Promotion Of Equity Research Articles

Digital determinants of health as a way to address multilevel complex causal model in the promotion of Digital health equity and the prevention of digital health inequities: A scoping review.

With the progressive digitization of health services and the current spread of Telemedicine and e-Health, it became clear that promoting Digital health equity (DHE) is necessary to support health potential, to avoid that some individuals can incur in unintended inequities. In this paper, we address the complex causal process(es) that may generate risk of inequities, considering the so-called "Digital Determinants of health" (DDoH) and their relationship with determinants of health (DoH). We conducted a scoping review, according to methodological framework proposed in PRISMA-ScR guidelines, on the definition of DDoH (Scopus, Pubmed and Web of Science electronic databases). Inclusion criteria: papers on the definition of DDoH, no time limits, all study designs eligible. There is an agreement on the link between DDoHs and "digital divide" and on their effects on a wide range of health, functioning outcomes, both as barriers and as facilitators. Authors proposed to modify or integrate with DDoHs the "Rainbow model" or other conceptual models on DoH. To promote DHE, authors suggest considering a multidimensional complex causal model, with interdependence among the different levels and the mutually reinforcing effects. To study DDoH and their relationship with main determinants of health could be a way to address the complex causal model in the promotion of DHE. However, as they act in a multidimensional causal context, any intervention may consider the interdependence among different involved levels, within them, and the mutually reinforcing effects. Further research is needed to gain a more complete picture of the field.

Promotion of Urban and Rural Educational Equity Through Online Education: A Case Study on Three Schools

Promotion of Urban and Rural Educational Equity Through Online Education: A Case Study on Three Schools

Examining implementation determinants of a culturally grounded, school-based prevention curriculum in rural Hawai'i: A test development and validation study.

This study examined the implementation determinants of a culturally grounded, school-based drug prevention curriculum in rural Hawai'i. Test development and validation procedures were used to examine the impact of implementation barriers and facilitators of the curriculum in public or charter middle/intermediate schools on Hawai'i Island. A five-phase, mixed-methods approach toward test development and validation was used. These phases included item generation (Phase 1), item refinement and selection (Phase 2), item reduction (Phase 3), reliability testing (Phase 4), and validity testing (Phase 5). Educational administrators, teachers, and staff employed by the Hawai'i State Department of Education (HIDOE) participated in the study. Phases 1 and 2 yielded 50 implementation barriers and 27 implementation facilitators that were evaluated by 204 HIDOE administrators, teachers, and staff. Factor analysis of the barrier items indicated a four-factor solution: (1) Innovation Barriers, (2) HIDOE State-Level Barriers, (3) Teacher-Level Barriers, and (4) Administrator-Level Barriers. Mean comparisons indicated that several barrier and facilitator items differentiated teachers from administrators in the sample. This study contributes to the implementation measurement literature, specifically in the areas of mental health and substance use. It also highlights the importance of addressing multiple contextual levels in the implementation of culturally focused prevention interventions. Examining Implementation Barriers and Facilitators for School-Based Prevention in Hawai'i. Plain Language Summary Compared with other major ethnic groups, Native Hawaiian and Pacific Islander (NHPI) youth have substantially higher rates of substance use and higher adverse mental and physical health effects related to their use. Despite these disparities, educational and community-based practitioners have long struggled with implementing and sustaining promising substance use interventions for NHPI youth. This study contributes to our understanding of measuring implementation barriers and facilitators for substance use prevention for NHPI youth in rural school settings. It contributes to the field of health disparities and health equity promotion, by addressing calls for research to understand factors affecting successful implementation of prevention programs. This is critical toward achieving health equity for underrepresented and vulnerable populations, such as NHPI and rural youth.

