Whether and how people reach care.
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701 to 725 of 2,047Access to health and health care: how race and ethnicity matter.
Racial and ethnic disparities in health are multifactorial; they reflect differences in biological vulnerability to disease as well as differences in social resources, environmental factors, and health care interventions. Understanding and intervening in health inequity require an understanding of the disparate access to all of the personal resources and environmental conditions that are needed to generate and sustain health, a set of circumstances that constitute access to health. These include access to health information, participation in health promotion and disease prevention activities, safe housing, nutritious foods, convenient exercise spaces, freedom from ambient violence, adequate social support, communities with social capital, and access to quality health care. Access to health care is facilitated by health insurance, a regular source of care, and a usual primary care provide…
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Physical performance limitations in the Childhood Cancer Survivor Study cohort.
Physical performance limitations are one of the potential long-term consequences following diagnosis and treatment for childhood cancer. The purpose of this review is to describe the risk factors for and the participation restrictions that result from physical performance limitations among childhood cancer survivors who participated in the Childhood Cancer Survivor Study (CCSS). Articles previously published from the CCSS cohort related to physical performance limitations were reviewed and the results summarized. Our review showed that physical performance limitations are prevalent among childhood cancer survivors and may increase as they age. Host-based risk factors for physical disability include an original diagnosis of bone tumor, brain tumor, or Hodgkin's disease; female sex; and an income less than $20,000 per year. Treatment-based risk factors include radiation and treatment with …
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Feder G, Ramsay J, Dunne D, Rose M, Arsene C, Norman R, Kuntze S, Spencer A, Bacchus L, Hague G, Warburton A, Taket A (2009)reviewMEDLINE-indexed journal, not yet read by usHealth technology assessment (Winchester, England)174 citations How far does screening women for domestic (partner) violence in different health-care settings meet criteria for a screening programme? Systematic reviews of nine UK National Screening Committee criteria.
Objectives: The two objectives were: (1) to identify, appraise and synthesise research that is relevant to selected UK National Screening Committee (NSC) criteria for a screening programme in relation to partner violence; and (2) to judge whether current evidence fulfils selected NSC criteria for the implementation of screening for partner violence in health-care settings.
Data sources: Fourteen electronic databases from their respective start dates to 31 December 2006.
Review methods: The review examined seven questions linked to key NSC criteria: QI: What is the prevalence of partner violence against women and what are its health consequences? QII: Are screening tools valid and reliable? QIII: Is screening for partner violence acceptable to women? QIV: Are interventions effective once partner violence is disclosed in a health-care setting? QV: Can mortality or morbidity be reduced foll…
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How does communication heal? Pathways linking clinician-patient communication to health outcomes.
Objective: Although prior research indicates that features of clinician-patient communication can predict health outcomes weeks and months after the consultation, the mechanisms accounting for these findings are poorly understood. While talk itself can be therapeutic (e.g., lessening the patient's anxiety, providing comfort), more often clinician-patient communication influences health outcomes via a more indirect route. Proximal outcomes of the interaction include patient understanding, trust, and clinician-patient agreement. These affect intermediate outcomes (e.g., increased adherence, better self-care skills) which, in turn, affect health and well-being. Seven pathways through which communication can lead to better health include increased access to care, greater patient knowledge and shared understanding, higher quality medical decisions, enhanced therapeutic alliances, increased so…
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Richter LM, Sherr L, Adato M, Belsey M, Chandan U, Desmond C, Drimie S, Haour-Knipe M, Hosegood V, Kimou J, Madhavan S, Mathambo V, Wakhweya A (2009)reviewMEDLINE-indexed journal, not yet read by usAIDS care82 citations Strengthening families to support children affected by HIV and AIDS.
This paper provides an overview of the arguments for the central role of families, defined very broadly, and we emphasise the importance of efforts to strengthen families to support children affected by HIV and AIDS. We draw on work conducted in the Joint Learning Initiative on Children and AIDS's Learning Group 1: Strengthening Families, as well as published data and empirical literature to provide the rationale for family strengthening. We close with the following recommendations for strengthening families to ameliorate the effects of HIV and AIDS on children. Firstly, a developmental approach to poverty is an essential feature of responses to protect children affected by HIV and AIDS, necessary to safeguard their human capital. For this reason, access to essential services, such as health and education, as well as basic income security, must be at the heart of national strategic appro…
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Social protection to support vulnerable children and families: the potential of cash transfers to protect education, health and nutrition.
