and patients’ health expenditure poverty in different regions of China, identify areas where equity in health service is lacking and provide ideas for improving patients’ health expenditure poverty.MethodData from China Family Panel Studies (CFPS) in 2018 and the HFGT index formula were used to calculate the health expenditure poverty index of each province. Moreover, Global Moran’s I and Local Moran’s I test are applied to measure whether there is spatial aggregation of health expenditure poverty. Finally, an elastic net regression model is established to analyze the impact of health service equity on health expenditure poverty, with the breadth of health expenditure poverty as the dependent variable and health service equity as the independent variable.ResultsIn the developed eastern provinces of China, the breadth of health expenditure poverty is relatively low. There is a significant positive spatial agglomeration. “Primary medical and health institutions per 1,000 population”, “rural doctors and health workers per 1,000 population”, “beds in primary medical institutions per 1,000 population”, “proportion of government health expenditure” and “number of times to participate in medical insurance (be aided) per 1,000 population” have a positive impact on health expenditure poverty. “Number of health examinations per capita” and “total health expenditure per capita” have a negative impact on health expenditure poverty. Both effects passed the significance test.ConclusionTo enhance the fairness of health resource allocation in China and to alleviate health expenditure poverty, China should rationally plan the allocation of health resources at the grassroots level, strengthen the implementation of hierarchical diagnosis and treatment and encourage the investment in business medical insurance industry. Meanwhile, it is necessary to increase the intensity of medical assistance and enrich financing methods. All medical expenses of the poorest should be covered by the government.

A multi-objective decision support framework to prioritize tree planting locations in urban areas

With tree planting initiatives being undertaken in different cities, careful thought needs to be put into the placement of trees, the beneficiaries of ecosystem services from these trees, and the potential impacts of alternative tree planting schemes. Using a spatially explicit methodology within biophysical ecosystem service models, this research develops a multi-objective decision support framework to guide future greening initiatives towards prioritizing planting locations that maximize multiple objectives. In a case study application of the framework in the Bronx, NY, the analysis utilizes spatially distributed census block group data and linear programming, a mathematical optimization technique, to identify optimal and equitable planting locations considering increases in tree cover, monetary benefits from avoided runoff, PM2.5 air pollutant removal and heat index reduction as well as tree planting costs and the equality and equity of urban tree ecosystem services. Using different optimization scenarios, the framework identifies optimal planting schemes by minimizing planting costs, maximizing increases in tree cover and ecosystem service benefits, and the equity of canopy cover and ecosystem services, arriving at a wide range of different planting recommendations. We conclude that multi-objective prioritization frameworks can identify optimal locations for greater total benefits from urban greening and that the proposed framework has the potential to inform decision making in different cities.

NURSES AS NAVIGATORS: PREVENTION AND CONTROL OF NON - COMMUNICABLE DISEASE

The heart of navigation is personalized care” which applies to patients, families, and caregivers. Nurse Navigators focus first & foremost on the clinical aspects of care. Nurse navigator can make a significant contribution to health reform by working towards patient-centred care where in patients receive timely, seamless, culturally appropriate guidance and support for developing health literacy. It has the system knowledge & access, clinical skills and time to understand each person’s needs and to partner with them to develop a plan of care that addresses their health needs and respects & values their time and circumstances. It also contributes to health system improvement by improving access, equity, efficiency, effectiveness and sustainability of health services. These improvements are most notable during transitions from acute to continuing care, where the nurse navigator can also be instrumental in achieving better service integration. The nurse navigator offer a unique service for the provision of quality care.

