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Frontiers in Public Health 2024Despite the incentives and provisions created for hospitals by the US Affordable Care Act related to value-based payment and community health needs assessments, concerns... (Review)
Review
BACKGROUND
Despite the incentives and provisions created for hospitals by the US Affordable Care Act related to value-based payment and community health needs assessments, concerns remain regarding the adequacy and distribution of hospital efforts to address SDOH. This scoping review of the peer-reviewed literature identifies the key characteristics of hospital/health system initiatives to address SDOH in the US, to gain insight into the progress and gaps.
METHODS
PRISMA-ScR criteria were used to inform a scoping review of the literature. The article search was guided by an integrated framework of Healthy People SDOH domains and industry recommended SDOH types for hospitals. Three academic databases were searched for eligible articles from 1 January 2018 to 30 June 2023. Database searches yielded 3,027 articles, of which 70 peer-reviewed articles met the eligibility criteria for the review.
RESULTS
Most articles (73%) were published during or after 2020 and 37% were based in Northeast US. More initiatives were undertaken by academic health centers (34%) compared to safety-net facilities (16%). Most (79%) were research initiatives, including clinical trials (40%). Only 34% of all initiatives used the EHR to collect SDOH data. Most initiatives (73%) addressed two or more types of SDOH, e.g., food and housing. A majority (74%) were downstream initiatives to address individual health-related social needs (HRSNs). Only 9% were upstream efforts to address community-level structural SDOH, e.g., housing investments. Most initiatives (74%) involved hot spotting to target HRSNs of high-risk patients, while 26% relied on screening and referral. Most initiatives (60%) relied on internal capacity vs. community partnerships (4%). Health disparities received limited attention (11%). Challenges included implementation issues and limited evidence on the systemic impact and cost savings from interventions.
CONCLUSION
Hospital/health system initiatives have predominantly taken the form of downstream initiatives to address HRSNs through hot-spotting or screening-and-referral. The emphasis on clinical trials coupled with lower use of EHR to collect SDOH data, limits transferability to safety-net facilities. Policymakers must create incentives for hospitals to invest in integrating SDOH data into EHR systems and harnessing community partnerships to address SDOH. Future research is needed on the systemic impact of hospital initiatives to address SDOH.
Topics: Humans; Social Determinants of Health; United States; Hospitals; Patient Protection and Affordable Care Act; Delivery of Health Care
PubMed: 38873294
DOI: 10.3389/fpubh.2024.1413205 -
PLOS Global Public Health 2024The incongruity between South Asia's economic growth and extreme poverty has led to a growing interest in social protection and subsequent implementation of anti-poverty...
The incongruity between South Asia's economic growth and extreme poverty has led to a growing interest in social protection and subsequent implementation of anti-poverty initiatives. However, many programs have consistently fallen short of their full potential in reaching the poor. We reviewed the literature to understand the factors behind this failure. A search of EconLit, Global Health Database, MEDLINE and SocINDEX, supplemented by an external search, yielded 42 papers evaluating 23 programs. Inclusion criteria included social and political determinants of program outcomes. Articles were assessed for quality using the GRADE and GRADE CERQual criteria and analyzed using Thomas & Harding's thematic synthesis approach. We identified five themes: (1) structurally flawed program theories overlook the complexities of poverty and are rooted in simplistic cause-and-effect approaches; (2) elite capture through appropriation of benefits, powerful positioning in program implementation, and gatekeeping through relationships of patronage; (3) insufficient targeting strategies to reach the poorest; (4) neglect of gendered restrictions, hidden costs, lack of legal documentation, and physical and social exclusion; (5) active self-exclusion from social protection to maintain dignity, a perception that programs are substandard, and a lack of resources required. The review highlights the well-documented disconnect between South Asian social protection program designs and the ground realities of their 'ideal' beneficiaries. This stems from a dominance of Western-led poverty discourse that disregards the influence of caste, the challenge of effective engagement with a group whose identity remains unclear, and fast-paced funding calls that do not lend themselves to meaningful identification and collaboration with the invisible poor. We suggest this disconnect is intentional and reflects a broader power dynamic rooted in geopolitical interests and national priorities. Study limitations reflect the shortcomings of the existing literature, which largely uses quantitative research methods that fail to capture the multidimensional experiences of the poor.