Investing in social protection in sub-Saharan Africa has taken on a new urgency as HIV and AIDS interact with other drivers of poverty to simultaneously destabilise livelihoods systems and family and community safety nets. Cash transfer programmes already reach millions of people in South Africa, and in other countries in southern and East Africa plans are underway to reach tens and eventually hundreds of thousands more. Cash transfers worldwide have demonstrated large impacts on the education, health and nutrition of children. While the strongest evidence is from conditional cash transfer evaluations in Latin America and Asia, important results are emerging in the newer African programmes. Cash transfers can be implemented in conjunction with other services involving education, health, nutrition, social welfare and others, including those related to HIV and AIDS. HIV/AIDS-affected famil…
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Social inequality and racial discrimination: risk factors for health disparities in children of color.
A child's sense of control over life and health outcomes as well as perceptions of the world as fair, equal, and just are significantly influenced by his or her social experiences and environment. Unfortunately, the social environment for many children of color includes personal and family experiences of racial discrimination that foster perceptions of powerlessness, inequality, and injustice. In turn, these perceptions may influence child health outcomes and disparities by affecting biological functioning (eg, cardiovascular and immune function) and the quality of the parent-child relationship and promoting psychological distress (eg, self-efficacy, depression, anger) that can be associated with risk-taking and unhealthy behaviors. In this article we review existing theoretical models and empirical studies of the impact of racial discrimination on the health and development of children …
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De Santis JP (2009)reviewMEDLINE-indexed journal, not yet read by usThe Journal of the Association of Nurses in AIDS Care : JANAC115 citations HIV infection risk factors among male-to-female transgender persons: a review of the literature.
Male-to-female (MTF) transgender women experience a host of psychosocial issues such as discrimination, stigmatization, and marginalization. These challenges often limit economic opportunities, affect mental health, and may place members of this population at an increased risk for HIV infection. This report presents a review of the literature that focuses on risk factors for HIV infection specific to the MTF population. Factors including needle sharing and substance abuse, high-risk sexual behaviors, commercial sex work, health care access, lack of knowledge regarding HIV transmission, violence, stigma and discrimination, and mental health issues have been identified in the literature as risk factors for the acquisition of HIV infection by members of this population. Implications for care provided to MTF transgender persons are presented, and suggestions for future research are identifie…
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Depression and the workplace: a progress report.
There has been considerable interest recently in the relationship between depression and the workplace. This interest is driven by the growing recognition that depressive disorders are highly prevalent in the workplace and have an enormously negative impact on performance, productivity, absenteeism, and disability costs. A variety of clinical research with occupational-related samples has helped to define those at risk for depression and has led to a better understanding of the overlap of the construct of clinical depression with more longstanding occupational health and organizational psychology models such as stress, burnout, and job satisfaction. From an employer perspective, depression's impact remains largely unmitigated due to stigma, uncertainty about treatment's cost effectiveness, and lack of effective interventions delivered in a workplace setting. Progress in these areas is re…
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A multi-perspective approach for defining neighbourhood units in the context of a study on health inequalities in the Quebec City region.
Background: Identification of socioeconomic and health inequalities at the local scale is facilitated by using relevant small geographical sectors. Although these places are routinely defined according to administrative boundaries on the basis of statistical criteria, it is important to carefully consider the way they are circumscribed as they can create spatial analysis problems and produce misleading information. This article introduces a new approach to defining neighbourhood units which is based on the integration of elements stemming from the socioeconomic situation of the area, its history, and how it is perceived by local key actors.
Results: Using this set of geographical units shows important socioeconomic and health disparities at the local scale. These disparities can be seen, for example, in a 16-year difference in disability-free life expectancy at birth, and a $10,000-diffe…
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Promoting health and physical function among cancer survivors: potential for prevention and questions that remain.
