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TitleSocial Determinants of Potential eHealth Engagement Among People Living with HIV Receiving Ryan White Case Management: Health Equity Implications from Project TECH.
AuthorsMarhefka, SL; Lockhart, E; Turner, D; Wang, W; Dolcini, MM; Baldwin, JA; Roig-Romero, RM; Lescano, CM; Glueckauf, RL
JournalAIDS and behavior
Publication Date1 May 2020
Date Added to PubMed13 Dec 2019
AbstractEvaluate the relationships between social characteristics of Floridian persons living with HIV (PLWH) and both use of digital technologies and willingness to use eHealth for HIV-related information. Ryan White case managers (N = 155) from 55 agencies in 47 Florida counties administered a survey to PLWH (N = 1268) from June 2016-April 2017. Multilevel logistic regression models were used to identify correlates of technology use and willingness. Use of mobile phones with text messaging was high (89%). Older (vs. younger) adults and non-Hispanic blacks (vs. whites) were less likely to use most technologies. These groups, along with Hispanics (vs. whites) were less likely to express willingness to use technologies for HIV-related information in models adjusting for use. Among PLWH in Florida, eHealth-related inequities exist. Willingness to engage in HIV-related eHealth is affected by social determinants, even when considering technology access. Although eHealth may reduce some healthcare inequities, it may exacerbate others.
TitleAdvancing health equity and access using telemedicine: a geospatial assessment.
AuthorsKhairat, S; Haithcoat, T; Liu, S; Zaman, T; Edson, B; Gianforcaro, R; Shyu, CR
JournalJournal of the American Medical Informatics Association : JAMIA
Publication Date1 Aug 2019
Date Added to PubMed25 Jul 2019
AbstractHealth disparity affects both urban and rural residents, with evidence showing that rural residents have significantly lower health status than urban residents. Health equity is the commitment to reducing disparities in health and in its determinants, including social determinants. This article evaluates the reach and context of a virtual urgent care (VUC) program on health equity and accessibility with a focus on the rural underserved population. We studied a total of 5343 patient activation records and 2195 unique encounters collected from a VUC during the first 4 quarters of operation. Zip codes served as the analysis unit and geospatial analysis and informatics quantified the results. The reach and context were assessed using a mean accumulated score based on 11 health equity and accessibility determinants calculated for each zip code. Results were compared among VUC users, North Carolina (NC), rural NC, and urban NC averages. The study concluded that patients facing inequities from rural areas were enabled better healthcare access by utilizing the VUC. Through geospatial analysis, recommendations are outlined to help improve healthcare access to rural underserved populations.
TitleImproving health equity for ethnic minority women in Thai Nguyen, Vietnam: qualitative results from an mHealth intervention targeting maternal and infant health service access.
AuthorsMcBride, B; O'Neil, JD; Hue, TT; Eni, R; Nguyen, CV; Nguyen, LT
JournalJournal of public health (Oxford, England)
Publication Date1 Dec 2018
Date Added to PubMed27 Sep 2018
AbstractEthnic minority women (EMW) in Vietnam experience disproportionately high infant and maternal mortality rates due to low social status, poverty and remoteness from health centres. This project piloted and evaluated a low-cost mobile health (mHealth) intervention called mMom utilizing behaviour change communication (BCC) to improve access to maternal, newborn and child health (MNCH) services and health equity among EMW living in remote areas. The mMom intervention built an integrated mHealth platform which sent timely MNCH information and BCC text messages to participants, and engaged health workers towards increasing their interaction and building demand for quality natal care. Mid-term and final qualitative evaluations were conducted to assess the intervention's acceptability and impact. In evaluations, all participants expressed satisfaction with the quality, timeliness and convenience of the messages, and health workers reported increased efficiency and quality of care. The use of BCC increased care-seeking from EMW and strengthened relationships with health providers. The mMom project demonstrated the acceptability of mHealth in a remote Vietnamese region with a high proportion of disadvantaged EMW. The messages promoted increased contact between participants and health providers, which holds potential to address the marginalization of EMW from the health system. behaviour change communication, eHealth, ethnic minorities, health equity, mHealth, MNCH, mobile health, Vietnam.
TitleeHealth versus equity: Using a feminist poststructural framework to explore the influence of perinatal eHealth resources on health equity.
