scholarly journals Health equity implications of COVID-19 on dementia care in community for people of African descent

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 1015-1016
Author(s):  
Mary Lukindo ◽  
Barbara Hamilton-Hinch ◽  
OmiSoore Dryden ◽  
Katie Aubrecht
Keyword(s):  
Health System ◽  
Health Equity ◽  
African Descent ◽  
Quality Care ◽  
Dementia Care ◽  
Policy Practice ◽  
Related Stigma ◽  
Provider Knowledge ◽  
Services And Supports ◽  
The Impact

Abstract This presentation shares results from an analysis of interviews conducted to understand the health equity implications of COVID-19 responses on dementia care in the community for people of African descent in Nova Scotia, Canada. Interviews were embedded within a larger multi-method rapid research project that aimed to assess the impact of COVID-19 on dementia care for geographically and socially marginalized groups in the province. Data from the interviews was analyzed using a constructivist thematic analysis method, guided by an intersectional theoretical scaffold. Three themes were identified related to systemic barriers, mental health, system navigation and self-care, and collected under the overarching theme of ‘facing the unknown with dementia’. Results emphasized the value and notable absence of community driven, culturally specific dementia programs, resources and navigators for people living with dementia, family caregivers and care workers of African descent. Participants identified lack of health system and care provider knowledge and understanding of the cultures and histories of people of African descent as a barrier to quality care and to addressing dementia-related stigma. Conversations focused on the need for practical and accessible tools, strategies and perspectives responsive to the actually lived realities and needs of people in community, and for research that actually contributes to individual and collective life in tangible, timely and culturally meaningful ways. Recommendations focus on the importance of centering community in dementia care programs, policy, practice and research to improve services and supports for people of African descent.

scholarly journals Race, Class, and the Nursing Home Workforce: Experiences of Staff of Color in High-Minority-Proportion Nursing Homes

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 689-689
Author(s):  
Odichinma Akosionu ◽  
Janette Dill ◽  
Manka Nkimbeng ◽  
Tricia Skarphol ◽  
Tetyana Shippee
Keyword(s):  
Nursing Home ◽  
Quality Of Care ◽  
Quality Care ◽  
Structured Interviews ◽  
Culturally Sensitive Care ◽  
Services And Supports ◽  
Staff Wellbeing ◽  
The Impact

Abstract The long-term services and supports workforce is an important part of delivering quality care for nursing home (NH) residents – and increasingly includes staff who are from diverse communities. Our study captured staff (n=61) perspectives on resident quality of care and quality of life through semi-structured interviews, using thematic analysis in six Minnesota high proportion minority NHs. Findings show that although staff of color are valued for the diversity they contribute to the workforce, and the culturally sensitive care they provide, they are also exposed to discriminatory events. In addition, tensions exist between U.S. and non-U.S. born staff of color in NHs. Overall, staff of color who are lower ranked may feel less empowered. Research is needed to explore the impact of negative and discriminatory exposures on staff wellbeing and related outcomes in addition to the direct and indirect impact on the quality of care delivered to NH residents.

scholarly journals Health equity impacts of COVID-19 policies on dementia-relevant community services: A SGBA+ policy scan

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 966-966
Author(s):  
Katie Aubrecht ◽  
Rosanne Burke ◽  
Jacqueline Gahagan ◽  
Laura Dowling ◽  
Christine Kelly Mary Jean Hande ◽  
...  
Keyword(s):  
Health Equity ◽  
Assessment Tool ◽  
Community Services ◽  
Dementia Care ◽  
Sex And Gender ◽  
Potential Health ◽  
Health Crisis ◽  
Regulatory Policies ◽  
Government Websites ◽  
The Impact

Abstract This presentation shares the methodology and early findings from a policy scan conducted to understand and assess the impact of COVID-19 policies on dementia care in the community for diverse populations in the province of Nova Scotia, Canada. The scan provided baseline information on: 1) Provincial legislative and regulatory policies related to dementia care in the community; 2) Orders and legislation enacted in response to COVID-19 that potentially impact those policies. Information was obtained from publicly accessible databases and government websites. Searches were also conducted using Google. 135 Acts were collected and reviewed. A specific aim of the scan was to generate knowledge about the impact of these layered policies in the context of a public health crisis from the perspective of local socially and geographically marginalized communities. A Sex and Gender Based Analysis Plus analytical approach was used to assess potential health equity impacts of COVID-19 policies on dementia care in the community. Information was organized using an adapted Health Equity Impact Assessment tool and Systems Health Equity Lens. Strengths and limitations of the approach and tools are discussed.

scholarly journals Incorporating Stigma Into Implementation Science: Linking Societal Influence to the Clinical Encounter to Understand Inequities in Healthcare Delivery

