Patients' Experiences With Digitalization in the Health Care System: Qualitative Interview Study.

BACKGROUND: The digitalization of public and health sectors worldwide is fundamentally changing health systems. With the implementation of digital health services in health institutions, a focus on digital health literacy and the use of digital health services have become more evident. In Denmark, public institutions use digital tools for different purposes, aiming to create a universal public digital sector for everyone. However, this digitalization risks reducing equity in health and further marginalizing citizens who are disadvantaged. Therefore, more knowledge is needed regarding patients' digital practices and experiences with digital health services. OBJECTIVE: This study aims to examine digital practices and experiences with public digital health services and digital tools from the perspective of patients in the neurology field and address the following research questions: (1) How do patients use digital services and digital tools? (2) How do they experience them? METHODS: We used a qualitative design with a hermeneutic approach. We conducted 31 semistructured interviews with patients who were hospitalized or formerly hospitalized at the department of neurology in a hospital in Denmark. The interviews were audio recorded and subsequently transcribed. The text from each transcribed interview was analyzed using manifest content analysis. RESULTS: The analysis provided insights into 4 different categories regarding digital practices and experiences of using digital tools and services in health care systems: social resources as a digital lifeline, possessing the necessary capabilities, big feelings as facilitators or barriers, and life without digital tools. Our findings show that digital tools were experienced differently, and specific conditions were important for the possibility of engaging in digital practices, including having access to social resources; possessing physical, cognitive, and communicative capabilities; and feeling motivated, secure, and comfortable. These prerequisites were necessary for participants to have positive experiences using digital tools in the health care system. Those who did not have these prerequisites experienced challenges and, in some cases, felt left out. CONCLUSIONS: Experiences with digital practices and digital health services are complex and multifaceted. Engagement in digital practices for the examined population requires access to continuous assistance from their social network. If patients do not meet requirements, digital health services can be experienced as exclusionary and a source of concern. Physical, cognitive, and communicative difficulties might make it impossible to use digital tools or create more challenges. To ensure that digitalization does not create inequities in health, it is necessary for developers and institutions to be aware of the differences in digital health literacy, focus on simplifying communication with patients and next of kin, and find flexible solutions for citizens who are disadvantaged.

Bridging gaps in health? A qualitative study about bridge-building and social inequity in Danish healthcare.

Attendance to health appointments may pose challenges to patients, especially when living in socially disadvantaged situations, with a fragile network. Inequality in health is increasingly highlighted in Denmark. To enhance social equity in health, a non-governmental organization introduced bridge-building, where healthcare students volunteer to accompany persons in socially vulnerable situations to health appointments.The purpose of the study was to explore what bridge-building entails and which gaps bridge-building attempts to span, in a welfare state, based on equal rights to healthcare.The study is based on an ethnographic fieldwork among the stakeholders in bridge-building, using interviews and participant observation in the form of "walking fieldwork".Informants emphasized safe-making and wayfinding as important components in bridge-building, with bridge-builders acting as as-if-relatives. Bridge-building navigates in borderlands, the in-between spaces with fluid and contested borders, encompassing public, civic society, and family spheres. All informants emphasized that bridge-building covers a need in contemporary Danish healthcare.Bridge-building entails a double temporality, a here-and-now intervention where persons in vulnerable situations get social support to make it to health appointments, and a future investment in future health professionals' understanding of vulnerability in lives and barriers to health access; insights that may be valuable in their future job positions.

Creating equity in health research to drive more and better evidence.

Health research is rapidly changing with evidence being gathered through new agile methods. This evolution is critical but must be globally equitable so the poorest nations do not lose out. We must harness this change to better tackle the daily burden of diseases that affect the most impoverished populations and bring research capabilities to every corner of the world so that rapid and fair responses to new pathogen are possible; anywhere they appear. We must seize this opportunity to make research easier, better and more equitable. Currently too many nations are unable to generate the evidence or translate it to directly change health outcomes in their own communities. It is essential to act and harness this emerging change in how research data can be generated and shared, so that all nations sustainably gain from this development. There are positive examples to draw on from COVID-19, but we now need to act. Here we present an initiative to develop a new framework that can guide researchers in the design and execution of their studies. This highly agile system will work by adapting to risk and complexity in any given study, whilst generating quality, safe and ethical data.