Cancer survivors are at increased risk, not only for progressive and recurrent disease, but also other cancers, cardiovascular disease, diabetes, osteoporosis, and functional decline. Lifestyle interventions to improve dietary and physical activity behaviors, and smoking cessation, have the potential to improve the overall health and quality of life of this vulnerable population. Studies on overall health and physical function from 1966 and beyond regarding the impact of behavioral interventions that used randomized and controlled designs were identified through MEDLINE and PubMed searches. Published reports currently exist for 22 exercise interventions, 11 diet-related interventions (excluding those limited to dietary supplements or single nutrients), two diet and exercise interventions, and 10 behavioral-based smoking cessation interventions. Although many interventions have been succe…
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Javed A, Lee C, Zakaria H, Buenaventura RD, Cetkovich-Bakmas M, Duailibi K, Ng B, Ramy H, Saha G, Arifeen S, Elorza PM, Ratnasingham P, Azeem MW (2021)reviewMEDLINE-indexed journal, not yet read by usAsian journal of psychiatry156 citations Reducing the stigma of mental health disorders with a focus on low- and middle-income countries.
Mental health disorders are a burgeoning global public health challenge, and disproportionately affect the poor. Low- and middle-income countries (LMICs) bear 80 % of the mental health disease burden. Stigma associated with mental health results in delayed help seeking, reduced access to health services, suboptimal treatment, poor outcomes and an increased risk of individuals' human rights violations. Moreover, widespread co-occurrence of physical comorbidities such as noncommunicable diseases with mental health disorders makes the treatment of both conditions challenging and worsens prognosis. This paper explores various aspects of stigma towards mental health with a focus on LMICs and assesses measures to increase help-seeking and access to and uptake of mental health services. Stigma impacts persons living with mental illness, their families and caregivers and healthcare professionals…
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Caring for Young People Who Self-Harm: A Review of Perspectives from Families and Young People.
Self-harm among young people remains largely stigmatised and misunderstood. Parents have been identified as key facilitators in the help-seeking process, yet they typically report feeling ill-equipped to support the young person in their care. The aim of this review was to examine the perspectives of both young people (aged 12⁻28) and parents and to develop the conceptual framework for a future qualitative study. A systematic search of MEDLINE and PsycINFO was performed to identify articles that focused on the experiences of family members and young people related to managing the discovery of self-harm. Fourteen articles were included for review. Four addressed the perspectives of young people and 10 reported on the impact of adolescent self-harm on parents. The impact of self-harm is substantial and there exists a discrepancy between the most common parental responses and the preference…
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Empirical Studies of Self-Stigma Reduction Strategies: A Critical Review of the Literature.
Objective: The purpose of this article was to comprehensively review published literature about strategies to reduce self-stigma among people with mental illness. Recommendations and implications for research also are discussed.
Methods: The electronic databases of Ovid, PubMed, and PsycINFO were searched for peer-reviewed articles published between January 2000 and August 2011 by using the key words “self-stigma,” “internalized stigma,” “perceived stigma,” and “stigma intervention.” The search was further narrowed to studies that described a detailed intervention and that used self-stigma as a primary or secondary outcome, tested the intervention among individuals with a psychiatric illness, and analyzed data quantitatively with acceptable statistical tools.
Results: Fourteen articles met inclusion criteria, and eight reported significant improvement in self-stigma outcomes. Participant…
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Depression and Korean American immigrants.
Koreans are a relatively new and fast-growing immigrant group in the United States. Research has shown that immigration experiences are associated with depression, whereas acculturation and social support are moderating factors. Korean culture is informed by Confucianism, which emphasizes family integrity, group conformity, and traditional gender roles, and has influenced how Korean immigrants conceptualize depression, express depressive symptoms, and demonstrate help-seeking behavior. An understanding of Korean patterns of manifesting and expressing depression will be helpful to provide culturally appropriate mental health services to Korean American immigrants.
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Amaddeo F, Jones J (2007)editorial or commentMEDLINE-indexed journal, not yet read by usEpidemiologia e psichiatria sociale19 citations What is the impact of socio-economic inequalities on the use of mental health services?
Amartya Sen, who received the Nobel Prize for Economics, has demonstrated that the incidence of deprivation, in terms of capability, can be surprisingly high even in the most developed countries of the world. The study of socio-economic inequalities, in relation to the utilisation of health services, is a priority for epidemiological research. Socio-economic status (SES) has no universal definition. Within the international research literature, SES has been related to social class, social position, occupational status, educational attainment, income, wealth and standard of living. Existing research studies have shown that people from a more deprived social background, with a lower SES, are more likely to have a higher psychiatric morbidity. Many studies show that SES influences psychiatric services utilization, however the real factors linking SES and mental health services utilisation r…
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Gandhi AP, Selvaraj K, Kuruvatti N, Deshmukh PR, Solanki R, Kushwaha A, Sujiv A, Selokar D, Sabale RM, Inamdar AS, Bharadwaj V, Babu BV (2026)MEDLINE-indexed journal, not yet read by usBMC public health Socio economic vulnerability and forgone health care among tribal population: a cross-sectional study from a block of Nagpur district in central India.