2020 ◽  
Author(s):  
M. Elle Saine ◽  
III Vincent Lo Re ◽  
Frances K. Barg ◽  
Julia E. Szymczak
Keyword(s):  
Implementation Science ◽  
Health Equity ◽  
Negative Impact ◽  
Healthcare Delivery ◽  
Evidence Based ◽  
Implementation Framework ◽  
Stigma Scale ◽  
Scale Scores ◽  
Related Stigma ◽  
The Impact

Abstract Background: Disease-related stigma is an important, but under recognized barrier to the implementation of evidence-based therapies. Existing implementation science frameworks do not adequately specify the mechanisms by which the outer societal context produces disparate implementation outcomes. Our aim in this study was to evaluate how stigma influences the implementation of evidence-based hepatitis C virus (HCV) care and, in so doing, make the case for incorporating stigma into the Health Equity Implementation Framework.Methods: From 2015-2019, we conducted a concurrent explanatory mixed-methods study among people living with HCV in Philadelphia. We administered the validated 33-item HCV-stigma scale. Semi-structured interviews were conducted among a purposive subsample of survey respondents. Summative HCV-stigma scale scores and descriptive statistics were calculated. Interviews were transcribed and analyzed for common themes. Survey responses were linked to interview data.Results: Surveys were completed by 265 participants; 22 interviews were conducted with a subset of these respondents. Hispanic/Latinx ethnicity was associated with significantly higher HCV-stigma scale scores (adjusted mean, 81.39 [95% CI, 76.44-86.33] versus 74.28 [95% CI, 70.51-78.05]; P=0.025). In interviews, participants described the impact of stigma on their engagement with HCV care. Stigma associated with their diagnosis contributed to feelings of dirtiness and shame. Participants described the critical importance of interactions with medical providers and the healthcare system as a whole to either facilitating or mitigating the negative impact of enacted stigma on their trust in medicine and willingness to engage with HCV care. Interactions with family and friends, especially surrounding disclosure of one's diagnosis, were an important mediator of the experience of stigma. Hispanic/Latinx participants described greater feelings of isolation and stigma from family and friends as a result of their diagnosis. Finally, participants described the way stigma shaped their and society's perceptions of HCV therapies, including the media portrayal of pharmaceuticals, the high cost of drugs and insurer denials of treatment.Conclusions: Experiences of HCV-related stigma influence engagement with HCV care at multiple levels: patient, provider, family and community, and perceptions of the therapy itself. Incorporating stigma into the Health Equity Implementation Framework can improve the utility of the framework by specifying a mechanism by which the social context influences the uptake of evidence-based innovations.

scholarly journals Effect of Health Systems Strengthening in Influencing Maternal and Neonatal Health Outcomes in Bungoma County, Kenya

2020 ◽  
Author(s):  
Beverly Ochieng ◽  
Giorgia Lattanzi ◽  
Milka Choge ◽  
Amarddep Thind
Keyword(s):  
Health System ◽  
Quality Care ◽  
Real Life ◽  
Health Indicators ◽  
Health Facilities ◽  
Health Systems Strengthening ◽  
Data Availability ◽  
Health System Strengthening ◽  
The Impact

Abstract Kenya is estimated to have a population of 47.6 million people. Its maternal and neo natal health indicators have steadily improved over the years. Despite the progress, many significant challenges remain, including persistent inequities between population subgroups, and a health care system that provides variable quality and inconsistent access to care, especially for women and new-borns. Purpose of this paper was to assess the impact of the maternal and new-born improvement intervention in Bungoma County, with a focus on access and quality of maternal and neonatal care services.Methodology: The study design was quasi-experimental, using household surveys to assess outcomes.Findings: Provision of transport vouchers decreased barriers to accessing care, resulting to an increased number of deliveries in health facilities. The health system strengthening intervention possibly had a role in improving potential and actual access to antenatal care and health facility delivery services for mothers as well as positively impacting quality of care provision in the intervention sub-counties. However, actual access for babies (measured by provision of PNC care within 48 hours of delivery) seemed to worsen in the intervention sub-counties.Conclusion: Our analysis suggests that it is possible to conduct an evaluation of the impact of interventions in messy real-life contexts where data availability is challenging. Key elements of health system strengthening include reducing cost barriers and enhancing the capacity of the health facilities to deliver the high quality care. These can fruitfully be implemented in other regions.

scholarly journals Dementia Ready: Comparing Approaches for Building Caregiver Readiness and Knowledge of Dementia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 972-973
Author(s):  
Michael Lepore ◽  
Kate Keefe ◽  
Erica DeFrancesco ◽  
Julie Robison ◽  
Alis Ohlheiser ◽  
...  
Keyword(s):  
Nursing Home ◽  
Health Outcomes ◽  
Quality Care ◽  
Dementia Care ◽  
Substantial Impact ◽  
Disease Knowledge ◽  
Dementia Caregiver ◽  
People With Dementia ◽  
Knowledge Scale ◽  
The Impact

