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Research into Women's Health and Care Disparities

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A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Women's Health Care".

Deadline for manuscript submissions: closed (27 December 2024) | Viewed by 14634

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Special Issue Editor

Dr. Ines Aguinaga-Ontoso

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Guest Editor

Department of Health Sciences, Public University of Navarra, Pamplona, Spain
Interests: maternal and child health; physical activity; environmental health; health promotion

Special Issue Information

Dear Colleagues,

This Special Issue of our scientific journal delves into the persistent and complex problem of women's health and care disparities. Despite global efforts, considerable disparities in healthcare access, diagnosis, treatment, and outcomes exist between genders. These disparities further intersect with identities such as race, age, socioeconomic status, and disability, thereby creating intricate patterns of health inequalities. Our goal is to enhance our understanding of these disparities, inform policies, and improve health outcomes for women.

We aim to probe the gender-based differences and disparities among women, emphasizing epidemiological studies highlighting discrepancies in healthcare services' access, diagnosis, and treatment. We are interested in contributions that deepen our understanding of disparities' causes and provide solutions.

This Special Issue is a platform to stimulate vital discussions on women's health and care disparities, focusing on contributing factors and potential remedies. Our investigation will cover areas such as differential access to healthcare, variations in health outcomes, intersectionality, impacts of societal and cultural norms, and the role of policy.

We eagerly await your submissions in these crucial areas, contributing to the field of women's health disparities. We welcome original research papers, reviews, case reports, methodological papers, brief reports, and commentaries that explore the following areas:

Epidemiological Studies and Mechanisms: Investigations into gender-based disparities in diagnosis, treatment, health outcomes, and the underlying mechanisms leading to these disparities.
Intersectionality and Health Disparities: Analyses of intersectional effects of race, age, socioeconomic status, and disability on women's health outcomes and access to care.
Culturally Informed Approaches and Policies: Studies exploring culturally informed approaches and policy interventions for addressing disparities in women's health.
Societal Factors and Case Studies: Examination of societal, policy, and cultural influences on women's health disparities, with case studies demonstrating successful mitigation efforts.
Disparity Variations and Innovative Interventions: Discussions on variations in disparities influenced by socioeconomic and demographic factors, alongside innovative strategies promising in disparity reduction.
Role of Technology in Women's Healthcare: Assessments of the influence of technology and digitalization in either exacerbating or mitigating disparities in women's healthcare.
Psychosocial Variables and Specific Health Conditions: Evaluations of psychosocial factors impacting women's health behaviors and effects of specific health conditions on women's health outcomes.
Health Promotion Behaviors: Investigations into health promotion behaviors among diverse ethnic/racial women, including motivating factors for physical activity and weight management.
Barriers in Medical Research: Exploration of challenges hampering progress in women's health research, especially among minority women.
Comparative Studies and Intervention Effectiveness: Comparative studies examining health disparities among different demographic groups and evaluations of intervention effectiveness in promoting health behaviors among low-income women.

While these themes serve as a guide, they are not exhaustive. We are open to contributions exploring under-discussed or overlooked areas pertinent to our topic. We aim to compile a robust collection of work that can steer future research, policy, and practice toward improved health equity in women's healthcare.

Dr. Ines Aguinaga-Ontoso
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

women's health
care disparities
gender disparities
health equity
intersectionality
access to healthcare
diagnosis and treatment patterns
health outcomes

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Published Papers (7 papers)

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Research

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12 pages, 910 KiB

Open AccessArticle

Leveraging Machine Learning to Predict and Assess Disparities in Severe Maternal Morbidity in Maryland

by Qingfeng Li, Y. Natalia Alfonso, Carrie Wolfson, Khyzer B. Aziz and Andreea A. Creanga

Healthcare 2025, 13(3), 284; https://doi.org/10.3390/healthcare13030284 - 31 Jan 2025