PubMed: 38870219
DOI: 10.1371/journal.pgph.0002710 -
Clinical Rehabilitation Jun 2024The objective of this systematic review and meta-analysis was to evaluate the effectiveness of social prescribing interventions in the management of long-term conditions...
OBJECTIVE
The objective of this systematic review and meta-analysis was to evaluate the effectiveness of social prescribing interventions in the management of long-term conditions in adults.
DATA SOURCES
Eleven electronic databases were searched for randomised and quasi-randomised controlled trials.
REVIEW METHODS
Outcomes of interest were quality of life, physical activity, psychological well-being and disease-specific measures. Bias was assessed with the Cochrane Risk of Bias 2 tool. A narrative synthesis and meta-analysis were performed.
RESULTS
Twelve studies ( = 3566) were included in this review. Social prescribing interventions were heterogeneous and the most common risks of bias were poor blinding and high attrition. Social prescribing interventions designed to target specific long-term conditions i.e., cancer and diabetes demonstrated significant improvements in quality of life ( = 2 studies) and disease-specific psychological outcomes respectively ( = 3 studies). There was some evidence for improvement in physical activity ( = 2 studies) but most changes were within group only ( = 4 studies). Social prescribing interventions did not demonstrate any significant changes in general psychological well-being.
CONCLUSION
Social prescribing interventions demonstrated some improvements across a range of outcomes although the quality of evidence remains poor.
PubMed: 38863236
DOI: 10.1177/02692155241258903 -
PloS One 2024Young people leaving state care often experience hardship in many areas of their life. At a population level, their outcomes in early adulthood are poorer compared to...
Understanding how young people transitioning from out-of-home care acquire and develop independent living skills and knowledge: A systematic review of longitudinal studies.
Young people leaving state care often experience hardship in many areas of their life. At a population level, their outcomes in early adulthood are poorer compared to general populations. Effective preparation for leaving care and post-care support systems is vital to improving outcomes. Individual and systemic support for young people to acquire Independent Living Skills (ILS) in the following eight ILS domains have been identified: Financial Management, Knowledge of Accessing Available Supports, Managing Housing, Education Planning, Job Seeking, Health Risk Management, Domestic and Self-help Task, and Managing Relationships. This systematic review aims to identify, summarise, and appraise longitudinal studies that address ILS across these ILS domains to understand better how outcomes could be improved. Seven databases (CINAHL, Embase, ProQuest, PsychINFO, PubMed, Scopus, and Web of Science) were searched on 20th July 2023. In total, twenty-seven studies published between 1994 and 2022 from various countries met the eligibility criteria. The included studies reported on 2-4 waves and adopted different methodological approaches. Study quality was scored using Qualsyst. Study characteristics and details of the interventions are presented in tables. Studies cover overlapping ILS domains, which are mapped in a matrix. Results revealed that nearly three-quarters (74% or 20 out of 27) of studies explored four or fewer of the eight ILS domains. The most frequent ILS domain covered was 'Knowledge of Accessing Available Supports' (19/27 studies). The main conclusion considers the concept of independence as a misnomer, with ILS covering multiple, intersecting, and interdependent domains, which ultimately help and hinder one another. Further research is required to adopt a more comprehensive approach encompassing all the domains to better inform policy, programs, and practice. A limitation is that a meta-analysis was not conducted for this review. This study registered a 'Protocol' with OSF Registries (DOI: 10.17605/OSF.IO/MJ3ZX) on June 5th, 2022.
