Equity Gap Research Articles

Participation in Undergraduate Research Reduces Equity Gaps in STEM Graduation Rates.

Many students who enroll in a public U.S. 4-y college will not graduate. The odds of completing a college degree are even lower for students who have been marginalized in higher education, especially in Science, Technology, Engineering, and Math (STEM) fields. Can undergraduate research increase a student's likelihood of graduating college and close educational equity gaps in college completion? To answer this question, we use data from six public U.S. universities (N = 120,308 students) and use Propensity Score Matching to generate a comparison group for analyses. We conducted logistic regressions on graduation rates and equity gaps in 4 and 6 y using the matched comparison group and undergraduate researchers in STEM (n = 2727). When being compared with like-peers and controlling for background characteristics and prior academic performance, students who participated in undergraduate research were twice as likely to graduate in 4 y and over 10 times as likely to graduate in 6 y. We also found that equity gaps in 4-y graduation rates for students of color, low-income, and first-generation students were cut in half for undergraduate researchers. At 6 y, these gaps were completely closed for undergraduate researchers. As we seek ways to close education gaps and increase graduation rates, undergraduate research can be a meaningful practice to improve student success.

Content Coverage as a Persistent Exclusionary Practice: Investigating Perspectives of Health Professionals on the Influence of Undergraduate Coursework.

STEM undergraduates navigate lengthy sequences of prerequisite courses covering volumes of science content. Given that these courses may contribute to attrition and equity gaps in STEM, research is needed to test the assumption that prerequisite content benefits students in their future studies and careers. We investigated the relevance of prerequisite course content for students' careers through semistructured interviews with practicing nurses regarding their undergraduate anatomy and physiology (A&P) courses. Nurses reported that A&P content does not align with the skills and knowledge needed in the nursing profession. Interviewees averaged 39% on a brief A&P assessment, suggesting A&P prerequisites failed to impart a high degree of long-term A&P knowledge among nurses. Further, practicing nurses perceived overcommitment to A&P content coverage as an exclusionary practice that eliminates capable individuals from the prenursing pathway. These findings challenge assumptions surrounding the justification for prerequisite course content and raise questions of whether content expectations actively exclude individuals from STEM or healthcare careers. We aspire for this study to stimulate conversation and research about the goals of prerequisite content, who is best positioned to articulate prerequisite content objectives, and the influence of content coverage on equity and justice in undergraduate STEM education.

Inequities and trends of polio immunisation among children aged 12–23 months in Ethiopia: a multilevel analysis of Ethiopian demographic and health survey

IntroductionDespite Ethiopia’s policy intention to provide recommended vaccination services to underprivileged populations, inequity in polio immunisation persists.ObjectiveThis study examined inequity and trends in polio immunisation and determinant factors among children...

Inequity in the face of success: understanding geographic and wealth-based equity in success of facility-based delivery for under-5 mortality reduction in six countries

BackgroundBetween 2000–2015, many low- and middle-income countries (LMICs) implemented evidence-based interventions (EBIs) known to reduce under-5 mortality (U5M). Even among LMICs successful in reducing U5M, this drop was unequal subnationally, with varying success in EBI implementation. Building on mixed methods multi-case studies of six LMICs (Bangladesh, Ethiopia, Nepal, Peru, Rwanda, and Senegal) leading in U5M reduction, we describe geographic and wealth-based equity in facility-based delivery (FBD), a critical EBI to reduce neonatal mortality which requires a trusted and functional health system, and compare the implementation strategies and contextual factors which influenced success or challenges within and across the countries.MethodsTo obtain equity gaps in FBD coverage and changes in absolute geographic and wealth-based equity between 2000–2015, we calculated the difference between the highest and lowest FBD coverage across subnational regions and in the FBD coverage between the richest and poorest wealth quintiles. We extracted and compared contextual factors and implementation strategies associated with reduced or remaining inequities from the country case studies.ResultsThe absolute geographic and wealth-based equity gaps decreased in three countries, with greatest drops in Rwanda – decreasing from 50 to 5% across subnational regions and from 43 to 13% across wealth quintiles. The largest increases were seen in Bangladesh – from 10 to 32% across geography – and in Ethiopia – from 22 to 58% across wealth quintiles. Facilitators to reducing equity gaps across the six countries included leadership commitment and culture of data use; in some countries, community or maternal and child health insurance was also an important factor (Rwanda and Peru). Barriers across all the countries included geography, while country-specific barriers included low female empowerment subnationally (Bangladesh) and cultural beliefs (Ethiopia). Successful strategies included building on community health worker (CHW) programs, with country-specific adaptation of pre-existing CHW programs (Rwanda, Ethiopia, and Senegal) and cultural adaptation of delivery protocols (Peru). Reducing delivery costs was successful in Senegal, and partially successful in Nepal and Ethiopia.ConclusionVariable success in reducing inequity in FBD coverage among countries successful in reducing U5M underscores the importance of measuring not just coverage but also equity. Learning from FBD interventions shows the need to prioritize equity in access and uptake of EBIs for the poor and in remote areas by adapting the strategies to local context.

