Healthcare Engagement Research Articles

Challenges for Antepartum Care of the Individual with Perinatal Substance Use: An Empirical Integrative Review of Novel Approaches to Improve Care.

Perinatal substance use continues to rise across the United States presenting unique challenges to providing antepartum care. Polysubstance use, limited and late engagement in health care, co-occurring mood disorders, and several social barriers are well documented. This review seeks to summarize these barriers and present novel approaches to caring for this high-risk population. Inclusion criteria for this study focused on peer-reviewed articles that explicitly detailed a direct impact on the provision or receipt of antenatal care in the setting of substance use within the United States that were published in the last 5 years. PubMed and Web of Science were used to find applicable articles. Of the 156 articles found, 10 relevant articles were selected for the final empirical integrative review that entailed data evaluation using the Mixed Methods Appraisal Tool (MMAT) and thematic analysis. 10 review articles met inclusion; 3 were qualitative, 6 were quantitative and nonrandomized, and one was quantitative descriptive. Six articles met MMAT quality criteria, and there were significant limitations in every article. Topics included opioid use disorder (n = 6), general substance use (n = 3), and tobacco use (n = 1). Themes included integrated models of prenatal care, colocated care, resource coordination, and peer support along with the role of the perinatal health care professional and consistent use of a substance use screening tool. A comprehensive and multidisciplinary care model is necessary to meet the complex and urgent needs of individuals with perinatal substance use that not only meets recommendations for opioid maintenance therapy or substance use cessation but the important areas of accessibility and interpersonal support. Future research should focus on the development, implementation, and evaluation of new models of care for this vulnerable population.

Government Digital Transformation and the utilization of Basic Public Health Services by China’s migrant population

BackgroundThis research delves into the ramifications of Government Digital Transformation (GDT) on Basic Public Health Services (BPHS) utilization among China’s migrant populace. Within the framework of escalating digital incorporation into public services, it becomes imperative to assess how GDT initiatives could ameliorate healthcare access for migrants, a group habitually confronted with systemic obstacles. Such scrutiny is crucial for the formulation of evidence-based policies that harness digital innovations to mitigate healthcare disparities.MethodsThe analysis employs data from the 2018 China Migrants Dynamic Survey, matched with details on the National Pilot Cities for Information Benefit to the Public policy at the prefecture city level, yielding a dataset comprising 113,905 observations. To gauge BPHS utilization among migrants, two indicators were developed: the establishment of health records and registration with family doctors. The influence of GDT on BPHS access was estimated utilizing Ordinary Least Squares regression for the initial analysis, incorporating a comprehensive array of individual and household attributes, alongside province fixed effects, to ensure a thorough evaluation.ResultsBaseline regression analyses revealed that GDT is significantly correlated with an enhanced probability of migrants establishing health records and registering with family doctors, with increases of 7.53% and 2.75%, respectively. Subsequent robustness checks, including sensitivity analyses with alternate dependent variables, the Propensity Score Matching method, Double/Debiased Machine Learning method, and placebo tests, further substantiated these findings. Additionally, the analysis explored mechanisms through which GDT facilitates BPHS access, identifying health information accessibility as a significant mediator in promoting healthcare engagement among migrants. Notably, both individual and regional heterogeneity were observed in GDT’s impact: female migrants, those with lower educational levels, older individuals, and rural hukou holders experienced more pronounced benefits, while the effects of GDT were also stronger in cities with lower GDP and smaller populations. These findings suggest that GDT is particularly effective in bridging healthcare access gaps in economically or demographically constrained areas.ConclusionsThe outcomes underscore that GDT significantly enhances BPHS utilization among migrants, positioning digital governance as an instrumental mechanism in bridging healthcare access gaps. The observed differential impacts across various subgroups and regions emphasize the importance of customized digital health strategies that cater to the diverse needs of migrant communities. For instance, targeted interventions in lower-GDP or smaller cities could maximize the benefits of GDT in under-resourced areas. Contributing to the body of empirical evidence on digital governance and public health, this research advocates for the expanded deployment of GDT initiatives to foster more equitable health service provision for migrant demographics, promoting inclusivity within a rapidly urbanizing society.