Topics: Humans; Longitudinal Studies; Independent Living; Adolescent; Young Adult
PubMed: 38861497
DOI: 10.1371/journal.pone.0304965 -
Scientific Reports Jun 2024The effectiveness of psychological interventions (PI) for malignant diseases is controversial. We aimed to investigate the effect of PI on survival and quality of life... (Meta-Analysis)
Meta-Analysis
The effectiveness of psychological interventions (PI) for malignant diseases is controversial. We aimed to investigate the effect of PI on survival and quality of life (QoL) in patients with cancer. We performed a systematic search of MEDLINE, Cochrane, and Embase databases to identify randomized controlled trials comparing PI to standard care (PROSPERO registration number CRD42021282327). Outcomes were overall survival (OS), recurrence-free survival (RFS), and different domains of QoL. Subgroup analysis was performed based on the provider-, type-, environment-, duration of intervention; cancer stage, and type. Pooled hazard ratios (HR) and standardized mean difference (SMD) with 95% confidence intervals (CI) were calculated using a random-effects model. The OS and RFS did not differ significantly between the two groups (OS:HR = 0.97; CI 0.87-1.08; RFS:HR = 0.99; CI 0.84-1.16). However, there was significant improvement in the intervention group in all the analyzed domains of QoL; in the global (SMD = 0.65; CI 0.35-0.94), emotional (SMD = 0.64; CI 0.33-0.95), social (SMD = 0.32; CI 0.13-0.51) and physical (SMD = 0.33; CI 0.05-0.60) domains. The effect of PI on QoL was generally positive immediately, 12 and 24 weeks after intervention, but the effect decreased over time and was no longer found significant at 48 weeks. The results were better in the breast cancer group and early stages of cancer. PIs do not prolong survival, but they significantly improve the QoL of cancer patients. PI should be added as standard of care 3-4 times a year, at least for patients with early-stage cancer.
Topics: Humans; Quality of Life; Randomized Controlled Trials as Topic; Neoplasms; Psychosocial Intervention; Neoplasm Staging; Female
PubMed: 38853187
DOI: 10.1038/s41598-024-63431-y -
BMJ Open Jun 2024This study aimed to identify the types of transparency interventions in the health systems of the low-income and middle-income countries and the outcomes of such...
OBJECTIVES
This study aimed to identify the types of transparency interventions in the health systems of the low-income and middle-income countries and the outcomes of such interventions in those systems.
METHOD
We searched major medical databases including PubMed, Embase and Scopus, for any kind of interventional study on transparency in health systems. We also looked for additional sources of information in organisational websites, grey literature and reference checking. Using the PRISMA algorithm for identifying related studies, we included 24 articles.
RESULTS
Our initial search, from 1980 to August 2021, retrieved 407 articles, 24 of which were narratively analysed. Response to a problem (mostly corruption) was the main reason for the initiation of a transparency intervention. Transparency interventions differed in terms of types, performance methods, collaboration partners and outcomes. They help improve the health system mostly in the short term and in some cases, long term.
CONCLUSION
Although our findings revealed that transparency initiatives could reduce some problems such as counterfeit drugs and corruption, and improve health indicators in a short term, still their sustainability remains a concern. Health systems need robust interventions with clearly defined and measured outcomes, especially sustainable outcomes to tackle corruption fundamentally.
Topics: Humans; Developing Countries; Delivery of Health Care; Quality Improvement
PubMed: 38844391
DOI: 10.1136/bmjopen-2023-081152 -
International Journal For Equity in... Jun 2024The provision of diversity-sensitive care is a promising approach towards reducing health disparities. Recent criticism and a scientific gap demonstrate the need for the...
BACKGROUND
The provision of diversity-sensitive care is a promising approach towards reducing health disparities. Recent criticism and a scientific gap demonstrate the need for the patient perspective on diversity-sensitive care. This systematic review aims to describe the patient perspective, including patient experiences, expectations, and satisfaction with diversity-sensitive care provided by healthcare providers.
METHODS
In December 2022 the Medline ALL, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO and additionally Google Scholar were searched for original studies that described or measured patient expectations, experiences, and/or satisfaction, specifically focusing on cultural or diversity competence of healthcare providers. Analysis of the collected data was performed using a convergent mixed-methods design based on thematic synthesis.
RESULTS
From initially 5,387 articles, 117 were selected for full-text screening, and ultimately, 34 articles were included in this study. The concept of diversity-sensitive care was observed to comprise three components. The first component is focused on patient-centered care and includes competencies such as clear and direct communication, shared decision-making, individualized care, empathy, and consideration. The second component centers on providing culturally tailored information, adjusting care to cultural needs, working with interpreters, allyship, community partnerships, self-awareness, and cultural knowledge, and builds upon the first component. Across the first two components of diversity-sensitive care, patients have reported experiencing dissatisfaction and encountering shortcomings in their healthcare providers, sometimes resulting in the third and final component pertaining to provider care. This component underscores the importance of linguistic, ethnic, cultural, and gender concordance in delivering quality care.