Integrated Management of Childhood Illness implementation in Nepal: understanding strategies, context, and outcomes

BackgroundHealth system-delivered evidence-based interventions (EBIs) are important to reducing amenable under-5 mortality (U5M). Implementation research (IR) can reduce knowledge gaps and decrease lags between new knowledge and its implementation in real world settings. IR can also help understand contextual factors and strategies useful to adapting EBIs and their implementation to local settings. Nepal has been a leader in dropping U5M including through adopting EBIs such as integrated management of childhood illness (IMCI). We use IR to identify strategies used in Nepal’s adaptation and implementation of IMCI.MethodsWe conducted a mixed methods case study using an implementation research framework developed to understand how Nepal outperformed its peers between 2000–2015 in implementing health system-delivered EBIs known to reduce amenable U5M. We combined review of existing literature and data supplemented by 21 key informant interviews with policymakers and implementers, to understand implementation strategies and contextual factors that affected implementation outcomes. We extracted relevant results from the case study and used explanatory mixed methods to understand how and why Nepal had successes and challenges in adapting and implementing one EBI, IMCI.ResultsStrategies chosen and adapted to meet Nepal’s specific context included leveraging local research to inform national decision-makers, pilot testing, partner engagement, and building on and integrating with the existing community health system. These cross-cutting strategies benefited from facilitating factors included community health system and structure, culture of data use, and local research capacity. Geography was a critical barrier and while substantial drops in U5M were seen in both the highest and lowest wealth quintiles, with the wealth equity gap decreasing from 73 to 39 per 1,000 live births from 2001 to 2016, substantial geographic inequities remained.ConclusionsNepal’s story shows that implementation strategies that are available across contexts were key to adopting and adapting IMCI and achieving outcomes including acceptability, effectiveness, and reach. The value of choosing strategies that leverage facilitating factors such as investments in community-based and facility-based approaches as well as addressing barriers such as geography are useful lessons for countries working to accelerate adaptation and implementation of strategies to implement EBIs to continue achieving child health targets.

Reducing the equity gap in under-5 mortality through an innovative community health program in Ethiopia: an implementation research study

BackgroundThe Ethiopian government implemented a national community health program, the Health Extension Program (HEP), to provide community-based health services to address persisting access-related barriers to care using health extension workers (HEWs). We used implementation research to understand how Ethiopia leveraged the HEP to widely implement evidence-based interventions (EBIs) known to reduce under-5 mortality (U5M) and address health inequities.MethodsThis study was part of a six-country case study series using implementation research to understand how countries implemented EBIs between 2000–2015. Our mixed-methods research was informed by a hybrid implementation science framework using desk review of published and gray literature, analysis of existing data sources, and 11 key informant interviews. We used implementation of pneumococcal conjugate vaccine (PCV-10) and integrated community case management (iCCM) to illustrate Ethiopia’s ability to rapidly integrate interventions into existing systems at a national level through leveraging the HEP and other implementation strategies and contextual factors which influenced implementation outcomes.ResultsEthiopia implemented numerous EBIs known to address leading causes of U5M, leveraging the HEP as a platform for delivery to successfully introduce and scale new EBIs nationally. By 2014/15, estimated coverage of three doses of PCV-10 was at 76%, with high acceptability (nearly 100%) of vaccines in the community. Between 2000 and 2015, we found evidence of improved care-seeking; coverage of oral rehydration solution for treatment of diarrhea, a service included in iCCM, doubled over this period. HEWs made health services more accessible to rural and pastoralist communities, which account for over 80% of the population, with previously low access, a contextual factor that had been a barrier to high coverage of interventions.ConclusionsLeveraging the HEP as a platform for service delivery allowed Ethiopia to successfully introduce and scale existing and new EBIs nationally, improving feasibility and reach of introduction and scale-up of interventions. Additional efforts are required to reduce the equity gap in coverage of EBIs including PCV-10 and iCCM among pastoralist and rural communities. As other countries continue to work towards reducing U5M, Ethiopia’s experience provides important lessons in effectively delivering key EBIs in the presence of challenging contextual factors.