'They got my back': Thematic analysis of relationship building in nurse home visiting in Aboriginal communities.

The client-practitioner relationship is the cornerstone of nurse home-visiting programs. Little is understood about how relationship-based maternal and early childhood health care is perceived by women in remote Aboriginal communities. As part of an evaluation of nurse home-visiting in the Northern Territory, this research examines how relationships are established with clients, and what elements are valued most by women. Maternal Early Childhood Sustained Home-visiting (MECSH) is an Australian model of nurse-led home-visiting targeted at women facing adversity who need extra support. The model provides parenting information, health education and psychosocial support during pregnancy and the first 3 years of children's development. Interviews were conducted with 92 Aboriginal women and 11 practitioners including nurses, social workers and community workers. Qualitative semi-structured interviews were conducted with convenience samples of MECSH clients and practitioners. Data were analysed using a two-step process of structural coding and thematic analysis. Trust was the foundation of clients' positive perception of the relationship with their MECSH provider. Relationships took time to develop, often beginning with practical support to meet clients' basic needs. Practitioner dependability and flexibility to client priorities, communication, confidentiality and being helpful to the woman and her family was important. Clients emphasised emotional support and friendship. The relationship-based approach was valued and consistent with culturally safe and trauma informed ways of working with Aboriginal families. Effort is required to commit to the model to address ongoing healthcare engagement and health outcomes in remote Northern Territory communities.

Differences in Use of a Patient Portal Across Sociodemographic Groups: Observational Study of the NHS App in England.

The adoption of patient portals, such as the National Health Service (NHS) App in England, may improve patient engagement in health care. However, concerns remain regarding differences across sociodemographic groups in the uptake and use of various patient portal features, which have not been fully explored. Understanding the use of various functions across diverse populations is essential to ensure any benefits are equally distributed across the population. This study aims to explore differences in the use of NHS App features across age, sex, deprivation, ethnicity, long-term health care needs, and general practice (GP) size categories. We used weekly NHS App use data from the NHS App dashboard for 6386 GPs in England from March 2020 to June 2022. Negative binomial regression models explored variations in weekly rates of NHS App features used (registrations, log-ins, prescriptions ordered, medical record views, and appointments booked). Outcomes were measured as weekly rates per 1000 GP-registered patients, and we conducted separate models for each outcome. Regression models included all covariates mentioned above and produced incident rate ratios, which we present here as relative percentages for ease of interpretation. GP-level covariate data on sociodemographic variables were used as categorical variables in 5 groups for deprivation (Q1=least deprived practices and Q5=most deprived practices) and 4 groups for all other variables (Q1=least deprived practices and Q4=most deprived practices). We found variations in the use of different features overall and across sociodemographic categories. Fully adjusted regression models found lower use of features overall in more deprived practices (eg, Q5 vs Q1: registrations=-34%, log-ins=-34.9%, appointments booked=-39.7%, medical record views=-32.3%, and prescriptions ordered=-9.9%; P<.001). Practices with greater proportions of male patients also had lower levels of NHS App use (eg, Q4 vs Q1: registration=-7.1%, log-in=-10.4%, and appointments booked=-36.4%; P<.001). Larger practices had an overall higher use of some NHS App features (eg, Q4 vs Q1: registration=3.2%, log-ins=11.7%, appointments booked=73.4%, medical record views=23.9%, and prescriptions ordered=20.7%; P<.001), as well as those with greater proportions of White patients (eg, Q4 vs Q1: registration=1.9%, log-ins=9.1%, appointments booked=14.1%, medical record views=28.7%, and prescriptions ordered=130.4%; P<.001). Use patterns varied for practices with greater proportions of patients with long-term health care needs (eg, Q4 vs Q1: registrations=-3.6%, appointments booked=-20%, and medical record views=6%; P≤.001). This study highlights that the use of the NHS App features varied across sociodemographic groups. In particular, it is used less by people living in more deprived areas. Tailored interventions and patient support are required to ensure that any benefits from the NHS App are spread equally throughout the population.