CONCLUSION
In conclusion, the patient perspective on diversity-sensitive care encompasses multiple components, from patient-centered care to concordant care. The components incorporate various competencies as communication skills, empathy, self-awareness and adjusting care to cultural needs. Patients reported experiencing dissatisfaction and shortcomings across all components of diversity-sensitive care provided by healthcare providers.
Topics: Humans; Cultural Diversity; Patient-Centered Care; Cultural Competency; Patient Satisfaction; Empathy; Health Personnel; Communication
PubMed: 38840119
DOI: 10.1186/s12939-024-02189-1 -
Journal of Medical Internet Research Jun 2024Social media use has potential to facilitate the rapid dissemination of research evidence to busy health and social care practitioners. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Social media use has potential to facilitate the rapid dissemination of research evidence to busy health and social care practitioners.
OBJECTIVE
This study aims to quantitatively synthesize evidence of the between- and within-group effectiveness of social media for dissemination of research evidence to health and social care practitioners. It also compared effectiveness between different social media platforms, formats, and strategies.
METHODS
We searched electronic databases for articles in English that were published between January 1, 2010, and January 10, 2023, and that evaluated social media interventions for disseminating research evidence to qualified, postregistration health and social care practitioners in measures of reach, engagement, direct dissemination, or impact. Screening, data extraction, and risk of bias assessments were carried out by at least 2 independent reviewers. Meta-analyses of standardized pooled effects were carried out for between- and within-group effectiveness of social media and comparisons between platforms, formats, and strategies. Certainty of evidence for outcomes was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework.
RESULTS
In total, 50 mixed-quality articles that were heterogeneous in design and outcome were included (n=9, 18% were randomized controlled trials [RCTs]). Reach (measured in number of practitioners, impressions, or post views) was reported in 26 studies. Engagement (measured in likes or post interactions) was evaluated in 21 studies. Direct dissemination (measured in link clicks, article views, downloads, or altmetric attention score) was analyzed in 23 studies (8 RCTs). Impact (measured in citations or measures of thinking and practice) was reported in 13 studies. Included studies almost universally indicated effects in favor of social media interventions, although effect sizes varied. Cumulative evidence indicated moderate certainty of large and moderate between-group effects of social media interventions on direct dissemination (standardized mean difference [SMD] 0.88; P=.02) and impact (SMD 0.76; P<.001). After social media interventions, cumulative evidence showed moderate certainty of large within-group effects on reach (SMD 1.99; P<.001), engagement (SMD 3.74; P<.001), and direct dissemination (SMD 0.82; P=.004) and low certainty of a small within-group effect on impacting thinking or practice (SMD 0.45; P=.02). There was also evidence for the effectiveness of using multiple social media platforms (including Twitter, subsequently rebranded X; and Facebook), images (particularly infographics), and intensive social media strategies with frequent, daily posts and involving influential others. No included studies tested the dissemination of research evidence to social care practitioners.
CONCLUSIONS
Social media was effective for disseminating research evidence to health care practitioners. More intense social media campaigns using specific platforms, formats, and strategies may be more effective than less intense interventions. Implications include recommendations for effective dissemination of research evidence to health care practitioners and further RCTs in this field, particularly investigating the dissemination of social care research.
TRIAL REGISTRATION
PROSPERO International Prospective Register of Systematic Reviews CRD42022378793; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=378793.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
RR2-10.2196/45684.
Topics: Humans; Health Personnel; Information Dissemination; Social Media
PubMed: 38838330
DOI: 10.2196/51418 -
Rural and Remote Health May 2024Ninety-seven per cent of Indigenous Peoples live in low-and middle-income countries (LMICs). A previous systematic integrative review of articles published between 2000... (Review)
Review
INTRODUCTION
Ninety-seven per cent of Indigenous Peoples live in low-and middle-income countries (LMICs). A previous systematic integrative review of articles published between 2000 and 2017 identified numerous barriers for Indigenous women in LMICs in accessing maternal healthcare services. It is timely given the aim of achieving Universal Health Coverage in six years' time, by 2030, to undertake another review. This article updates the previous review exploring the recent available literature on Indigenous women's access to maternal health services in LMICs identifying barriers to services.