Economic status and catastrophic health expenditures in China in the last decade of health reform: a systematic review and meta-analysis

BackgroundIn order to solve the problem of “expensive medical treatment and difficult medical treatment” for patients and improve the equity of medical services, China started the health-care reform in 2009, and proposed ambitious goals of providing fair and high-quality basic medical and health services to all citizens and reducing economic burden of diseases. This study was to systematically explore the association between population economic status and incidence of catastrophic health expenditures (CHE) in mainland China in the last decade since 2009 health reform.MethodsThis systematic review was reported according to the standard of preferred reporting items for systematic reviews and meta-analyses (PRISMA). We systematically searched Chinese Electronic literature Database of China Journal Full Text Database, Chinese Biomedical Journal Database, Wan fang Data Resource System, VIP Database, and English literature databases of PubMed, SCI, EMbase and Cochrane Library from January 2000 to June 2020, and references of included studies. Two reviewers independently selected all reports from 2000 to 2020 for empirical studies of CHE in mainland China, extracted data and evaluated the quality of the study. We conducted meta-analysis of the incidence of CHE and subgroup analysis according to the time of the study and the economic characteristics of residents.ResultsFour thousand eight hundred seventy-four records were retrieved and eventually 47 studies with 151,911 participants were included. The quality scores of most of studies were beyond 4 points (91.49%). The pooled incidence of CHE of Chinese residents in the last two decades was 23.3% (95% CI: 21.1 to 25.6%). The CHE incidence increased from 2000 to 2017, then decreased over time from 2017 to 2020. From 2000 to 2020, the CHE incidence in rural areas was 25.0% (95% CI: 20.9 to 29.1%) compared to urban 20.9% (95% CI: 18.3 to 23.4%); the CHE incidence in eastern, central and western China was 25.0% (95% CI: 19.2 to 30.8%), 25.4% (95% CI: 18.4 to 32.3%), and 23.1% (95% CI: 17.9 to 28.2%), respectively; the CHE incidence was 30.9% (95% CI: 22.4 to 39.5%), 20.3% (95% CI: 17.0 to 23.6%), 19.9% (95% CI: 15.6 to 24.1%), and 23.7% (95% CI: 18.0 to 29.3%) in poverty group, low-income group, middle-income group, and high-income group, respectively.ConclusionsIn the past two decade, the incidence of CHE in rural areas is higher than that of urban residents; higher in central areas than in eastern, western and other regions; in poverty households than in low-income, middle-income and high-income regions. Further measures should be taken to reduce the incidence of CHE in susceptible people.

Equity in Public Services: A Systematic Literature Review

AbstractSince the New Administration perspective was introduced by Dwight Waldo, equity has played a key role in public administration and public policy studies. Much research has focused on employment, politics, jurisprudence, voting and many other issues, while neglecting the role of public services. As gross societal inequities in the world still abound, this article aims at mapping the structure of the knowledge on equity in public services as well as the main conceptualizations and determinants of equity. Quantitative (bibliometrix) and qualitative (narrative) analyses are combined in the analysis of 145 articles from 69 journals. The greatest concentration areas and main drivers of equity (i.e., representative bureaucracy, administrative burden, horizontal and vertical decentralization, privatization, co‐production and performance management) are identified. The review contributes to the advancement of social equity in public administration scholarship and practice by improving the conceptual clarity of the term and by mapping the various literature streams.

Customer-based brand equity and customer engagement in experiential services: insights from an emerging economy

The aim of this research is to analyze links between customer-based brand equity and customer engagement in the field of experiential services (e.g., private health clinics)—taking an emerging economy context as our reference. The authors put forth a chain of effects—based in Social Capital Theory—to test the impact of customer-based brand equity on customer engagement, mediated by satisfaction and customer reputation. Causal model estimation results suggest that customer-based brand equity has both a direct, positive impact on customer satisfaction and customer reputation and an indirect impact on customer engagement. The final section of the paper presents theoretical discussion of the results and the main implications for business practice.

Time of transition: lessons from China's progress in reproductive, maternal, newborn, child, and adolescent health