Background: Indigenous or tribal population are the most socio economically vulnerable group in India. Their health-seeking behaviour is in turn influenced by socio-cultural perceptions of health and access to health care. Addressing forgone health care in tribal populations is essential for reducing health disparities and improving public health outcomes.
Objectives: To estimate the foregone health care in the tribal community of central India and determine its associations with the socioeconomic status and financial risk protection measures.
Methods: A cross-sectional study was undertaken in 2020-21 among 2085 households belonging to tribal communities in Ramtek block of Nagpur district in Maharashtra, India. Multi stage stratified sampling procedure was followed to choose households. Trained field investigators collected data from the eligible tribal households using a structured inte…
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Barriers to postpartum health and opinions on a postpartum peer navigator program amongst refugee women resettled in California.
Background: The aim of this study is to identify postpartum challenges and assess for interest in a postpartum peer navigator program amongst refugee women resettled in California.
Methods: Participants were recruited through ethnic community-based organizations in California using convenience and snowball sampling. Arabic, Dari, or Pashto speaking women who have given birth in the United States within the last five years and entered the country as refugees, special immigrant visa holders, or asylum seekers were eligible to participate. Semi-structured interviews were analyzed using Braun and Clarke's thematic analysis.
Results: We interviewed 26 participants. The mean age was 30 years (SD = 6.3) and mean length of time in the United States was 4.5 years (SD = 3.0). All participants are state insurance recipients. Most participants (89%, n = 23) utilize an interpreter. We identified seve…
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Awareness of access to health care: a significant need of the Narikuravar people, India.
Introduction: To examine access to health care among the Narikuravar community and identify distinct challenges for delivering existing healthcare resources, a mixed-methods study was conducted among local Narikuravar community people in Poonjeri village, Tamil Nadu, India.
Methods: Data were collected from 81 Narikuravar individuals using a structured questionnaire describing demographic characteristics, health-seeking behaviour and the availability of government-issued healthcare cards. Qualitative one-on-one interviews were conducted. Content analysis of the transcribed data was performed to achieve a deeper insight into determinants of healthcare access.
Results: Most participants (82%) had no knowledge of the processes required for procuring healthcare services and privileges. They demonstrated significant hospital utilisation, with a majority (58%) having recently visited a hospita…
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Delay in timing of first antenatal care utilisation among women of reproductive age in sub-Saharan Africa: a multilevel mixed effect analysis.
Background: Several studies in sub-Saharan Africa and elsewhere have affirmed the importance of community-level factors in influencing maternal health seeking behaviour. However, literature shows no uniform pattern in terms of how contextual-level factors influence delay in seeking antenatal care service in different parts of the region. The association of contextual factors and timing of antenatal care is not well documented at regional level. Thus, this study was conducted to examine how community-level characteristics influence decision not to initiate antenatal care in the first trimester. Regional-level analyses of antenatal care utilisation in sub-Saharan Africa are important because they help identify geographic disparities in access and utilisation of the service. Thus, allowing for targeted interventions to improve maternal health outcomes.
Methods: Data from the most recent Dem…
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Nakagawa F, Palich R, Kall M, Sewell J, Smith C, Kelly C, Kitt H, Pelchen-Matthews A, Aghaizu A, Sparrowhawk A, Mackie N, Djuretic T, Schoeman S, Humphreys C, Lipman M, Lampe FC, Rodger AJ, PV2022 Study Group (2025)MEDLINE-indexed journal, not yet read by usHIV medicine2 citations Impact of COVID-19 and factors associated with long COVID and COVID-19 vaccine uptake in people with HIV in the United Kingdom: Results from Positive Voices 2022.
Objectives: We assessed the impact of COVID-19, and the prevalence and factors associated with a history of COVID-19 infection, long COVID and incomplete COVID-19 vaccine uptake among people with HIV.