Viewed by 933

Abstract

Background: Severe maternal morbidity (SMM) is increasing in the United States. The main objective of this study is to test the use of machine learning (ML) techniques to develop models for predicting SMM during delivery hospitalizations in Maryland. Secondarily, we examine disparities in SMM by key sociodemographic characteristics. Methods: We used the linked State Inpatient Database (SID) and the American Hospital Association (AHA) Annual Survey data from Maryland for 2016–2019 (N = 261,226 delivery hospitalizations). We first estimated relative risks for SMM across key sociodemographic factors (e.g., race, income, insurance, and primary language). Then, we fitted LASSO and, for comparison, Logit models with 75 and 18 features. The selection of SMM features was based on clinical expert opinion, a literature review, statistical significance, and computational resource constraints. Various model performance metrics, including the area under the receiver operating characteristic curve (AUC), accuracy, precision, and recall values were computed to compare predictive performance. Results: During 2016–2019, 76 per 10,000 deliveries (1976 of 261,226) were in patients who experienced an SMM event. The Logit model with a full list of 75 features achieved an AUC of 0.71 in the validation dataset, which marginally decreased to 0.69 in the reduced model with 18 features. The LASSO algorithm with the same 18 features demonstrated slightly superior predictive performance and an AUC of 0.80. We found significant disparities in SMM among patients living in low-income areas, with public insurance, and who were non-Hispanic Black or non-English speakers. Conclusion: Our results demonstrate the feasibility of utilizing ML and administrative hospital discharge data for SMM prediction. The low recall score is a limitation across all models we compared, signifying that the algorithms struggle with identifying all SMM cases. This study identified substantial disparities in SMM across various sociodemographic factors. Addressing these disparities requires multifaceted interventions that include improving access to quality care, enhancing cultural competence among healthcare providers, and implementing policies that help mitigate social determinants of health. Full article

(This article belongs to the Special Issue Research into Women's Health and Care Disparities)

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28 pages, 8959 KiB

Open AccessArticle

Association Between Income and Well-Being Among Working Women in Japan

by Takao Suzuki, Kiriko Sasayama, Etsuko Nishimura, Noyuri Yamaji, Erika Ota, Eiko Saito and Daisuke Yoneoka

Healthcare 2025, 13(3), 240; https://doi.org/10.3390/healthcare13030240 - 24 Jan 2025

Viewed by 1743

Abstract

Background: Income is a key determinant of well-being; however, its effects are often nonlinear. In Japan, working women face unique limitations to their well-being, including substantial gender wage gaps, caregiving responsibilities, and female-specific health conditions. This study aimed to investigate the association between income and well-being, with a focus on potential nonlinear patterns and effect modification with various factors. Methods: A nationwide survey of 10,000 working women aged 20–64 years was conducted in Japan in 2023. Well-being was assessed using four items from the Office for National Statistics-4 questionnaire, each rated on a 0–10 Likert scale. Tobit regression models were used to assess the association between household income and well-being after adjusting for demographic, socioeconomic, and health-related factors. Results: Annual household income was positively associated with well-being in women earning up to 8–10 million JPY annually, beyond which the effect was attenuated. Women with mental health issues or insomnia reported significantly lower well-being scores regardless of their income level (p < 0.05). Marital status and caregiving responsibilities had moderate effects, whereas having more children diminished the positive effect of income among higher-income households earning over 8 million JPY annually. Conclusions: This study highlights the need for integrated policies that address both economic disparities and health-related challenges to improve the well-being of working women in Japan. Targeted interventions focusing on female-specific health conditions are particularly important. Full article

(This article belongs to the Special Issue Research into Women's Health and Care Disparities)

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13 pages, 277 KiB

Open AccessArticle

Interaction Processes between Health Professionals and Moroccan Immigrant Women in Reproductive Healthcare: The Disagreement in the Encounter—A Qualitative Study

by María Idoia Ugarte-Gurrutxaga, Sara María Ulla Diez, Brígida Molina-Gallego, María Humanes-García, Gonzalo Melgar de Corral and Fernando Jesús Plaza del Pino

Healthcare 2024, 12(16), 1577; https://doi.org/10.3390/healthcare12161577 - 8 Aug 2024

