Isolation, Marginalisation and Disempowerment – Understanding How Interactions with Health Providers Can Influence Smoking Cessation in Pregnancy

BackgroundMaternal smoking during pregnancy can lead to serious adverse health outcomes for both women and their infants. While smoking in pregnancy has declined over time, it remains consistently higher in women with lower socioeconomic circumstances. Furthermore, fewer women in this group will successfully quit during pregnancy. AimThis study explores the barriers to smoking cessation experienced by socially disadvantaged pregnant women and investigates how interactions with health providers can influence their smoking cessation journey.Methodsomen (either pregnant or birthed in the previous 10 years, who smoked or quit smoking in pregnancy) were recruited from a metropolitan public hospital antenatal clinic in South Australia and community organisations in surrounding suburbs. Seventeen women participated in qualitative semi-structured small focus groups or interviews. The focus groups and interviews were recorded, transcribed and thematically analysed. FindingsFour interconnected themes were identified: 1) smoking embedded in women’s challenging lives and pregnancies, 2) cyclic isolation and marginalisation, 3) feeling disempowered, and 4) autonomy and self-determination. Themes 3 and 4 are characterised as being two sides of a single coin in that they coexist simultaneously and are inseparable. A key finding is a strong unanimous desire for smoking cessation in pregnancy but women felt they did not have the necessary support from health providers or confidence and self-efficacy to be successful.ConclusionWomen would like improvements to antenatal care that increase health practitioners’ understanding of the social and contextual healthcare barriers faced by women who smoke in pregnancy. They seek assistance from health providers to make informed choices about smoking cessation and would like women-centred care. Women feel that with greater support, consistency and encouragement from health providers they could be more successful at antenatal smoking cessation.

Healthcare Barriers Among Working-Age Persons with Disabilities in Trinidad

Even though easily accessible and cost-effective healthcare is a fundamental human right, many persons with disabilities experience healthcare barriers and poor health outcomes. We explore the healthcare barriers among working-age persons with disabilities in Trinidad using a qualitative descriptive approach. Semi-structured interviews with 26 participants reveal barriers at the personal, healthcare facility, and societal levels. The findings indicate the need for a nation-wide integrated digitalized system and increased intersectoral collaborations to support adequate healthcare among persons with disabilities in Trinidad. Increased consultation with persons with disabilities and transformation of the disability discourses within the healthcare system and at the national level are also recommended as part of the humanisation of their care.

Perceived Impact of COVID-19 on Older Adults’ Mental Health and Barriers to Mental Health Care

COVID-19 disproportionately impacted older adults in terms of fatalities, but also increased stress, isolation, and loneliness (Chen, 2020). We examined older adults’ anxiety, depression, and barriers to mental healthcare during the COVID-19 pandemic and their perceptions of these variables prior to the pandemic. Further, we explored whether any perceived changes differed based on geographical location (rural, suburban, urban). Data were collected online between mid-June and mid-July of 2020 from 244 individuals aged 65-82 years (M=68.3, SD=3.5). The sample was primarily White (91%) and female (60%); most (n=119) lived in suburban settings, with 63 in urban and 60 in rural settings. Repeated-measures ANOVAs at alpha=.01 showed that depressive symptoms, measured by the CESD-10 (p<.001), and anxiety symptoms, measured by the GAD-7 (p<.001), increased during the pandemic as did mental healthcare barriers related to transportation (p=.004) and beliefs that depression is a normal part of aging (p<.001). Only transportation concerns differed based on where older adults lived; those in rural (p<.001) and urban (p=.004) settings reported greater transportation barriers than those in suburban settings. No differences over time were found for barriers related to help-seeking (p=.403), stigma (p=.156), knowledge/fear (p=.180), finding a therapist (p=.030), ageism (p=.302), psychotherapist qualifications (p=.265), physician referrals (p=.207), or finances (p=.818). These findings highlight the impact of COVID-19 on older adults’ perceptions of changes in their psychological well-being as well as their experience navigating mental health services.

Memory-Related Limitations and Care Needs of Gender Minority BIPOC Adults

Limited research exists investigating cognitive impairment and Alzheimer’s disease and related dementias (ADRD) among gender minority (GM) adults (transgender/non-binary/, including examining memory-related challenges among GMs who also identify as Black, Indigenous, or People of Color (BIPOC). 2015-2019 Behavioral Risk Factor Surveillance System data were used to explore care needs of GM and cisgender (CG) adults with subjective cognitive decline (SCD, N=441), which may be the first clinical manifestations of ADRD. Regression models examined SCD-associated functional limitations and care needs among GM-BIPOC, GM-White, CG-BIPOC, and CG-White adults. GM-BIPOC and GM-White were 2-4x more likely to have SCD-related limitations, require assistance with daily tasks, be unable to do day-to-day or social activities when compared to CG-White. GM-BIPOC were 2-5x more likely to be uninsured and experience cost-related healthcare barriers compared to GM-White and CG-White/BIPOC. Additional research is needed to improve care and well-being for this understudied population.

Newcomer challenges with accessing healthcare services in Saskatchewan, Canada

Newcomers experience a variety of barriers to healthcare services. The study objective is to identify newcomers’ healthcare barriers. During 2014-2015, we conducted in-depth interviews with service providers, and newcomer parents who had been in Saskatchewan for under 5 years. Primary themes include: 1) navigation difficulty, 2) limited awareness, 3) language, 4) interpretation and translation, 5) health benefits, 6) service limitations and stigma, 7) gender and cultural concerns, 8) health attitudes and beliefs, and 9) work demands. The results exposed service gaps and suggest options to improve access to healthcare. Consideration should be given to the development of formal processes to ensure the provision of information concerning healthcare and health benefit programs, as well as responsive healthcare services, including convenient primary healthcare sites that offer comprehensive care in a culturally responsive manner with embedded interpretation services to ensure that the Saskatchewan healthcare system does not perpetuate or create health disparities.

Syndemic Framework Evaluation of Severe COVID-19 Outcomes in the United States: Factors Associated With Race and Ethnicity

Socially and economically disadvantaged racial and ethnic minorities have experienced comparatively severe clinical outcomes from the coronavirus disease (COVID-19) pandemic in the United States. Disparities in health outcomes arise from a myriad of synergistic biomedical and societal factors. Syndemic theory provides a useful framework for examining COVID-19 and other diseases that disproportionately affect vulnerable populations. Syndemic models ground research inquiries beyond individual clinical data to include non-biological community-based drivers of SARS-CoV-2 infection risk and severity of disease. Given the importance of such economic, environmental, and sociopolitical drivers in COVID-19, our aim in this Perspective is to examine entrenched racial and ethnic health inequalities and the magnitude of associated disease burdens, economic disenfranchisement, healthcare barriers, and hostile sociopolitical contexts—all salient syndemic factors brought into focus by the pandemic. Systemic racism persists within long-term care, health financing, and clinical care environments. We present proximal and distal public policy strategies that may mitigate the impact of this and future pandemics.