Methods: Positive Voices 2022 is a questionnaire study of people accessing HIV care in the United Kingdom (March 2022-April 2023). Logistic regression assessed factors associated with a history of COVID-19 (previous positive test), long COVID among those with a history of COVID-19 (ongoing symptoms, with COVID-19 onset >3 months previously) and incomplete COVID-19 vaccine uptake (less than three doses of vaccine), adjusted for: age; gender; ethnicity; and year of HIV diagnosis.
Results: In all, 4188 participants were included. Commonly reported negative impacts of the pandemic were on social contact (44% of participants), mental health (30%), healthcare access (26%) and financial security (…
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Trust Matters: A Qualitative Study on Healthcare Access and Utilization Among African Immigrants in the United States.
Trust in healthcare is declining in the U.S. and is associated with decreased engagement in preventive care, low adherence to treatments, lack of motivation to seek care and poor health outcomes. Using the Health Belief Model (HBM), this study examined the impacts of trust on the healthcare access and utilization among African immigrants in Florida, United States. In-depth interviews were conducted with purposively selected African immigrants (N = 19) over the age of 18, lived in Florida for five or more years, and had recent experience with the U.S. healthcare system. Interviews were audio-recorded, transcribed verbatim, and analyzed using NVivo14. Perceived barriers to trust led to discontinuation and delays of care. Uncertainties on insurance coverage, ambiguous medical bills, and broken patient-provider communication constitute perceived barriers. Perceived benefit determined trust a…
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Alhaji MM, Umar L, Yusuf MA, Nyaga R, Singh J, Okafor A, Meyo F, Shayau ZH, Isah ZI, Abubakar M, Umar AI, Ozohu-Suleiman Y (2025)MEDLINE-indexed journal, not yet read by usBMC pregnancy and childbirth Supply and demand barriers to PHC maternal care services uptake: qualitative and behavioural insights from Gombe State, Nigeria.
Background: Several factors influence maternal morbidity and mortality in northeast Nigeria, and maternal care-seeking behaviour at primary healthcare facilities is a critical factor. This study, rooted in the Social Ecological Model (SEM) of behaviour change, investigated the structural and demand-side cognitive barriers that limit antenatal and family planning care-seeking behaviour among households in Gombe State, Nigeria.
Method: Qualitative in-depth interviews, each lasting 60-70 min, were conducted with 56 respondents, including mothers/expectant mothers (n = 15), their household decision-makers/spouses (n = 16), community leaders (n = 16), and primary healthcare centre (PHC) service providers and volunteers (n = 9). The qualitative instrument was developed and analysed based on four core elements of the SEM: intrapersonal, interpersonal, institutional, and community-level factors …
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Eating disorders in times of the COVID-19 pandemic-Results from an online survey of patients with anorexia nervosa.
Objective: The COVID-19 pandemic and the resulting public restrictions pose a psychological burden for humans worldwide and may be particularly detrimental for individuals with mental disorders. Therefore, the current study explored effects of the COVID-19 pandemic on eating disorder (ED) symptoms and other psychological aspects in former inpatients with anorexia nervosa (AN).
Method: One-hundred and fifty-nine patients with AN-discharged from inpatient treatment in 2019-completed an online survey on contact history with COVID-19, changes in ED symptoms and other psychological aspects, health care utilization, and strategies patients employed to cope during the pandemic.
Results: Approximately 70% of patients reported that eating, shape and weight concerns, drive for physical activity, loneliness, sadness, and inner restlessness increased during the pandemic. Access to in-person psychoth…
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Mothers' Perspectives on Follow-up for Postpartum Depression Screening in Primary Care.
Objective: To qualitatively assess mothers' perspectives on barriers to and facilitators of follow-up of at-risk postpartum depression (PPD) screening test results.
Methods: We conducted semistructured qualitative telephone interviews with 17 women who scored in the moderate or high-risk range on the Edinburgh Postpartum Depression Scale. Interviews explored personal experience with depressive symptoms, barriers and facilitators to receiving mental health care postpartum, and suggestions for primary care follow-up of at-risk screens. The team created a coding structure that was updated during review of transcripts. Findings were triangulated and external validity assessed via discussions with a mother who experienced PPD, a perinatal social worker, and a perinatal psychologist.
Results: Personal health/attitude, family/friends, community, and health care system factors influenced mothers…
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