The unequal effects of austerity measures between income-groups on the access to healthcare: a quasi-experimental approach.

BACKGROUND: The Great Recession, starting in 2008, was characterized by an overall reduction in living standards. This pushed several governments across Europe to restrict expenditures, also in the area of healthcare. These austerity measures are known to have affected access to healthcare, probably unevenly among social groups. This study examines the unequal effects of retrenchment in healthcare expenditures on access to medical care for different income groups across European countries. METHOD: Using data of two waves (2008 and 2014) of the European Union Statistics of Income and Living Conditions survey (EU-SILC), a difference-in-differences (DD) approach was used to analyse the overall change in unmet medical needs over time within and between countries. By adding another interaction, the differences in the effects between income quintiles (difference-in-difference-in-differences: DDD) were estimated. To do so, comparisons between two pairs of a treatment and a control case were made: Iceland versus Sweden, and Ireland versus the United Kingdom. These comparisons are made between countries with recessions equal in magnitude, but with different levels of healthcare cuts. This strategy allows isolating the effect of cuts, net of the severity of the recession. RESULTS: The DD-estimates show a higher increase of unmet medical needs during the Great Recession in the treatment cases (Iceland vs. Sweden: + 3.24 pp.; Ireland vs. the United Kingdom: + 1.15 pp). The DDD-estimates show different results over the two models. In Iceland, the lowest income groups had a higher increase in unmet medical needs. This was not the case in Ireland, where middle-class groups saw their access to healthcare deteriorate more. CONCLUSION: Restrictions on health expenditures during the Great Recession caused an increase in self-reported unmet medical needs. The burden of these effects is not equally distributed; in some cases, the lower-income groups suffer most. The case of Ireland, nevertheless, shows that certain policy measures may relatively spare lower-income groups while affecting middle-class income groups more. These results bring in evidence that policies can reduce and even overshoot the general effect of income inequalities on access to healthcare.

Sports-based recreation as a means to address social inequity in health: why, when, where, who, what, and how.

The rising global burden of noncommunicable diseases (NCDs) among people with low socioeconomic status (SES) has heightened awareness of the need for primary prevention programs in low-SES neighborhoods. Social inequity in health is apparent in mental, social and physical aspects of health among people living in low-SES neighborhoods. Viewing this problem from a life course perspective and adopting a vulnerable population approach points to the importance of inducing sustainable health behavior changes in children and young people living in low-SES neighborhoods. One important factor in lowering the risk of many NCDs while improving mental health is the promotion of physical activity (PA). In this paper, we argue that lowering the risk of many NCDs and improving mental health is best achieved through setting-based programs that facilitate long-term PA behavior changes in children and adolescents living in marginalized neighborhoods. Empirical evidence indicates that extrinsic motives for participating in physical activities, such as improving health, are insufficient when long-term participation is the goal. Therefore, we argue that interventions with the aim of affecting long-term PA in low-SES neighborhoods and thereby reducing social inequities in health should include activities that aim to create more intrinsic and autonomous motivations by building on more broad and positive understandings of health and participation. Here, we advocate that sports-based recreation (SR) holds several advantages. If implemented well, SR has the potential to be a health-promoting activity that is meaningful and motivating in itself and that involves physiological health-promoting aspects (e.g., PA), a social aspect (e.g., positive relations with others), and a psychological aspect (e.g., positive experiences of oneself). Further, we suggest four practicalities that should be considered when conducting interventions: the cost of participating, the location, the facilities required, and the suitability of the SR activities.