Codesign and evaluation of advanced therapeutic information resources for and with families of children with neurological conditions: a mixed methods cross-sectional study

ObjectiveParents and caregivers of children with neurological conditions express interest in new and developing treatments and trials; however, they have limited knowledge of, and access to, reliable information. This study...

Changes in diabetes care and management practices during the COVID-19 pandemic.

We examined changes in diabetes care and management practices before and during the COVID-19 pandemic. Population-based data regarding four diabetes-related healthcare engagement and four self-management indicators were obtained from adults with diabetes surveyed in 19 US States and Washington DC through the Behavioral Risk Factor Surveillance System. Using logistic regression, we estimated changes in the prevalence of each indicator, overall and by sociodemographic subgroups in 2019 (before the pandemic) and 2021 (during the pandemic). Between 2019 and 2021, the prevalence of biannual HbA1c tests reduced by 2.6 percentage points (pp; 95% confidence interval: -4.8, -0.4), from 75.4% to 73.1%, and prevalence of annual eye exams fell by 4.0pp (-6.2, -2.8), from 72.2% to 68.7%. The composite indicator of engagement with healthcare for diabetes control fell by 3.5pp (-5.9, -1.1), from 44.9% to 41.9%. Of self-management behaviors, avoidance of smoking increased by 2.0pp (0.4, 3.6) from 84.7% to 87.1%. The findings suggest a deterioration of the uptake of evidence-based, preventive health services requiring laboratory services and clinical examination for diabetes control during the pandemic. On the other hand, smoking rates decreased, suggesting potential positive impacts of the pandemic on health behaviors in people with diabetes.

Effectiveness of Integrated Marketing and Financial Strategies in Healthcare

In recent years, the healthcare sector has experienced a shift toward integrated marketing and financial strategies to drive better patient outcomes, streamline operational costs, and improve service delivery. This paper examines the effectiveness of these strategies by exploring how they align to optimize healthcare systems. It focuses on the benefits, challenges, and implications of integrating financial planning with marketing outreach, emphasizing the role of data analytics, technology, and consumer engagement in enhancing both patient satisfaction and financial performance. Through a detailed analysis of current literature, industry examples, and statistical insights, the paper aims to provide a comprehensive overview of how an integrated approach influences revenue cycles, operational efficiency, and patient engagement in healthcare.

Navigating Complexity: Chatbot Router Agents as a Key to Improved User Engagement in Healthcare

Navigating Complexity: Chatbot Router Agents as a Key to Improved User Engagement in Healthcare

“Because you love us as much as we love you”: The role of community relationships in facilitating Indigenous engagement in healthcare

Grounded in relational worldviews and ways of being, Indigenous health on Turtle Island once thrived. However, colonization disrupted and sought to delegitimize Indigenous relationships, having devastating impacts on Indigenous health and contributing to persistent Indigenous health disparities. Making matters worse, Indigenous Peoples face barriers to engagement in mainstream Canadian healthcare, including racism and the marginalization of Indigenous relational conceptions of health and ways of caring. Using an Indigenous methodology, we explored Kanyen’kehá:ka (Mohawk) relationality between community members and community-based healthcare providers (n=25), and how these ways of relating shaped engagement in community-based care. Our analysis identified three key themes: in Kenhté:ke (Tyendinaga) the concept of health goes beyond western definition and is broadly defined and relational; connectedness and shared experiences are foundational to Kenhté:ke identity and ways of caring; and relationships that reflect community connection foster more engagement in healthcare than otherwise in western care settings. These findings have critical implications for western norms of healthcare professional training and practice and the need to include Indigenous relational ways of caring and conceptions of health.