AuthorsRichardson, B; Goldberg, L; Aston, M; Campbell-Yeo, M
JournalJournal of clinical nursing
Publication Date1 Nov 2018
Date Added to PubMed3 Jul 2018
AbstractTo explore whether and how eHealth resources targeted to families during the perinatal period effectively reach a diverse population or further oppress marginalised groups. eHealth is often intended to reach a broad population, thus health content must be relatively generalised which limits the ability to tailor health education and interventions to individual needs. Generalisation of health information has historically represented a hegemonic depiction of the health consumer, especially within the perinatal period, often disregarding the diversity that exists in the world and perpetuating heteronormative constructs within healthcare systems as a result. A critical review of the literature regarding perinatal eHealth resources was conducted using a feminist poststructuralist approach for analysis. Included literature addresses the development, implementation and/or evaluation of perinatal eHealth resources. This approach uncovered hegemonic discourses related to the current state of perinatal eHealth resources. Nurses and midwives have the unique advantage of interacting and understanding diverse populations. Thus, nurses and midwives are integral to the development, implementation and evaluation of eHealth resources to reduce social health inequity. This paper acts as an exemplar on how to apply feminist poststructuralism to highlight inequities that exist and identifies strategies for nurses and midwives to become involved in the development of eHealth resources or advocate for greater visibility within current resources.
TitleDigital health, gender and health equity: invisible imperatives.
AuthorsSinha, C; Schryer-Roy, AM
JournalJournal of public health (Oxford, England)
Publication Date1 Dec 2018
Date Added to PubMed18 Oct 2018
AbstractA growing body of evidence shows the use of digital technologies in health-referred to as eHealth, mHealth or 'digital health'-is improving and saving lives in low- and middle-income countries. Despite this prevalent and persistent narrative, very few studies examine its effects on health equity, gender and power dynamics. This journal supplement addresses these invisible imperatives by going beyond traditional measures of coverage, efficacy and cost-effectiveness associated with digital health interventions, to unpack different experiences of health workers and beneficiaries. The collection of papers presents findings from a cohort of implementation research projects in Africa, Asia, Latin America and the Middle East, and two commentaries offer observations from learning-oriented evaluative activities across the entire cohort. The story emerging from this cohort is comprised of three themes: (i) digital health can positively influence health equity; (ii) gender and power analyses are essential; and (iii) digital health can be used to strengthen upward and downward accountability. These findings, at the individual project level and at the level of the cohort, provide encouraging recommendations on how to approach the design, implementation and evaluation of digital health interventions to address the Sustainable Development Goals agenda of leaving no one behind.
TitleTowards Developing an eHealth Equity Conceptual Framework.
AuthorsAntonio, MG; Petrovskaya, O
JournalStudies in health technology and informatics
Publication Date1 Dec 2019
Date Added to PubMed12 Feb 2019
AbstractEarly implementation of electronic health records and patient portals had great promise of addressing the widening disparities in health. However, recent research has found that not only are these disparities persisting, but the differences in health outcomes between populations are increasing. Addressing this gap specific to ehealth calls for attention to health equity. Health equity approaches reveal the systematic and societal structures that contribute to preventable and unjust outcomes for different populations. To conceptualize and apply a health equity approach within ehealth, we propose the eHealth Equity Framework (eHEF). Derived from the World Health Organization's conceptual framework for actions on the social determinants of health, eHEF can be useful for public health practitioners, researchers, policymakers and information technology designers to keep health equity agenda at the forefront of all stages of health information technology lifecycle.
TitleAssessing the feasibility of eHealth and mHealth: a systematic review and analysis of initiatives implemented in Kenya.
AuthorsNjoroge, M; Zurovac, D; Ogara, EA; Chuma, J; Kirigia, D
JournalBMC research notes
Publication Date10 Feb 2017
Date Added to PubMed12 Feb 2017
AbstractThe growth of Information and Communication Technology in Kenya has facilitated implementation of a large number of eHealth projects in a bid to cost-effectively address health and health system challenges. This systematic review aims to provide a situational analysis of eHealth initiatives being implemented in Kenya, including an assessment of the areas of focus and geographic distribution of the health projects. The search strategy involved peer and non-peer reviewed sources of relevant information relating to projects under implementation in Kenya. The projects were examined based on strategic area of implementation, health purpose and focus, geographic location, evaluation status and thematic area. A total of 114 citations comprising 69 eHealth projects fulfilled the inclusion criteria. The eHealth projects included 47 mHealth projects, 9 health information system projects, 8 eLearning projects and 5 telemedicine projects. In terms of projects geographical distribution, 24 were executed in Nairobi whilst 15 were designed to have a national coverage but only 3 were scaled up. In terms of health focus, 19 projects were mainly on primary care, 17 on HIV/AIDS and 11 on maternal and child health (MNCH). Only 8 projects were rigorously evaluated under randomized control trials. This review discovered that there is a myriad of eHealth projects being implemented in Kenya, mainly in the mHealth strategic area and focusing mostly on primary care and HIV/AIDs. Based on our analysis, most of the projects were rarely evaluated. In addition, few projects are implemented in marginalised areas and least urbanized counties with more health care needs, notwithstanding the fact that adoption of information and communication technology should aim to improve health equity (i.e. improve access to health care particularly in remote parts of the country in order to reduce geographical inequities) and contribute to overall health systems strengthening.