Determinantes sociales en el consumo de sustancias psicoactivas en estudiantes universitarios en 2016 / Determinantes sociais no consumo de substâncias psicoativas em estudantes universitários 2016 / Social determinants in the consumption of psychoactive substances in university students in 2016

Resumen: En este artículo se dan a conocer los resultados de una investigación que tuvo como objetivo describir los determinantes sociales asociados al consumo de sustancias psicoactivas (SPA) en estudiantes de una universidad pública de Colombia, modalidad presencial diurna. Se realizó un estudio descriptivo, cuantitativo, transversal, con una muestra de n= 341 estudiantes; se realizó muestreo estratificado, con selección aleatoria y se aplicó el cuestionario utilizado en el II Estudio Epidemiológico Andino sobre Consumo de Drogas en la Población Universitaria, Proyecto PRADICAN (Programa Antidrogas Ilícitas en la Comunidad Andina), previa autorización de los participantes de estudio. Se realizó un análisis descriptivo y se calcularon frecuencias relativas. Los resultados mostraron que el 61% de los encuestados pertenecen al estrato socioeconómico 1, el más bajo; el 77,4% se dedica exclusivamente a sus estudios; el 22,6% trabaja además de estudiar. La relación con sus padres es buena (90%). 56% tienen amigos consumidores y el 20,5% tienen familiares cercanos consumidores de SPA ilegales. Los resultados permitieron establecer que se debe aumentar la cobertura de los programas de apoyo que ofrece la universidad a través de Bienestar Universitario para intervenir positivamente los determinantes identificados, diseñar y desarrollar estrategias que permitan generar cultura de autocuidado y prevención del consumo de SPA.

Resumo: Este artigo divulgou os resultados de uma investigação que teve como objetivo descrever os determinantes sociais associados ao uso de substâncias psicoativas (SPA) em estudantes de uma universidade pública, modalidade dia. Foi realizado um estudo descritivo, quantitativo, transversal, com uma amostra de n = 341 alunos; amostragem estratificada foi realizada com seleção aleatória, foi aplicado o questionário do Estudo Epidemiológico II Andino sobre Uso de Drogas na Cidade Universitária, Projeto PRADICAN (Programa de Combate às Drogas ilegal na Comunidade Andina), a aprovação prévia dos participantes do estudo. Uma análise descritiva foi realizada, as frequências relativas foram calculadas. Os resultados mostraram que 61% dos respondentes pertencem ao estrato socioeconômico 1; 77,4% são dedicados exclusivamente a seus estudos; 22,6% trabalham além de estudar. O relacionamento com os pais é bom (90%). 56% têm amigos do consumidor e 20,5% têm parentes próximos que usam SPA ilegal. Os resultados permitiram estabelecer que a cobertura dos programas de apoio oferecidos pela universidade através do Bem-Estar Universitário deve ser ampliada para intervir positivamente nos determinantes identificados; conceber e desenvolver estratégias para gerar uma cultura de autocuidado e prevenção do consumo de SPA.

Abstract: In this article we present the results of an investigation aimed to describe the social determinants associated with the consumption of psychoactive substances (SPA) in students of a public university in Colombia, in face-to-face modality. A descriptive, quantitative, cross-sectional study was carried out with a sample of n = 341 students; stratified sampling was used, with random selection, applying the questionnaire used in the II Andean Epidemiological Study on Drug Use in the University Population, Project PRADICAN (Illicit Anti-Drug Program in the Andean Community), with prior authorization of the study participants. A descriptive analysis was carried out and the relative frequencies were calculated. The results showed that 61% of the respondents belong to the socioeconomic stratum 1, the lowest one; 77.4% are dedicated exclusively to their studies and 22.6% work in addition to studying. The relationship with their parents is good (90%). 56% have substance consuming friends and 20.5% have close relatives who use illegal SPA. The results allowed to establish that the coverage of the support programs offered by the university through University Welfare should be increased in order to positively intervene the identified determinants, design and develop strategies to generate a culture of self-care and prevention of SPA consumption.

Utilization of health-care services by young children: The aftermath of the Turkish Health Transformation Program.