METHODS
An integrative review of literature published between 2018 and 2023 was undertaken. This review followed a systematic process using Whittemore and Knafl's five-step framework for integrative reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 944 articles were identified from six databases: Academic Search Premier, MEDLINE, Psychology and Behavioral Sciences Collection, APA PsycInfo, CINAHL Plus with Full Text and APA PsycArticles (through EBSCOhost). The search was undertaken on 16 January 2023. After screening of the title/abstract and the full text using inclusion and exclusion criteria 26 articles were identified. Critical appraisal resulted in 24 articles being included in the review. Data were extracted using a matrix informed by Penchansky and Thomas's taxonomy, extended by Saurman, which focused on six dimensions of access to health care: affordability, accessibility, availability, accommodation, acceptability and awareness. Ten studies took place in Asia, 10 studies were from the Americas and four studies took place in the African region. Seventeen articles were qualitative, two were quantitative and five were mixed methods. The methods for the integrative review were prespecified in a protocol, registered at Open Science Framework.
RESULTS
Barriers identified included affordability; community awareness of services including poor communication between providers and women; the availability of services, with staff often missing from the facilities; poor quality services, which did not consider the cultural and spiritual needs of Indigenous Peoples; an overreliance on the biomedical model; a lack of facilities to enable appropriate maternal care; services that did not accommodate the everyday needs of women, including work and family responsibilities; lack of understanding of Indigenous cultures from health professionals; and evidence of obstetric violence and mistreatment of Indigenous women.
CONCLUSION
Barriers to Indigenous women's access to maternal health services are underpinned by the social exclusion and marginalisation of Indigenous Peoples. Empowerment of Indigenous women and communities in LMICs is required as well as initiatives to challenge the stigmatisation and marginalisation that they face. The importance of community involvement in design and interventions that support the political and human rights of Indigenous Peoples are required. Limitations of this review include the possibility of missing articles as it was sometimes unclear from the articles whether a particular group was from an Indigenous community. More research on access to services in the postnatal period is still needed, as well as quality quantitative research. There is also a lack of research on Indigenous groups in North Africa, and in sub-Saharan Africa - especially hunter-gatherer groups - as well as the impact of COVID-19 on access to services.
Topics: Humans; Health Services Accessibility; Maternal Health Services; Female; Developing Countries; Indigenous Peoples; Health Services, Indigenous; Pregnancy
PubMed: 38826130
DOI: 10.22605/RRH8520 -
Seizure Jul 2024Psychological interventions are the most recommended treatment for functional/dissociative seizures (FDS); however, there is ongoing uncertainty about their... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Psychological interventions are the most recommended treatment for functional/dissociative seizures (FDS); however, there is ongoing uncertainty about their effectiveness on seizure outcomes.
METHODS
This systematic review and meta-analysis synthesises the available data. In February 2023, we completed a systematic search of four electronic databases. We described the range of seizure-related outcomes captured, used meta-analytic methods to analyse data collected during treatment and follow-up; and explored sources of heterogeneity between outcomes.
RESULTS
Overall, 44 relevant studies were identified involving 1,300 patients. Most were categorised as being at high (39.5 %) or medium (41.9 %) risk of bias. Seizure frequency was examined in all but one study; seizure intensity, severity or bothersomeness in ten; and seizure duration and cluster in one study each. Meta-analyses could be performed on seizure freedom and seizure reduction. A pooled estimate for seizure freedom at the end of treatment was 40 %, while for follow-up it was 36 %. Pooled rates for ≥50 % improvement in seizure frequency were 66 % and 75 %. None of the included moderator variables for seizure freedom were significant. At the group level, seizure frequency improved during the treatment phase with a moderate pooled effect size (d = 0.53). FDS frequency reduced by a median of 6.5 seizures per month. There was also evidence of improvement of the other (non-frequency) seizure-related measures with psychological therapy, but data were insufficient for meta-analysis.
CONCLUSIONS
The findings of this study complement a previous meta-analysis describing psychological treatment-associated improvements in non-seizure-related outcomes. Further research on the most appropriate FDS-severity measure is needed.
Topics: Adult; Humans; Dissociative Disorders; Psychotherapy; Seizures; Treatment Outcome
PubMed: 38824867
DOI: 10.1016/j.seizure.2024.05.016