The unified state examination in mathematics in urban and rural schools: The impact of the 2020-2021 pandemic

This mixed methods study investigates the impacts of the COVID-19 pandemic on outcomes and perceptions related to the high-stakes unified state exam (USE) mathematics assessment in Russia. Quantitative descriptive analyses of USE scores from 2018-2021 revealed statistically significant distributional differences over time, with progressive increases in higher performance tiers. However, while a positive trend was discernible, strength of association tests indicated it was marginally moderate across years. Stratified pass rate analyses illuminated between-group variances, with specialized schools strongly rebounding after initial 2020 declines observed universally. To gain stakeholder insights, surveys were administered to students and teachers from urban versus rural regions. Attitudes regarding the mandatory USE removal diverged between groups; optimism permeated small rural schools despite hardships, while skepticism was pronounced among urban teachers citing accountability concerns. Stress perceptions revealed dissonances signaling wellbeing impacts. Overall, while achievement markers show positive trajectories, attitudinal variations based on school-types underline social dimensions shaping high-stakes test experiences. Results implicate targeted support policies and context-sensitive analytical approaches for optimal crisis mitigation. Granular investigations of less-understood equity gaps, expanding methodologies and detailed demographic profiling would enrich these findings. By quantifying exam trends alongside experiential nuances, the study develops a contextualized understanding of mathematical assessment transformations, informing localized continuity planning for uncertain futures.

Motivations for investigating health inequities in observational epidemiology: a content analysis of 320 studies

ObjectivesTo enhance equity in clinical and epidemiological research, it is crucial to understand researcher motivations for conducting equity-relevant studies. Therefore, we evaluated author motivations in a randomly selected sample of equity-relevant observational studies published during the COVID-19 pandemic. Study Design and SettingWe searched MEDLINE for studies from 2020 to 2022, resulting in 16,828 references. We randomly selected 320 studies purposefully sampled across income setting (high vs low–middle-income), COVID-19 topic (vs non–COVID-19), and focus on populations experiencing inequities. Of those, 206 explicitly mentioned motivations which we analyzed thematically. We used discourse analysis to investigate the reasons behind emerging motivations. ResultsWe identified the following motivations: (1) examining health disparities, (2) tackling social determinants to improve access, and (3) addressing knowledge gaps in health equity. Discourse analysis showed motivations stem from commitments to social justice and recognizing the importance of highlighting it in research. Other discourses included aspiring to improve health-care efficiency, wanting to understand cause-effect relationships, and seeking to contribute to an equitable evidence base. ConclusionUnderstanding researchers' motivations for assessing health equity can aid in developing guidance that tailors to their needs. We will consider these motivations in developing and sharing equity guidance to better meet researchers' needs.

Implementation of rapid genomic sequencing in safety-net neonatal intensive care units: protocol for the VIrtual GenOme CenteR (VIGOR) proof-of-concept study

IntroductionRapid genomic sequencing (rGS) in critically ill infants with suspected genetic disorders has high diagnostic and clinical utility. However, rGS has primarily been available at large referral centres with the...

Women in Health and their Economic, Equity and Livelihood statuses during Emergency Preparedness and Response (WHEELER) protocol: a mixed methods study in Kenya

IntroductionKenya reported its first COVID-19 case on 13 March 2020. Pandemic-driven health system changes followed and unforeseen societal, economic and health effects reported. This protocol aims to describe the methods...

Does access to assistive technologies enhance labour force participation amongst the disabled population? Evidence from India

PurposePersons with disabilities (PwD) are generally less likely to be employed than the general population. The paper aims to investigate whether access to assistive technologies (AT) impacts labour force participation in the disabled population.Design/methodology/approachThe study utilises the nationally representative survey on disability in India conducted in 2018 through multi-stage sampling by the Ministry of Statistics and Programme Implementation (MOSPI), Government of India. The instrumental variable (IV) approach has been employed to infer causality between AT and labour market participation.FindingsThe study found that the labour force participation rate (LFPR) in India amongst the disabled population was 29% in the age group of 15–65 years in 2017–2018, as compared to 52% in the general population. Around two-thirds of the PwD respondents who were advised to acquire aid appliances acquired them, implying limited access to AT. The probability of LFPR in disabled population increases by 26.6% with access to AT particularly in urban areas.Practical implicationsPersistent issues such as lack of adequate amenities, poor literacy and a lack of vocational skills need to be addressed to improve labour market outcomes for the disabled population in rural areas.Originality/valueDespite its role in promoting distributive justice and inclusive development, research on equity gaps in access to AT and its impact on labour market outcomes is scant. This is the first paper that provides empirical evidence on the impact of access to AT on LFPR in the context of low- and middle-income countries.