How to Engage Men in Preconception Health?: A Scoping Review

Background: Men’s engagement in maternal and child health care in the preconception health forum is essential because it allows primary prevention of maternal and infant mortality and morbidity. This review aimed to identify strategies to engage men in preconception health. Materials and Methods: This scoping review was conducted from August to September 2022. The database searches included PubMed, EBSCO, and ProQuest from 2012 to 2022, related to men’s involvement in reproductive health, preconception health, family planning, maternity, and infant care; articles written in English; national (Indonesia) and international articles; and appropriate thesis. The searched keywords were man/male role, premarital, preconception, reproductive health, and fertility. Results: The electronic searches turned to 1969 articles, 16 of which met the inclusion criteria and were selected for study analysis. This review identified three themes: identifying programs that are sensitive to the limitations of men; developing community outreach strategies; and engaging management principles, policy, and legislation. Conclusions: Efforts to engage men in preconception health can be complicated, but several strategic programs have demonstrated some success. Subsequent programs that require men’s participation in preconception health services must be sensitive to the identified barriers.

Implementing and Evaluating a Pilot Interprofessional Training Program to Engage Health Care Teams in Cost of Care Conversations.

This study evaluated the impact of Financial and Insurance Navigation Assistance-Training - a pilot interprofessional training program to facilitate cost of care (CoC) conversations and address health-harming social determinants of health in a pediatric hematology-oncology clinic. A pre-post study design was used to evaluate the impact of Financial and Insurance Navigation Assistance-Training on an interprofessional health care team's (clinicians, social workers, financial navigator, and legal advocates) knowledge, attitudes, and behaviors related to CoC conversations and screening, referring, and collaborating with interprofessional team members. Data were collected via surveys administered at baseline/pretraining, immediate post-training, and 12-month post-training. Most health care team members (n= 21) reported improvement in their knowledge of available financial (66.7%) and legal resources (86.7%) and ability to address social needs (93.3%), financial needs (93.3%), and facilitate CoC conversations with patients and caregivers (66.7%). Improvements in attitudes and behaviors toward engaging in CoC conversations, screenings, and referrals were relatively improved as a result of the training. However, there was a lower positive rate for actual behaviors around routine screening and initiating discussions on out-of-pocket costs, suggesting a need to address barriers. Study findings highlight the importance of interprofessional education in helping health care teams address social determinants of health through effective CoC conversations.

6.Y.2. AI and health care: what are the capabilities and limitations?

Abstract With the rapid advancement of artificial intelligence (AI) technologies and their implementation in health care, there is a critical need to explore the different applications and implications of AI. This workshop seeks to look at different aspects of AI, both potential applications for AI technology in health, public opinions of use of AI in health care, and the reality of implementing AI in different contexts. Understanding health care approaches to AI from different countries is a unique opportunity for shared learning of innovations across various sectors of health care and patient engagement in order to most effectively engage this emerging field. AI, in whichever form it may be incorporated into health care, has the opportunity to impart meaningful, innovative change, but understanding this new technology comes with important questions. This session will dive into research on AI in various areas of health care by 1) looking at different ways AI is being harnessed in health care; 2) discussing lessons which can be learned and adapted from other countries; 3) discussing promising solutions and approaches to implementing AI in health care; 4) discussing the limitations or concerns of integrating AI in health care. The panel will be composed of 1 moderator and 2 panelists. Panelists are experts in their fields, established researchers and practitioners, and alumni of the Harkness Fellowship from Germany and the United Kingdom. A moderator will briefly frame the discussion for the audience and introduce the speakers and their presentations before leading an interactive, engaging question and answer portion. The coherence of this panel lays in its theme of leveraging AI to enhance healthcare delivery and understanding ways we can work across countries to foster ethical, equitable AI technologies that revolutionize healthcare practices with the ultimate goal of improving patient outcomes and health system efficiencies. Dr. Saira Ghafur from the U.K. will begin by presenting her research on evidence-based reasons for implementing AI in health care and Dr. Benedikt Simon from Germany will close out by discussing his work in AI in Germany and the challenges that have prevented robust integration. Each panelist will speak for roughly 8-10 minutes, with about 5 minutes reserved for moderator and audience questions. Key messages • Sharing cross-country experiences and research enables us to better understand how AI can impact health care. • In weighing both the benefits and challenges or limitations of implementing AI, we can best understand effective approaches to utilizing AI in health care.