Unlocking natural resource potential: A balanced strategies for a fair and sustainable economic recovery

Over the last thirty years, China, currently holding the position of the second-largest global economy, has had a tremendous period of expansion. This study examines China's economic trajectory from 1990 to 2021, explicitly emphasizing the sustainable use of resources and the promotion of equity. Using the STIRPAT model, we investigate the interrelationship of natural resource exploitation, economic progress, ecological durability, and societal equity. The findings emphasize China's transition from resource exploitation to a fairer strategy to achieve long-term economic sustainability. The implementation of new policies, developments in technology, and increased financial accessibility have effectively reduced the negative effects on the environment while facilitating the fair distribution of wealth and enhancing economic resilience. This research highlights the importance of ongoing innovation and policy adjustment to effectively utilize natural resources for China's equitable and environmentally sustainable economic recovery.

EMPOWERING LGBTQ OLDER ADULTS: PROMOTING HEALTH EQUITY AND WELL-BEING ACROSS THE LIFE COURSE

Abstract The population is becoming more diverse in terms of sexual orientation and gender identity across all age groups. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults are found to experience health disadvantages over time. However, there is a lack of research on health-related mechanisms, so it is important to understand the unique needs and resources in these underserved communities. This symposium fills this research gap by examining the factors that affect LGBTQ health trajectories and subgroup differences using a life course developmental framework, the Health Equity Promotion Model (HEPM). The HEPM model highlights historical, social, environmental, and cultural influence on health and well-being and varying adaptations of LGBTQ older adults. The symposium draws on data from the first national and longitudinal study, Aging with Pride: National Health, Aging and Sexuality/Gender study, which has been following 2,450 LGBTQ midlife and older adults since 2014. Dr. Nelson will discuss sexual and gender identities and their associations with physical and psychological health-related quality of life. By investigating the interplay between marginalization, health behaviors, and health care access over time, Dr. Fredriksen-Goldsen assesses quality of life over time by gender and generational differences. Dr. Kim will discuss the role of social connectivity and intersectionality in predicting cognitive impairment over time among racially and ethnically diverse LGBTQ older adults. Using a health equity lens, this symposium will shed new light on the ways in which historical and environmental contexts influence human development and how marginalization and resilience shape lives over time. This is a Rainbow Research Group Interest Group Sponsored Symposium.

GENDER DIFFERENCES IN COGNITIVE IMPAIRMENT OF AFRICAN AMERICAN AND HISPANIC SEXUAL AND GENDER MINORITY OLDER ADULTS

Abstract Cognitive health of sexual and gender minority (SGM) older adults with intersecting racial/ethnic minority identities is an under-researched topic. This research utilizes data from Aging with Pride: National Health Sexuality/Gender study to examine differences in health-promoting and risk factors for cognitive impairment among African American and Hispanic SGM older adults. Informed by the Health Equity Promotion Model, bivariate statistics and linear regression models were applied to better understand subgroup differences in cognitive impairment and risk and protective factors. Daily discrimination and identity stigma were positively associated with cognitive impairment for African American and Hispanic groups. Outdoor leisure was negatively associated with cognitive impairment for African Americans whereas social support was negatively associated with cognitive impairment for Hispanics. Analysis of gender differences revealed that African American men experienced significantly higher rates of identity stigma than African American women; however, the effect of identity stigma on cognitive impairment was stronger for African American women. Among Hispanics, women compared to men were significantly more vulnerable to the effects of daily discrimination and identity stigma on cognitive impairment. Regarding cognitive impairment, engaging in physical activity and outdoor leisure were significantly protective for African American men but not for women, whereas social support was significantly protective for both Hispanic men and women. These findings address a void in SGM aging research by examining racial/ethnic and gender differences in cognitive health. They highlight the need for intersectionality and subgroup differences in research to develop tailored interventions to improve cognitive health among racially/ethnically diverse SGM older adults.

"I Want to Grow Older With Dignity": Older LGBTQ+ Canadian Adults' Perceptions and Experiences of Aging.