Managed competition in Colombia: convergence of public and private insurance and delivery.

The Colombian health system has made a deep transition into managed competition since a major reform in 1993. A market for insurers was created, the consumer has free choice of insurer and a national-level equalisation fund distributes revenues via a per-capita payment. Fully subsidised insurance for the poor and informal, and a comprehensive standardised benefit package for subsidised and contributory schemes (both schemes covering 98 per cent of the population), has led to a low level of out-of-pocket expenses and high financial protection, as well as to reduced gaps in equity in access. The preconditions for managed competition are largely met, but improving health care providers' organisation towards integrated care, to enable them to deliver more value, is a necessary step to achieve the expected results of managed competition in terms of efficiency and quality. Although the current system is likely to be reformed in the coming months, the nature and extent of those reforms are not defined yet, so our analysis is based on the current system.

Prioritizing Equitable Mathematics Teaching Practices: A Case for Culturally Responsive Instructional Supervision

Scholars suggest that culturally responsive instructional supervision (CRIS) is an important component of equitable teaching practices in schools. This fictional case study details the experiences of a fifth-grade team who, along with their principal and their instructional coach, perform a discourse analysis of their own mathematics lessons to diagnose the equity gaps in their teaching and make necessary adjustments. The case narrative highlights the need for equitable teaching practices in the mathematics classroom and the potential needs of school leaders as they work to create more equitable learning environments in their schools through the use of CRIS.

Exploring Socioeconomic Landscape: A survey dataset analysis of household income among Malaysian public higher learning institution students

Exploring Socioeconomic Landscape: A survey dataset analysis of household income among Malaysian public higher learning institution students

Whoever wants better healthcare simply pays more: citizens' perception about voluntary private health insurance in Colombia

ObjectivesTo explore the perceptions that Colombians have about voluntary private health insurance plans (VPHI) in the health system to identify the tensions that exist between the public and private systems.MethodsA qualitative case study approach with 46 semi structured interviews of patients, healthcare workers, healthcare administrators, decision-makers, and citizens. Interviews were recorded, transcribed, anonymized, digitally stored, and analyzed following grounded theory guidelines.ResultsWe developed a paradigmatic matrix that explores how, in a context mediated by both the commodification of health and social stratification, perceptions about the failures in the public health system related to lack of timely care, extensive administrative procedures, and the search for privileged care led to positioning VPHI as a solution to these failures. The interviewees identified three consequences of using VPHI: first, the worsening of problems of timely access to care in the public system; second, higher costs for citizens translated into double payment for technologies and services to which they are entitled; third, the widening of inequity gaps in access to health services between people with similar needs but different payment capacities.ConclusionsThese findings can help decision makers to understand citizens´ perceptions about the implications that VPHI may have in worsening equity gaps in the Colombian health system. It also shows, how VPHI is perceived as a double payment for services covered within social security plans and suggests that the perceived lack of timely access to care in the public systems and the fear that citizens have for themselves or their family members when using suboptimal healthcare are important drivers to purchase these private insurances.

Prioritizing Equity in Antimicrobial Stewardship Efforts (EASE): a framework for infectious diseases clinicians.

Health equity gaps persist across minoritized groups due to systems of oppression affecting health-related social needs such as access to transportation, education and literacy, or food and housing security. Consequently, disparities in the prevalence of multidrug-resistant infections, infectious disease outcomes, and inappropriate antimicrobial use have been reported across minoritized populations. The Joint Commission and Centers for Medicare and Medicaid Services (CMS) have formally acknowledged the importance of integrating health equity-focused initiatives into existing hospital quality improvement (QI) programs. Here, we review documented disparities in antimicrobial stewardship and offer a framework, derived from components of existing health equity and QI tools, to guide clinicians in prioritizing equity in antimicrobial stewardship efforts (EASE).

Latinx/a/o Senior Leaders in U.S Higher Education: A Systematic Review of the Literature

Latinx/a/o senior leaders remain underrepresented in the executive ranks, and more research is needed to adequately address equity gaps in higher education leadership. By employing a systematic literature review approach, we examined 57 pieces of scholarship that focused on the experiences of senior Latinx/a/o leaders in postsecondary education. This exploration was aimed at equipping higher education scholars and practitioners with the tools to understand how Latinx/a/o leaders navigate challenges and opportunities in higher education. We identified three major themes: 1) scholarship focusing on individual traits and important identity-based differences; 2) research describing the environmental and structural conditions that shape these leaders’ realities; and 3) literature describing these individuals’ leadership pathways. As an effort to make this body of work more accessible to researchers and decision-makers, we provided implications for research and practice to shape the field of Latinx/a/o leadership in higher education.