Effectiveness of Integrated Marketing and Financial Strategies in Healthcare

In recent years, the healthcare sector has experienced a shift toward integrated marketing and financial strategies to drive better patient outcomes, streamline operational costs, and improve service delivery. This paper examines the effectiveness of these strategies by exploring how they align to optimize healthcare systems. It focuses on the benefits, challenges, and implications of integrating financial planning with marketing outreach, emphasizing the role of data analytics, technology, and consumer engagement in enhancing both patient satisfaction and financial performance. Through a detailed analysis of current literature, industry examples, and statistical insights, the paper aims to provide a comprehensive overview of how an integrated approach influences revenue cycles, operational efficiency, and patient engagement in healthcare.

Improving Diabetes Education and Metabolic Control in Children Using Social Robots: A Randomized Trial

Robot engagement in healthcare has the potential to alleviate medical personnel workload while improving efficiency in managing various health conditions. This study evaluates the impact of robot-assisted education on knowledge acquisition and metabolic control in children with Type 1 Diabetes Mellitus (T1DM) compared to traditional education methods. A randomized controlled trial was conducted at the pediatric diabetes clinic of the University of Tabuk Medical Center, Saudi Arabia. Thirty children aged 5–15 years with T1DM were randomly divided into two groups: the robot education (intervention) group and the control education group. Both groups participated in six weekly one-hour educational sessions, with the intervention group interacting with a Pepper robot assistant and the control group receiving education from a qualified diabetes educator nurse. Knowledge was assessed using a 12-item questionnaire before and after the intervention, while metabolic control was evaluated through weekly mean home blood glucose measurements and HbA1c levels before and three months post intervention. The intervention group demonstrated a significantly greater improvement in knowledge scores compared to the control group (p &lt; 0.05). Weekly mean blood glucose levels were consistently lower in the intervention group throughout the study period (p &lt; 0.05 for all samples). Both groups showed a reduction in HbA1c levels after three months, with the intervention group exhibiting a greater mean decrease. The engagement of the Pepper robot in T1DM education for children resulted in improved knowledge acquisition and better metabolic control compared to traditional education methods. This approach may establish a foundation for “learning by interacting with robots” in long-term diabetes management. Further research with larger sample sizes and longer follow-up periods is warranted to confirm these findings and explore the long-term benefits of robot-assisted education in pediatric diabetes care.

Lesbian, Gay, Bisexual, Transgender and Queer People's Experiences of Stigma Across the Spectrum of Inpatient Psychiatric Care: A Systematic Review.

Lesbian, gay, bisexual, transgender, queer and other diverse sexual orientations and gender identity groups (LGBTQ+) face high rates of poor mental health. In the most severe and emergent of instances, inpatient psychiatric care may be required. LGBTQ+ people report experiences of mistreatment in healthcare settings broadly, such as denial of healthcare services and harassment from healthcare providers and other patients. However, little is known about the experiences of LGBTQ+ people in inpatient psychiatric care settings, specifically. The purpose of this review was to assess the existing literature for descriptions of LGBTQ+ people's experiences within inpatient psychiatric care. We searched multiple databases (i.e., PubMed, PsychINFO, CINAHL, Web of Science and Google Scholar) for peer-reviewed articles that described the experiences of LGBTQ+ people within inpatient psychiatric care that were published in English. The included articles (N = 14) were analysed using a conceptual model of stigma and organised within those strata (structural, interpersonal and individual stigma) across the inpatient experience, (admission, inpatient unit, and discharge). Themes identified included: noninclusive intake tools and pervasive misgendering during the admission process; lack of healthcare infrastructure, inadequate training and lack of cultural humility, pervasive discrimination and victimization, silencing of LGBTQ+ patients, and feelings of fear and shame while on inpatient units, and lack of community resources during the discharge process. Clinicians should consider the perspectives and experiences of LGBTQ+ people to enact identity-affirming care practices that may increase mental healthcare engagement and improve long-term mental health outcomes.