The number of older LGBTQ+ adults is growing worldwide. Yet few studies outside of the United States have examined their experiences of aging. Drawing on the Health Equity Promotion Model and contextualized in Canada's unique socio-political history, our study used multiple, in-depth, qualitative interviews to examine 30 older Canadian LGBTQ+ adults' (aged 65-83) perceptions and experiences of growing older. Our descriptive thematic analysis identified three overarching categories: "Losses," "gains," and "needs." Losses referred to the changes in the participants' health, autonomy, and relationships that had occurred with age. Gains entailed positive later life changes, including increased wisdom, flexibility, and social connections. Finally, needs referred to those things that the participants deemed essential for aging well, namely, inclusive health care, meaningful activities, and supportive networks. We discuss the policy and practice implications of our findings for the fostering of health, well-being, and social inclusion amongst this often-marginalized population.

Respondents to an American College of Veterinary Surgeons diplomate survey support the promotion of diversity, equity, and inclusion initiatives.

To objectively measure the current demographic makeup of the American College of Veterinary Surgeons (ACVS) diplomates and to develop a survey tool to be used as a metric to measure future changes in the ACVS demographic profile. 737 ACVS diplomates. A 14-item electronic survey was sent to 2,199 ACVS diplomates between August 25 and September 9, 2021, via email. Survey items included demographic information as well as perceptions about the ACVS and diversity, equity, and inclusion (DEI). Responses were quantitatively and qualitatively analyzed. The survey response rate was 34% (737/2,199). The median age category among respondents was 45 to 54. The median years in practice as a diplomate was 11 to 15. The majority of respondents identified as white/Caucasian and heterosexual, with male and female respondents being similarly represented. Most respondents identified English as their first language. Few considered themselves first-generation college graduates or identified as disabled. Many respondents considered DEI to be an important initiative to promote in the ACVS. Findings suggested that the majority of ACVS respondents are supportive of DEI efforts. This study also serves as an objective analysis that can be reassessed in the future to determine the success of such initiatives.

Toward promotion of health equity in pediatric disorders of gut–brain interaction: A call to action.

Toward promotion of health equity in pediatric disorders of gut–brain interaction: A call to action.

Admitting the heterogeneity of social inequalities: intersectionality as a (self-)critical framework and tool within mental health care

Inequities shape the everyday experiences and life chances of individuals at the margins of societies and are often associated with lower health and particular challenges in accessing quality treatment and support. This fact is even more dramatic for those individuals who live at the nexus of different marginalized groups and thus may face multiple discrimination, stigma, and oppression. To address these multiple social and structural disadvantages, intersectional approaches have recently gained a foothold, especially in the public health field. This study makes an empirically informed argument for the merits of increasing the use of intersectional frameworks in the mental health field. In the mental health field, the potential for greater attention to multiple unjustified disadvantages appears to be of particular importance, as many mental health service users already face stigma and discrimination because of their mental health issues and thus may benefit particularly frequently and far-reachingly from effective problem awareness about multiple disadvantages. Intersectional approaches may help address the complexity, interdependence, and mutual constitution of social inequalities better than previous approaches that examined only one category of sociostructural stratification. By helping to identify the needs of those at the greatest risk of poor health, intersectional frameworks and tools can contribute not only to better address the needs of multiple disadvantaged individuals with mental health issues but also to the promotion of equity in the field of mental health, contributing to the reduction of health disparities.

Reimagining Approaches to Out-of-School Time Spaces That Center Youth

Abstract The beginning of 2020 marked the onset of the COVID-19 pandemic and a new reality. Mainstream learning loss discourse emerged as young people faced new social challenges and rising inequities. However, how we define some of these challenges may pose new barriers to equity promotion. Deficit-based narratives often negatively construct youth identities and intertwine with neoliberal forces and systemic inequities. Out-of-school time (OST) spaces offer hope and opportunity for a re-envisioned environment to centralize youth voice and provide critical time for leisure and reconnection. In this article, authors explore the strategies that can exist between youth workers and social workers in cultivating OST spaces for young people to engage with complex social justice development in humane, nurturing, and respectful environments. Authors center the argument for shifting away from extractive neoliberal models that commodify youth, the importance of becoming cognizant of OST’s impact on young people’s development, and raising awareness of the possibilities within OST spaces through youth-focused frameworks.