Sexual and Reproductive Health Service Access among Aboriginal and Torres Strait Islander Young People in Regional NSW, Australia

Owing to the historical and ongoing impacts of colonisation, there is a large health equity gap in sexual and reproductive health (SRH) outcomes between Aboriginal and Torres Strait Islander peoples and non‐Indigenous populations. Whilst qualitative research has identified the barriers and enablers to sexual healthcare engagement among young Aboriginal and Torres Strait Islander people in remote settings, little is known about the ways in which young people navigate sexual healthcare in a regional setting. This study aims to address this gap. Sixty‐five young (aged 15–29) Aboriginal and Torres Strait Islander people participated in semistructured interviews across three regional communities in New South Wales, Australia. The candidacy framework informed this analysis. A large proportion of participants expressed having agency and resources to attend health services for SRH needs (primarily STI testing and contraception). Women in particular described being supported by social networks to access SRH services. Male participants were less likely to identify their own candidacy for healthcare. Services that were culturally safe and had trustworthy, nonjudgemental staff and a feeling of community were easier to access (more permeable). Factors that decreased accessibility were confidentiality concerns, difficulty making appointments, and lack of visibility of services, or what they offer. Using the candidacy framework, this study identified the importance of culturally safe service provision, reducing barriers to accessing appointments and the provision of nonjudgemental care in engaging young Aboriginal and Torres Strait Islander people in SRH care. This study also highlighted the various strategies and actions that young Aboriginal and Torres Strait Islander people are already taking to protect their sexual health and that of their partners.

Strengthening the evidence base on the use of digital health technologies to accelerate progress towards universal health coverage

Abstract Digital health and the digital transformation of health systems are an enabler and accelerator to achieving Universal Health Coverage (UHC) in low- and middle-income countries. This can help close equity gaps, enhance primary healthcare, and improve efficiency and health outcomes. However, the digital health landscape is characterized by fragmented initiatives and investments, insufficient political will, and inadequate governance of health data. This special collection of Oxford Open Digital Health showcases impacts of digital health interventions and approaches towards expanded healthcare access and improved health outcomes. This commentary makes the case for policy innovation and leadership, improved investments, robust health data governance and a people-centred approach to leverage the benefits of digital health transformation. Prioritizing these areas can enhance the accessibility, affordability, and quality of care, towards UHC goals.

Utilizing Community Health Ambassadors to improve COVID-19 vaccine uptake in equity priority neighborhoods in Toronto, Canada

East Toronto Health Partners (ETHP) is comprised of 100+ health and social organizations, with a leadership council consisting of patient/caregivers and six anchor organizations representing the continuum of care. During the pandemic ETHP implemented a Community Health Ambassador (CHA) Model to increase access to COVID19 vaccinations in underserved neighborhoods through health promotion activities and referral to COVID19 outreach Centers (CoCs).
 The intervention focuses on equity priority neighborhoods with significant concentrations of underserved populations including but not limited to newcomers and households with low incomes.
 Early in the COVID-19 pandemic it became apparent that the impact was disproportionally high in equity priority neighbourhoods. Once COVID19 vaccine became available to the public, it became evident that the wealth of knowledge residing within the community was essential to improve vaccine uptake, particularly in priority neighbourhoods. ETHP partnered with the community to co-design outreach strategies. A particularly meaningful partnership was the collaboration with community members who assisted us in designing our CHA model. The CHAs program was administered through one of the community ETHP health service providers.
 CHAs were localized to the neigbourhood where they lived and utilized their knowledge of the community to identify and address misinformation and barriers to vaccination. CHAs were able to engage in individualized educational interventions locally and escalate systemic barriers to the ETHP. These issues were addressed through rapid cycle change quality improvement methodology by the members of the ETHP.
 From December, 2021 to March, 2022, we engaged and deployed 197 CHAs to conduct outreach activities. They reached out to over 25,000 individuals in our priority neighbourhoods. Their work bridged the equity gap in vaccination. In September 2021, there was a 20% point difference in 1st dose coverage between the most vaccinated and least vaccinated neighborhoods in East Toronto; in March 2022, this difference decreased to 16% partly as the result of CHA outreach in priority neighborhoods.
 Barriers to vaccine uptake could best be identified by hyper-local strategies implemented by CHA with a deep understanding of the local neighborhood. The barriers identified by CHAs could be addressed with the help of an integrated health system to improve equitable delivery of COVID-19 vaccine.
 Based on the success of the CHA model were are co-designing a strategy to utilize CHAs to assist with health care recovery focusing on other preventive interventions that not equitably delivered such as cancer screening.