Abstract Despite the rising prevalence of dementia and the high cost and complexity of care for people with dementia, most dementia care is provided at home by informal caregivers who are not clinically trained. Building caregiver readiness and knowledge of dementia is key to supporting quality care and desirable health outcomes, such as preventing falls and reducing nursing home admissions. We sought to determine and compare the impact of two interventions—Resilient Living with Dementia (RLWD) and Care of Persons with Dementia in their Environments (COPE)—and of their combined delivery (both RLWD and COPE) on increasing caregiver readiness and knowledge of dementia. Between January 2019 and March 2021, 77 caregivers of people with dementia in Connecticut participated in RLWD and/or COPE and completed the Alzheimer’s Disease Knowledge Scale (ADKS) and the Preparedness for Caregiving Scale (PCGS) at baseline and at four-month and ten-month follow-ups. Analyses were conducted to compare outcomes by intervention(s). From baseline to four months and to ten months, we observed statistically significant (p < .05) improvement on the ADKS among participants in RLWD, and on the PCGS among participants in COPE and among participants in RLWD. The most substantial impact on PCGS was observed among participants in both COPE and RLWD. No improvement in the ADKS was observed among participants in only COPE, but ADKS improvement was observed at four months among participants in COPE and RLWD. Findings suggest that the benefits of COPE and RLWD for building dementia caregiver readiness are complementary and mutually reinforcing.

Assessing baccalaureate nursing students’ knowledge and attitudes of social determinants of health after a health equity simulation

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Quyen Phan ◽  
Naomi Johnson ◽  
JoAnna Hillman ◽  
Daniel Geller ◽  
Laura P. Kimble ◽  
...  
Keyword(s):  
Nursing Students ◽  
Social Determinants Of Health ◽  
Health Equity ◽  
Social Determinants ◽  
Baccalaureate Nursing ◽  
Baccalaureate Nursing Students ◽  
Determinants Of Health ◽  
Marginalized Populations ◽  
Knowledge And Attitudes ◽  
The Impact

AbstractObjectiveFor nursing students, competency in population health management involves acquiring knowledge and forming attitudes about the impact of the social determinants of health (SDoH) on health equity. The purpose of this pilot study was to assess nursing students’ knowledge and attitudes about the SDoH and health equity following a focused simulation activity.MethodBaccalaureate nursing students (N=182) participated in a ninety-minute health equity simulation and a post-simulation debrief. Forty-four students (23%) completed a 19-item post-simulation survey.ResultsSixty-four percent of participants reported positive attitude change in working with marginalized populations caused by the SDoH, and 89% reported being knowledgeable about the role of the registered nurse in addressing health equity. Seventy-five percent reported enhanced knowledge of the SDoH through the health equity simulation.ConclusionUsing health equity simulation may be effective in enhancing students’ knowledge, as well as their attitudes in caring for the health of marginalized populations by addressing the SDoH.

scholarly journals The impact of economic sanctions on health and health systems in low- and middle-income countries

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Suhrcke ◽  
M Pinna Pintor ◽  
C Hamelmann
Keyword(s):  
Health Outcomes ◽  
Health System ◽  
Health Systems ◽  
Grey Literature ◽  
Economic Sanctions ◽  
Political Crisis ◽  
Middle Income ◽  
Financial Flows ◽  
Adverse Health ◽  
The Impact

Abstract Background Economic sanctions, understood as measures taken by one state or a group of states to coerce another into a desired conduct (eg by restricting trade and financial flows) do not primarily seek to adversely affect the health or health system of the target country's population. Yet, there may be indirect or unintended health and health system consequences that ought to be borne in mind when assessing the full set of effects of sanctions. We take stock of the evidence to date in terms of whether - and if so, how - economic sanctions impact health and health systems in LMICs. Methods We undertook a structured literature review (using MEDLINE and Google Scholar), covering the peer-reviewed and grey literature published from 1970-2019, with a specific focus on quantitative assessments. Results Most studies (23/27) that met our inclusion criteria focus on the relationship between sanctions and health outcomes, ranging from infant or child mortality as the most frequent case over viral hepatitis to diabetes and HIV, among others. Fewer studies (9/27) examined health system related indicators, either as a sole focus or jointly with health outcomes. A minority of studies explicitly addressed some of the methodological challenges, incl. control for relevant confounders and the endogeneity of sanctions. Taking the results at face value, the evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. Conclusions Quantitatively assessing the impact of economic sanctions on health or health systems is a challenging task, not least as it is persistently difficult to disentangle the effect of sanctions from many other, potentially major factors at work that matter for health (as, for instance, war). In addition, in times of severe economic and political crisis (which often coincide with sanctions), the collection of accurate and comprehensive data that could allow appropriate measurement is typically not a priority. Key messages The existing evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. There is preciously little good quality evidence on the health (system) impact of economic sanctions.

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