The Turkish Health Transformation Program, initiated in 2003, has identified achieving universal access to health care as 1 of its main tenets. To date, substantial progress has been made toward universal health coverage. Service utilization statistics display an upward trend. In this study, we use official and nationally representative microdata collected by the Turkish Health Research Surveys to examine young children's (ages 0-5) utilization of health services. Children in this age group deserve special attention because adverse health conditions in early childhood are known to have long-time consequences. Policy makers regularly monitor statistics such as infant mortality rate and under-5 mortality rate. We conduct logistic regression analyses to explain the probabilities of being taken to a health institution, to a dentist, and being included in the newborn screening program. We use a rich set of explanatory variables that represent the socioeconomic status (SES) of the child's household. Contrary to our expectations and to the goals of universal health coverage is SES indicators such as the insurance ownership of the parent matter for utilization. Decomposition analyses confirm these findings and reveal that the increase in utilization should have been higher than observed. Children from low SES households should be given special attention and that research efforts should focus on identifying the barriers that still hinder children's utilization of health-care services.

Gender roles and traits in stress and health.

Women have a life-expectancy advantage over men, but a marked disadvantage with regards to morbidity. This is known as the female-male health-survival paradox in disciplines such as medicine, medical sociology, and epidemiology. Individual differences in physical and mental health are further notably explained by the degree of stress individuals endure, with women being more affected by stressors than men. Here, we briefly examine the literature on women's disadvantage in health and stress. Beyond biological considerations, we follow with socio-cognitive explanations of gender differences in health and stress. We show that gender roles and traits (masculinity in particular) explain part of the gender differences in stress, notably cognitive appraisal and coping. Stress in turn degrades health. Implications are discussed. In conclusion, traditional socialization is advantageous for men in terms of health.

Medición de la inequidad en salud en adultos mayores de Medellín, 2009 / Measurement of health inequality in eldery people in Medellín during 2009

OBJETIVO: realizar la medición de la inequidad en salud a través de las diferencias injustas encontradas en el grupo de adultos mayores según la comuna de residencia de la ciudad de Medellín en el año 2009. METODOLOGIA: se realizó un estudio descriptivo ecológico utilizando como fuente de información secundaria las 11.948 personas de sesenta años y más, del municipio de Medellín; los datos fueron extraídos de la encuesta de calidad de vida del año 2009 del mismo municipio. El estado de salud como variable de interés fue analizado respecto a condiciones como el grado de escolaridad, número de consulta anual a los servicios de salud, ocupación y el ingreso económico por empleo. Estas variables se utilizaron para medir la inequidad, haciendo uso del INIQUIS como indicador útil para medir las desigualdades en salud. RESULTADOS: el 41,6% eran hombres, el promedio de edad fue 69,7 años (de 8,03 años). El 93,7% de los adultos mayores puede leer y escribir más de un párrafo. Una tercera parte percibe su estado de salud como malo o regular; el 15,3% trabaja, de estos solo el 32,8% percibe algún dinero por el oficio realizado, y de este total el 50% devenga un salario mensual hasta de $ 500.000 o menos, el otro 50% entre $ 501.000 y $15.000.000. Seis de las 16 comunas presentan las peores condiciones relacionadas con la salud de los adultos mayores. CONCLUSION: se identificó que el 93,7%(15/16) de las comunas y el 80% (4/5) de los corregimientos de Medellín presentan inequidades en salud, cuando se analizaron en función del estado de salud, grado de escolaridad, ocupación, número de consultas anuales a los servicios de salud y dinero percibido por empleo.

OBJECTIVE:to measure health inequality by examining unfair differences found in a group of elderly people according to the commune in which they live within the city of Medellin in 2009. METHODOLOGY: a descriptive ecological study using 11948 citizens of Medellín aged 60 and older as a source of information. Data was extracted from the survey of quality of life in 2009 for the municipality. Health status as a variable of interest was analyzed with respect to conditions such as schooling level, number of annual visits to the health services, employment and income from employment. These variables were used to measure inequity, using the (IHI) as a useful indicator to measure health inequalities. RESULTS :41.6% of the participants were men. The average age was 69.7 years (sd 8.03 years). 93.7% of the elderly participants can read and write more than one paragraph. One third of the sample perceived their state of health as bad or moderate. 15.3% of them work and, within this group of workers, 32.8% earn some money for the tasks performed. Similarly, out of this total, 50% earn a monthly salary up to $500,000 or less, while the other 50% earn from $501,000 to 15,000,000. Six of the sixteen communes showed the worst conditions regarding the health of the elderly. CONCLUSIONS:this study identified that 93.7% (15/16) of the communes, and 80% (4/5) of the townships in Medellín have health inequities when analyzed in terms of health status, schooling level, employment, number of annual visits to the health services and income from employment.