STEAM Activities in the Inclusive Classroom: Intentional Planning and Practice

The promotion of equity and access for all children to learn science is critical in early childhood settings. Considering the benefits of teaching science, technology, engineering, arts, and mathematics (STEAM), it is important that educators embed this pedagogy across early childhood settings. In order to promote access in inclusive early childhood settings that include young children from birth to 8 years of age with or without disabilities to STEAM pedagogy, educators need to be intentional about their practice. This article provides a four-step approach to using an intentional framework, universal design for learning (UDL), to plan for and implement STEAM pedagogy in the inclusive classroom. Practical implications are illustrated through examples of an early childhood educator and a child with autism in an inclusive urban education setting.

Single-sex schools VS mixed-gender schools: comparing impacts

This article provides an overview of the advantages and disadvantages of same-sex and mixed-gender schooling, the importance of diverse educational environments, the strategies for addressing disparities and promoting equality in education. The advantages of same-sex schools include potential benefits for academic achievement, social development, and the promotion of gender equity. However, disadvantages such as reinforcing gender stereotypes and limiting cross-gender interactions should be considered. Mixed-gender schools offer advantages such as diverse social interactions, balanced perspectives, and challenging gender stereotypes. However, potential disadvantages include gender disparities in attention and participation and the perpetuation of gender biases. Creating diverse educational environments is crucial for promoting positive outcomes in academic achievement, social development, cultural competence, and well-being. Strategies for addressing disparities and promoting equality include improving access to education, addressing gender disparities, prioritizing diversity and inclusion, enacting supportive legislation and policies, and engaging with communities. By implementing these strategies, educational institutions can create more equitable and inclusive learning environments. What makes this study particularly timely and relevant is the recent development of same-sex schools versus mixed schools as a political issue in Turkey. There are controversial discussions about this matter, and our research addresses these concerns with empirical evidence and a nuanced perspective.

The role of universities in Latin American social entrepreneurship ecosystems: a gender perspective

PurposeThis study examines the role of universities in the social entrepreneurship ecosystems (SEEs) in Latin America from the perspective of female academic staff, administrators and outreach workers of universities in the region.Design/methodology/approachUsing a qualitative approach, the study scrutinises in-depth interviews conducted with 24 women from eight Latin American universities.FindingsThe findings underscore the pivotal role of universities in promoting social entrepreneurship through knowledge generation, entrepreneur training, network enhancement and the promotion of equity. They also highlight the importance of incorporating a gender perspective into university programmes and practices.Research limitations/implicationsThe qualitative nature and small, diverse sample of this research inherently limit its scope. However, these limitations arise from the exploratory approach adopted, which was confined to eight Latin American countries. Further comparative studies in different contexts are needed to deepen the understanding of the dynamics involved.Practical implicationsUniversities should offer more tangible support and training in social entrepreneurship with a gender focus. Governments can create incentives for universities to prioritise their contribution in this area.Social implicationsThe study emphasises the potential of women-led social entrepreneurship initiatives to generate positive impact, underscoring the need for inclusive supportive environments.Originality/valueBy providing insights on the role of Latin American universities in SEEs from a gender perspective, this study contributes to limited literature on the intersection of social entrepreneurship, gender, higher education and geographic context in the region. The research underscores the need to further explore how gender and regional dynamics influence social entrepreneurial ecosystems.

The urgency of restructuring the landscape of behavioral medicine: Commentary from early-career diversity institute scholars.

Structural and systemic barriers entrenched in academia have sustained for decades, and resulted in a lack of diversity in leadership positions, inequitable workloads for women and underrepresented racial/ethnic groups, and increasing issues with retention of faculty, particularly following the COVID-19 pandemic. Increasing opposition to diversity, equity, and inclusion (DEI) efforts in higher education via legislation, policies, and general anti-DEI sentiment contextualizes the importance of prioritizing DEI. The goal of this commentary is to open discussion among academic institutions regarding changes in DEI culture that will facilitate the growth of diverse early-career faculty (ECF). We use an adapted framework which incorporates DEI into a faculty competency model to (i) guide our discussion of the rationale for restructuring academic systems to promote DEI and (ii) recommend strategies for institutional progress for ECF that can translate across academic institutions. Implementing policies and practices that seek to recruit, retain, and support historically underrepresented ECF are needed, and may involve faculty mentorship programs, establishing equitable funding mechanisms, reforming faculty evaluation practices, and examining and correcting inequities in faculty workloads. The onus is on institutions to recognize and replace the exclusionary practices and biases that have existed within their walls, and continuously promote and monitor their DEI efforts and initiatives to ensure their efficacy. Inclusive academic cultures that demonstrate their value of diversity and commitment to equity promotion at all levels of the organization, including among ECF, are necessary for ensuring excellence in scholarship in academia.