Engaging primary care patients at risk for suicide in mental health treatment: user insights to inform implementation strategy design

BackgroundGiven that the majority of suicide decedents visit primary care in the year preceding death, primary care has been identified as a key setting in which to engage patients at risk for suicide in mental health services. The objective of this research was to identify barriers and facilitators to engagement in mental health services among primary care patients at risk for suicide to inform the development of strategies to increase engagement.MethodsSeventy-four semi-structured qualitative interviews were conducted with primary care patients (n = 20), primary care (n = 18) and behavioral health (n = 12) clinicians, mental health intake coordinators (n = 4), and health system and clinic leaders (n = 20). Patients who had been referred for mental health services from primary care and reported an elevated score (≥ 1) on item 9 on the Patient Health Questionnaire at the time of referral were eligible to participate. Eligible clinicians and leaders were employed in a primary care or behavioral health setting in a single large health system with an integrated mental health program. Interviews typically lasted 30–60 min, were completed over video conference or phone, and were coded by members of the research team using a rapid qualitative analysis procedure.ResultsParticipants were primarily female (64.9%), white (70.3%) and non-Hispanic/Latine (91.9%). The most identified barriers to mental health care engagement were waitlists, capacity limits, insurance, patient characteristics, communication, collaboration, and/or difficulties surrounding travel. The most commonly cited facilitators of engagement included telehealth, integrated care models, reminders, case management support, psychoeducation, motivational enhancement, and scheduling flexibility. Concrete suggestions for improving engagement in mental health services included increasing communication between providers, streamlining referral and intake processes, providing reminders and follow ups, and advocacy for increased reimbursement for suicide risk assessment.ConclusionsResults underscore the myriad barriers patients at risk for suicide encounter when attempting to engage in mental health care in a primary care setting. Facilitators of engagement and suggestions for improving connections to care were also identified, which can inform the design of implementation strategies to improve engagement in mental health services among primary care patients at risk for suicide.Trial registrationClinicalTrials.gov Identifier: NCT05021224 (Registered August 19, 2021).

Sexual and Gender Identity-Associated Disparities in University Students' Experiences with Inappropriate, Disrespectful, and Coercive Health Care.

Purpose: Inappropriate, disrespectful, or coercive health care (IDCH) is associated with patient age and sexual orientation and gender identity (SOGI) and can impact healthcare engagement and outcomes. Emerging adulthood is a critical period for establishing trust in health care, yet little is known about university students' IDCH experiences. This study assessed the IDCH prevalence and identified IDCH-SOGI associations in a university student sample. Methods: Using data from the cross-sectional IDC Survey (2021), we quantified the lifetime prevalence of 18 IDCH items in a sample of 3403 university students. Chi-squared and Kruskal-Wallis tests were used to assess bivariate associations between IDCH items and SOGI. We modeled associations between demographic characteristics and two types of provider-sexual misconduct using logistic regression. Results: Statistically significant associations between SOGI and 17 of the analyzed IDCH items were identified. Self-reported IDCH experiences were more prevalent among minoritized SOGI students than heterosexual cisgender students, including receiving inappropriate/harmful treatment and dismissive or biased provider communication. Gender minority and sexual minority cisgender male and female students had significantly higher odds of ever being touched inappropriately during an exam, compared with heterosexual cisgender males (adjusted odds ratios [95% confidence interval]: 3.07 [1.59-5.93], 2.34 [1.24-4.41], and 1.85 [1.16-2.90], respectively). SOGI was not significantly associated with experiencing a provider's sexual advances. Conclusion: University students with historically minoritized SOGIs may be particularly vulnerable to IDCH experiences; research is needed to understand differential experiences within minoritized sexual and gender subpopulations. Patient and provider education about healthcare norms and trauma-centered care could potentially reduce IDCH and its harms.