The report of the Lancet Commission on 70 years of reproductive, maternal, newborn, child, and adolescent health (RMNCAH) in China 1 Qiao J Wang Y Li X et al. A Lancet Commission on 70 years of women's reproductive, maternal, newborn, child, and adolescent health in China. Lancet. 2021; (published online May 24.)https://doi.org/10.1016/S0140-6736(20)32708-2 Summary Full Text Full Text PDF PubMed Scopus (63) Google Scholar describes the country's achievements and discusses policy and socioeconomic transitions, and their impact on epidemiological and demographic transitions. Current challenges are identified by the Commission, including low fertility, the ageing population, undernutrition and overnutrition, and emerging diseases as China moves towards its final stage of ending preventable maternal 2 Souza JP Tunçalp Ö Vogel JP et al. Obstetric transition: the pathway towards ending preventable maternal deaths. BJOG. 2014; 121: 1-4 Crossref PubMed Scopus (133) Google Scholar and neonatal deaths. To move from the goal of surviving to thriving, actions to ensure quality care, dignity, equity, and universal coverage of RMNCAH services should be implemented. Alongside emphasising China's unique history, sociocultural factors, and hierarchical RMNCAH system, the Commission presents some key lessons for low-income and low-middle-income countries (LMICs). A Lancet Commission on 70 years of women's reproductive, maternal, newborn, child, and adolescent health in ChinaWomen's reproductive, maternal, newborn, child, and adolescent health (RMNCAH) is a cornerstone for the healthy development of the next generation and a driving force for the progress of population and society in the future, especially in this era of population ageing and low fertility in China. In past decades, China's RMNCAH has made remarkable achievements in development goals related to reducing maternal and child mortality. However, as China moves towards a thriving goal—namely, towards ensuring health and wellbeing—the country faces emerging problems and new challenges in RMNCAH. Full-Text PDF

Incorporating the indigenous evaluation framework for culturally responsive community engagement

AbstractNative American families, schools, and communities foster resilience among their youth who experience significant mental health disparities. To increase equity in mental health services for Native American students, it is essential that researchers employ culturally responsive community engagement when developing programs in schools. Guided by the Indigenous Evaluation Framework and Tribal Critical Race Theory, the aim of the current study was to examine our process of community engagement in the development of a culturally responsive school‐based mental health program for students attending public school on the land of the Confederated Salish and Kootenai Tribes. University‐affiliated members of the research team who were engaged in the community‐based participatory action research analyzed the process through individual reflexivity and collaborative discussions. Findings include themes of Centrality of Context and Relationships, Immersion into Community, Authentic Partnership, Storytelling and Metaphors, Community Liaison as Teacher, Cultural Broker, and Confidant, and Honoring Tribal Sovereignty. Implications for researchers and practitioners emphasize the importance of using decolonizing practices and community engagement in developing and implementing culturally responsive school‐based mental health programs to increase equity for Native American youth.

Health Care Disparities Add Insult to Spinal Cord Injury.

The authors describe the disparities and increased risk of traumatic spinal cord injury Black Americans face because of violence. This article should serve as a realization of these inequities and as a call to action to improve the equity of rehabilitation services in this population to improve outcomes.

The impact of interprofessional practice models on health service inequity: an integrative systematic review

PurposeThe purpose of this review was to explore the literature for evidence of the impact of interprofessional practice models on health service inequity, particularly within community care settings for diverse ageing populations.Design/methodology/approachAn integrative systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework combined with the EndNote reference management system. Following the collection and comprehensive screening process completion, a thematic analysis of the included articles occurred utilising within NVivo 12 software.FindingsThe review found that there was a paucity of evidence related to the relationship between interprofessional practice models (IPM) and health service equity for ageing populations. There is a need to improve collaborative practices between social care, public health care and health service providers to more clearly define team member roles. Key aspirations included the need for future innovations in health service delivery to place health service equity as a goal for interprofessional practice. There is a need to find ways to measure and articulate the impact for vulnerable populations and communities.Research limitations/implicationsThe review offers insight into the need for health care delivery models to place health service equity at the centre of the model design. In practice settings, this includes setting interprofessional team goals around achieving equitable care outcomes for, and with, vulnerable populations. Implications for practice relate to improving how interprofessional teams work with communities to achieve health care equity.Originality/valueThere is a consensus across the literature that there continues to be health service inequity, yet IPE and interprofessional collaborative practice (IPC) have been growing in momentum for some time. Despite many statements that there is a link between interprofessional practice and improved health service equity and health outcomes, evidence for this is yet to be fully realised. This review highlights the urgent need to review the link between education and practice, and innovative health models of care that enable heath care professionals and social care providers to work together towards achieving health equity for ageing populations. It is clear that more evidence is required to establish evidence for best practice in interprofessional care that has the mitigation of health care inequity as a central objective.