Health inequalities of LGBT persons in Switzerland – Results from the first national LGBT health study

Abstract Background Internationally, there is evidence that lesbian, gay, bisexual and transgender persons (LGBT persons) have poorer health outcomes than the heterosexual or cisgender population. In addition, LGBT populations face more frequent and unique healthcare access barriers. Barriers to healthcare among LGBT persons in Switzerland remained undocumented until recently, when the Swiss Federal Council mandated a report describing the health and healthcare access of LGBT persons, and related health inequalities. Methods Two data sets were included in analyses: (1) two waves of the representative Swiss Health Survey (SHS 2012, 2017) n = 29,793, ages 16 to 74, including 858 LGB persons, and (2) data from a non-representative national online survey (May to July 2021), including 1,542 LGB cisgender and 522 transgender persons, ages 15 to 81. Data were analyzed using descriptive and inferential statistics (e.g. binary logistic regression), controlling for potential confounding factors (e.g. year of study, age), using the Health Equity Promotion Model as a conceptual framework. Results The most significant areas of health inequalities across the groups of interest were mental health, experienced discrimination and violence, healthcare access barriers, substance use, and sexual health. For example, LGB persons experienced significantly higher rates of depression (16.0% vs. 7.4%; p<.001) and suicide attempts (11.0% vs. 3.3%; p<.001) compared to the heterosexual population. Additionally, LGB persons abstained from seeking medical care significantly more often than heterosexual persons (16.2% vs. 6.9%, respectively) due to a lack of trust in the healthcare system. Conclusions Besides targeted action in the identified (health) areas, a Health in All Policies Approach is needed to improve the lives and health of LGBT people in Switzerland by diminishing stigmatization and discrimination, and by implementing LGBT inclusive and specific protocols in healthcare and other settings.

The transition of sokshing (leaf litter forest) property rights and management: A case study of Punakha and Wangdue district, Bhutan

Prior to the government's involvement, the local communities had customary rights over the forest including access to, use of, and management of forest resources in Bhutan. However, the fate of customary rights changed with the provision of new governance. A case of sokshing (leaflitter forest) and its management under new regulations are discussed in this study. The sokshing which was de facto independent and owned by private households and communities, was nationalized under the provision of the Forest Act of 1969. Subsequently, the Land Act of 1978 permitted the use of sokshing for the collection of leaf litter and fodder, restraining the use of standing trees and land. However, with the Land Act of 2007, the user right was abolished and sokshing was completely nationalized and deregistered from lagthram (private land registration record), infringing the people's customary rights. This study examined how an individuals responded to changes in the legal ownership of sokshing and its effect on the sustainability, management, and preservation of sokshing land. To achieve this, 61 households comprising both sokshing and non-sokshing owners were interviewed using a semi-structured questionnaire. Ostrom and Schlager's bundles of rights framework were used to examine the changes in the forest property rights of local people. The results revealed that despite the enactment of the 2007 land act, the majority of respondents continued to manage and use sokshing for the production of leaf litter. However, there were concerns among local people about the ownership of their sokshing land due to poor implementation of the land act and lack of clarity on land property rights. Therefore, to address the concerns and ensure the sustainable management and utilization of sokshing land, it is recommended that the Land Act of 2007 be amended to include provisions for thorough consultation and participation, the development of a comprehensive management plan, and the promotion of equity in the use and management of sokshing resources.