Viewed by 1561

Abstract

Introduction: Spain is a multicultural society and has been defined by several authors as an immigrant-receiving country. Moroccan women of childbearing age constitute 28.20% of Moroccan immigrants. Objectives: describe the interaction processes that occur between health professionals and Moroccan immigrant women in reproductive healthcare. Methods: Qualitative descriptive study based on Grounded Theory. Thirty immigrant women from Morocco and thirty-five health professionals participated in the study. Specific dimensions of analysis were defined and used to design the interview guide and focus groups. Results: In the healthcare encounter, the construction of an effective communicative space between the people involved in it is essential; however, the language barrier and the interpersonal relationships characterized by silence in the encounter make a meaningful healthcare relationship difficult for those who participate in it. Conclusions: There are communication and relationship problems that alter healthcare and the professional–patient relationship which require the use of translation programs, the incorporation of intercultural meters, and the development of cultural competence in health professionals. Full article

(This article belongs to the Special Issue Research into Women's Health and Care Disparities)

23 pages, 783 KiB

Open AccessArticle

Community-Based Health Education Led by Women’s Groups Significantly Improved Maternal Health Service Utilization in Southern Ethiopia: A Cluster Randomized Controlled Trial

by Amanuel Yoseph, Wondwosen Teklesilasie, Francisco Guillen-Grima and Ayalew Astatkie

Healthcare 2024, 12(10), 1045; https://doi.org/10.3390/healthcare12101045 - 18 May 2024

Cited by 3 | Viewed by 2381

Abstract

Objective: This study aimed to evaluate the effect of health education intervention (HEI) on maternal health service utilization (MHSU) in southern Ethiopia. Methods: From 10 January to 1 August 2023, a community-based, two-arm, parallel-group cluster randomized controlled trial (cRCT) was conducted among pregnant mothers in the Northern Zone of Sidama National Regional State, Ethiopia. We utilized multilevel mixed-effects modified Poisson regression with robust variance to control for the effects of clustering and potential confounders. The level of significance was adjusted for multiple comparisons. Results: The overall utilization of at least one antenatal care (ANC) visit was 90.2% in the treatment group and 59.5% in the comparator group (χ² = 89.22, p < 0.001). Health facility delivery (HFD) utilization was considerably different between the treatment group (74.3%) and the comparator group (50.8%) (χ² = 70.50, p < 0.001). HEI significantly increased ANC utilization (adjusted risk ratio [ARR]: 1.32; 99% CI: 1.12–1.56) and HFD utilization (ARR: 1.24; 99% CI: 1.06–1.46). The utilization of at least one postnatal care (PNC) service was 65.4% in the treatment group and 52.1% in the comparator group (χ² = 19.51, p = 0.01). However, after controlling for the effects of confounders and clustering, the impact of HEI on PNC utilization was insignificant between the two groups (ARR: 1.15; 99% CI: 0.89–1.48). Conclusion: A community-based HEI significantly increased ANC and HFD utilization but did not increase PNC utilization. Expanding the HEI with certain modifications will have a superior effect on improving MHSU. Trial registration number: NCT05865873. Full article

(This article belongs to the Special Issue Research into Women's Health and Care Disparities)

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11 pages, 242 KiB

Open AccessArticle

Differing Effects of Body Size on Circulating Lipid Concentrations and Hemoglobin A1c Levels in Young and Middle-Aged Japanese Women

by Katsumi Iizuka, Kazuko Kobae, Kotone Yanagi, Yoshiko Yamada, Kanako Deguchi, Chihiro Ushiroda, Yusuke Seino, Atsushi Suzuki, Eiichi Saitoh and Hiroyuki Naruse

Healthcare 2024, 12(4), 465; https://doi.org/10.3390/healthcare12040465 - 13 Feb 2024

Cited by 1 | Viewed by 1394

Abstract

The condition of being underweight is a social problem in Japan among women. However, there is a lack of evidence for dietary guidance for underweight women because there has been no comparison of lipids or HbA1c among underweight, normal weight, and overweight women in different age groups. We analyzed the effect of body size and age on the serum lipid and hemoglobin A1c levels in Japanese women in a cross-sectional study. A total of 26,118 women aged >20–65 years underwent physical examinations between 2012 and 2022. Seventeen percent of women aged >20–29 years were underweight, and 8% of those aged 50–65 years were underweight. Total cholesterol and non-HDL-C concentrations increased with age, but the difference between underweight and overweight individuals was lowest among women aged 50–65 years. On the other hand, the differences in HDL-C, TG, and HbA1c levels between underweight and overweight subjects were greatest in the 50–65 age group, but the differences between underweight and normal weight subjects were much smaller. Considering that, unlike HDL-C, TG, and HbA1c, TC and non-HDL-C increase to levels comparable to overweight levels in underweight women in aged 50–65 years, educating people about a diet that lowers non-HDL-C is necessary even in young underweight women. Full article