Development and Acceptability of Provider Training to Increase Treatment Engagement of Parents in Their Children's Behavioral Health Care Need.

BACKGROUND: Disruptive, Impulse-Control, and Conduct disorders (DIC) affect 5 million children in the United States and often require comprehensive and long-term behavioral health care for which sustained parental involvement is essential. Our research team is developing an intervention to improve parental engagement in the behavioral health care of their children with DIC. The intervention, which will be a modification of an evidence-based shared decision-making intervention called DECIDE, will include a parent component and a provider component. AIM: To determine the acceptability of the provider component of the modified DECIDE intervention. METHODS: The provider intervention is an asynchronous self-paced online training program made up of five modules: introduction, shared decision-making, perspective-taking, attributional errors, and being a responsive provider. The training was piloted with 41 providers in two public child and adolescent treatment programs. Following completion of the training, semi-structured interviews were conducted with the providers to assess the acceptability of the training. The interviews were analyzed with conventional content analysis. RESULTS: The provider training was well received by providers, and many had made practice changes based on what they had learned. Several offered recommendations for improvement, most notably the need to tailor the training based on provider role, discipline, and level of expertise. CONCLUSIONS: The feedback given by providers will be used to refine future iterations of the provider training component of the modified DECIDE intervention. Psychiatric nurses and other clinicians may draw from strategies incorporated in the training program to improve parent engagement in the treatment of children with DIC.

Strategically communicating inclusion efforts at hospitals: Trust-signalling for community engagement.

Trust is a challenging and complex concept and takes on particular significance in the context of community engagement and communication in healthcare. For the purpose of making health services more inclusive and of tackling discrimination where it occurs, there is a need to articulate a vision for inclusion that communities of historically disadvantaged or stigmatised patients can trust. This article considers examples of diversity and inclusion 'signals' on the public websites of two large public hospitals in Melbourne, Australia. We suggest that there is value in public communications reaffirming respect for diversity and a commitment to inclusion in health services. We also make the case for interdisciplinary research into how trust-signalling strategies, that is, rhetorical strategies employed to reassure or convince, are developed by and for health services for the purposes of community engagement, and the specific effects that they may engender. Websites' framing of messages that affirm institutional commitments to fostering an inclusive environment and addressing barriers can serve as a means of explicitly encouraging patients and healthcare workers from marginalised communities to overcome potential obstacles to fuller healthcare engagement and workforce participation respectively.

A qualitative study of what motivates, facilitates, and hinders climate-engaged healthcare trainees to advance healthcare sustainability

IntroductionThere is a critical need for low-carbon, environmentally-sustainable health systems in the climate crisis. Healthcare trainees can play a vital role in this process, and we have aimed to explore how they can be motivated and supported by faculties of medicine and health systems to pursue this ambition by conducting an exploratory, qualitative descriptive study of Canadian healthcare trainees engaged in healthcare sustainability initiatives. Materials and MethodsTranscripts from individual in-depth interviews were analyzed to identify themes related to the actions that healthcare trainees can take to promote sustainable healthcare, as well as the motivators, barriers and facilitators of healthcare trainee engagement in sustainable healthcare. ResultsParticipants (N=17) engaged in a spectrum of healthcare sustainability initiatives, including education, quality improvement and advocacy. They were motivated to advance healthcare sustainability through positive role models, the health impacts of climate change, observation of unsustainable healthcare practices, and a sense of social responsibility. Participants articulated that supportive networks, access to resources and funding, and having a growth mindset were facilitators to their engagement, while the lack of institutional prioritization of healthcare sustainability, limitations of the trainee role, challenges finding allies, and the perceived futility of their individual actions were characterized as barriers. DiscussionHealthcare trainees could support healthcare decarbonization efforts if they are adequately supported by their learning environments. The study's findings can guide educational innovations and health systems transformations to motivate and empower healthcare trainees to reduce the climate impact of healthcare throughout their careers.