Las capacidades de investigación en Determinantes Sociales de la Salud de grupos registrados en Colciencias, Colombia (2005-2012) / Research capacities on social determinants in health of registered groups in Colciencias, Colombia 2005-2012

OBJETIVOS :analizar las capacidades de investigación en determinantes sociales de la salud (DSS) existentes en Colombia a partir de la información registrada en la plataforma de Colciencias entre enero del 2005 y abril del 2012, así como la opinión de coordinadores de grupos de investigación. METODOLOGIA: se diseñó un estudio observacional descriptivo sobre la base Scienti de Colciencias, específicamente sobre aspectos relacionados con los grupos, los investigadores y la producción científica sobre DSS. Se complementó con cuestionarios y grupos focales con previo consentimiento informado y estudio del sistema nacional de investigación. RESULTADOS: entre los 65 grupos registrados en el Programa de Ciencias de la Salud de Colciencias (6%) se han publicado 123 productos, mediante artículo científico en idioma español (48%). Privilegian estudios de poblaciones demográficamente relevantes sobre sistemas de salud, inequidad en salud y enfermedades prevalentes, elaborados con métodos empírico analíticos y algunos en proyectos en red de carácter nacional. Las dificultades se refieren al escaso respaldo político e institucional local y nacional para investigar en DSS, poca interacción con formuladores de políticas y con otros grupos en otros idiomas. CONCLUSIONES :predominan los estudios con el enfoque propuesto por la Comisión de Determinantes Sociales de la Salud en 2005. Recomendaciones: fortalecer capacidades de investigación en DSS desde diversos enfoques, especialmente los latinoamericanos, desarrollar proyectos colaborativos en red y movilizar acción colectiva con incidencia en políticas de investigación en salud pro equidad.

OBJECTIVE:this paper analyzes the ability to research on social determinants in health (sdh) in research groups registered in the Colciencias platform from January 2005 to June 2012, as well as the opinion of coordinators of research groups. METHODOLOGY a descriptive study to review the platform about information on research groups, researchers and research products on sdh was designed. It was contrasted with semistructured interviews and focus groups targeted at researchers with informed consent, and study of the national research system. RESULTS : the 65 groups registered in the Colciencias Program of Health Sciences (6%) have published 123 products by means of scientific articles in Spanish (48%). Studies on demographically relevant populations about health systems, health inequity and prevalent illnesses became conspicuous. They were accomplished through analytical and empirical methods and some projects in the national network were approached. The difficulties identified were scarce political and institutional support for local and national research in sdh an reduced interaction with policy makers and other groups using other languages . CONCLUSIONS : studies based on the approach proposed by the Commission on Social Determinants of Health in 2005 were prominent. Recommendations: it is essential to strengthen research capacities in various approaches to sdh, especially Latin American approaches, to develop collaborative projects and networking and to mobilize collective action network with policy advocacy for equitable health research.

Desigualdad y políticas sociales erróneas producen inequidad en México / Inequality and erroneous social policy produce inequity in México

Se discuten diferentes conceptualizaciones de equidad y desigualdad en salud, concluyendo que inequidad y desigualdad no son sinónimos, y se sugiere la utilización de desigualdad para describir perfiles epidemiológicos y equidad en relación con la distribución y el acceso de los servicios de atención a la salud. Se revisa en más detalle la situación de México, donde existe gran polarización socioeconómica, una reforma sanitaria privatizadora que ha aumentado la inequidad y una ciudadanía incompleta, como obstáculos principales para conseguir una disminución de la inequidad en salud.

The different conceptualisations regarding equity and inequality in health are discussed, concluding that inequity and inequality are not synonyms. It is suggested that inequality should be used for describing epidemiological profiles and equity in relationship to the distribution of and gaining access to health attention services. The situation in México is reviewed in greater detail, as there is great socioeconomic polarisation in this country, a privatising sanitary reform which has increased inequity and incomplete citizenry as the main obstacles for gaining a reduction in inequity in health.