Exploring the Role of Education in Promoting Social Equity in Sub Saharan Countries

Purpose: The aim of this study is to investigate the role of education in the promotion of social equity in Sub Saharan countries.
 Methodology: The study adopted a desktop methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library.
 Findings: The findings revealed that there exists a contextual and methodological gap relating to the role of education in the promotion of social equity. The empirical review revealed that it is evident that education plays a significant role in addressing social inequities and fostering inclusive societies. The findings highlight the potential of education to break the cycle of poverty, empower marginalized communities, and enhance social mobility. The study has revealed that disparities in educational opportunities persist, particularly among marginalized groups such as girls, ethnic minorities, rural populations, and individuals with disabilities. These disparities contribute to social exclusion and hinder the achievement of social equity. Therefore, targeted interventions and policies are necessary to address these educational inequalities and ensure that all individuals have equal access to quality education.
 Unique Contribution to Theory, Practice and Policy: The Social Reproduction theory, Capability Approach and the Critical Pedagogy may be used to anchor future studies on the role of education in the promotion of social equity. The study recommends that there be an enhanced access to quality education, to address gender disparities, to reduce socioeconomic barrier, to foster inclusive educational practices, strengthen teacher training and professional development and most importantly collaborate with stakeholders in realizing the transformative power of education in promoting social equity.

Lifetime Violence, Lifetime Discrimination, and Microaggressions in the Lives of LGBT Midlife and Older Adults: Findings from Aging with Pride: National Health, Aging, and Sexuality/Gender Study.

Purpose: There is a dearth of research on violence and adverse experiences among LGBT midlife and older adults. The goal of this article was to present tailored measures and investigate the relationship between adverse experiences, health, and age. Methods: Based on the Health Equity Promotion Model, we examined lifetime violence, lifetime discrimination, and contemporary microaggressions among LGBT adults, aged 50 and older, utilizing data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study. We examined subgroup differences, the interrelationships between adverse experiences, and the association with health, taking into consideration interactions by age. Results: Distinct aspects of these experiences were effectively captured by tailored measures. Important subgroup differences emerged with high levels of lifetime violence among sexually diverse adults, gay and bisexual men, and transgender adults. Experiences of violence remained a significant predictor across all three health outcomes, after controlling for both lifetime discrimination and microaggressions. Microaggressions had a significant contribution to comorbidity for those with a low level of lifetime violence. The interaction effects suggest that comorbidity increases as the number of lifetime violence experiences increases for those who are younger. As age increased, the lifetime violence effect on comorbidity diminished whereas the microaggressions effect became stronger. Conclusion: Greater attention to the sequelae of lifetime violence and other adverse events among midlife and older adults is needed as well as the development and testing of both downstream and upstream interventions to reduce and mitigate the impact of these experiences on the well-being of LGBT midlife and older adults.

Health equity is not possible without addressing disparities.

Health equity is the aspirational assurance of optimal health for all. Synonymous with fair and just opportunities for physical and mental health, equity work reflects intentional efforts to remove access barriers and allocate high-quality, need-based resources. Health equity is not possible without meaningful reductions in disparities-and evaluating progress goes further to describe, assess, and continuously evaluate fairness and social justice within structures, community contexts, and healthcare. The National Institute on Minority Health and Health Disparities (NIMHD) has a longstanding and deep commitment to advancing health equity. This article describes efforts in two specific areas: workforce diversity, equity, and inclusion (DEI) and scientific initiatives. We also summarize five actionable strategies for health equity promotion in health psychology-relevant research and practice, including increasing workforce DEI, inclusive research participation, cultural competence and humility, applying community-engaged research principles, and going beyond "do no harm." Meaningful equity work often requires major shifts in approaches, dedicated resources, and targeted efforts toward social justice. The current emphasis on addressing health disparities and understanding the structural factors underlying them presents unequivocal opportunities for changes in clinical practice and research. NIMHD seeks to support innovative health psychology and behavioral medicine research with the potential to transform health via effective and equitable interventions/treatments, systems changes, and policies. (PsycInfo Database Record (c) 2023 APA, all rights reserved).