TitleDigital Health Equity and COVID-19: The Innovation Curve Cannot Reinforce the Social Gradient of Health.
AuthorsCrawford, A; Serhal, E
JournalJournal of medical Internet research
Publication Date2 Jun 2020
Date Added to PubMed27 May 2020
AbstractDigital health innovations have been rapidly implemented and scaled to provide solutions to health delivery challenges posed by the coronavirus disease (COVID-19) pandemic. This has provided people with ongoing access to vital health services while minimizing their potential exposure to infection and allowing them to maintain social distancing. However, these solutions may have unintended consequences for health equity. Poverty, lack of access to digital health, poor engagement with digital health for some communities, and barriers to digital health literacy are some factors that can contribute to poor health outcomes. We present the Digital Health Equity Framework, which can be used to consider health equity factors. Along with person-centered care, digital health equity should be incorporated into health provider training and should be championed at the individual, institutional, and social levels. Important future directions will be to develop measurement-based approaches to digital health equity and to use these findings to further validate and refine this model.
TitleTarget women: Equity in access to mHealth technology in a non-communicable disease care intervention in Kenya.
AuthorsNgaruiya, C; Oti, S; van de Vijver, S; Kyobutungi, C; Free, C
JournalPloS one
Publication Date1 Dec 2019
Date Added to PubMed12 Sep 2019
AbstractNon-Communicable Diseases (NCDs) constitute 40 million deaths annually. Eighty-percent of these deaths occur in Low- and Middle-Income Countries. MHealth provides a potentially highly effective modality for global public health, however access is poorly understood. The objective of our study was to assess equity in access to mHealth in an NCD intervention in Kenya. This is a secondary analysis of a complex NCD intervention targeting slum residents in Kenya. The primary outcomes were: willingness to receive SMS, whether SMS was received, and access to SMS compared to alternative health information modalities. Age, sex, level of education, level of income, type of work, number of hours worked, and home environment were explanatory variables considered. Multivariable regression analyses were used to test for association using likelihood ratio testing. 7,618 individual participants were included in the analysis. The median age was 44 years old. Majority (75%, n = 3,691/ 4,927) had only attended up to primary (elementary) school. Majority reported earning "KShs 7,500 or greater" (27%, n = 1,276/ 4,736). Age and level of income had evidence of association with willingness to receive SMS, and age, sex and number of hours work with whether SMS was received. SMS was the health information modality with highest odds of being accessed in older age groups (OR 4.70, 8.72 and 28.89, for age brackets 60-69, 70-79 and 80 years or older, respectively), among women (OR = 1.86, 95% CI 1.19-2.89), and second only to Baraazas (community gatherings) among those with lowest income. Women had the greatest likelihood of receiving SMS. SMS performed equitably well amongst marginalized populations (elderly, women, and low-income) as compared to alternative health information modalities, though sensitization prior to implementation of mHealth interventions may be needed. These findings provide guidance for developing mHealth interventions targeting marginalized populations in these settings.
TitlePromoting access equity and improving health care for women, children and people living with HIV/AIDS in Burkina Faso through mHealth.
AuthorsYé, M; Kagoné, M; Sié, A; Bagagnan, C; Sanou, H; Millogo, O; Duclos, V; Tinto, I; Bibeau, G
JournalJournal of public health (Oxford, England)
Publication Date1 Dec 2018
Date Added to PubMed15 Dec 2018
AbstractIn Burkina Faso, access to health services for women, children and people living with HIV/AIDS (PLWHAs) remains limited. Mobile telephony offers an alternative solution for reaching these individuals. The objective of the study was to improve equity of access to health care and information among women and PLWHAs by reinforcing community participation. Using a quasi-experimental approach, a mobile telephone system was set up at five health centres to provide an automated reminder service for health care consultation appointments. Performance evaluations based on key performance indicators were subsequently conducted. A total of 1501 pregnant women and 301 PLWHAs were registered and received appointment reminders. A 7.34% increase in prenatal coverage, an 84% decrease in loss to follow-up for HIV (P < 0.001) and a 31% increase in assisted deliveries in 2016 (P < 0.0001) were observed in intervention areas. However, there was no statistically significant difference between intervention site and control site (P= 0.451 > 0.05) at post-intervention. Efforts to involve community members in decision-making processes contributed to improved health system governance. Mhealth may improve maternal and child health and the health of PLWHAs. However, establishment of a mHealth system requires taking into account community dynamics and potential technological challenges. access to care, Burkina Faso, equity, health system governance, mobile telephony, Nouna.
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