(This article belongs to the Special Issue Research into Women's Health and Care Disparities)

14 pages, 278 KiB

Open AccessArticle

Women’s Narratives on Infertility as a Traumatic Event: An Exploration of Emotional Processing through the Referential Activity Linguistic Program

by Alessia Renzi, Rachele Mariani, Fabiola Fedele, Vito Giuseppe Maniaci, Elena Petrovska, Renzo D’Amelio, Giuliana Mazzoni and Michela Di Trani

Healthcare 2023, 11(22), 2919; https://doi.org/10.3390/healthcare11222919 - 7 Nov 2023

Cited by 5 | Viewed by 1952

Abstract

Background: the diagnosis of infertility and its related treatment can be traumatic, leading to profound psychological distress and a variety of psychopathological symptoms. The primary objective of this study is to contrast the linguistic features of narratives from women undergoing Assisted Reproductive Treatment with those of women not undergoing any fertility treatment. This study examines the speech of both groups of individuals as an indicator of their capacity to cope with current and past distressing experiences. Method: 44 women (mean age 36.05; SD = 4.66) enrolled in a fertility medical center in Rome, and 43 control women (mean age 36.07; SD = 3.47) completed a socio-demographic questionnaire and a semi-structured interview designed to collect their memories of a neutral, a positive, and a negative event. This interview also aimed to investigate: (a) (for women with fertility difficulties) how they realized they and their partner had fertility problems and a description of an event when they talked about these difficulties with their partner; and (b) (for control group participants) the most difficult moment of their pregnancy and an event when they talked about it with their partner. The interviews were audio recorded and transcribed, and the text was analyzed using the referential process (RP) linguistic measures software. Results: Mann–Whitney non-parametric U tests for the independent samples showed several significant differences regarding the linguistic measures applied to the narratives of neutral, positive, negative, and difficult experiences in the form of a linguistic style, with more intellectualization and defenses in all the narratives associated with the women with fertility problems compared to the women in the control group. Conclusions: the traumatic and painful experience of infertility and ART seems to characterize the whole mode of narrating life experiences. Present findings sustain the importance of helping women to elaborate on their experience and to understand and recognize the difficult feelings that are activated in relation to the difficulties of having a child. Full article

(This article belongs to the Special Issue Research into Women's Health and Care Disparities)

Review

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14 pages, 950 KiB

Open AccessReview

A Concept Analysis of Maternal Resilience against Pregnancy-Related Mental Health Challenges in Low- and Middle-Income Countries

by Anila Naz AliSher, Samia Atta, Adnan Yaqoob, Tanseer Ahmed and Salima Meherali

Healthcare 2024, 12(16), 1555; https://doi.org/10.3390/healthcare12161555 - 6 Aug 2024

Cited by 1 | Viewed by 3179

Abstract

Suicide accounts for 33% of deaths of women during the postnatal period in many low- and middle-income countries (LMICs). Resilience refers to an ability to adapt and recover from adversity or misfortune. Resilience building against mental health challenges during pregnancy and the postnatal period is critical for women to raise their child efficiently and maintain a healthy life. The exploration of maternal resilience against mental health challenges including its developmental processes and the determinants of its successful or unsuccessful cultivation among mothers during pregnancy and childbirth is of paramount importance. Understanding why a subset of mothers effectively develops resilience while others significantly struggle is critical for devising targeted interventions and support mechanisms aimed at improving maternal well-being. This inquiry not only seeks to delineate the factors that contribute to or hinder the development of resilience but also aims to inform the creation of comprehensive support systems that can bolster maternal health outcomes. This paper endeavors to present a comprehensive analysis of maternal resilience, aiming to cultivate a nuanced and profound understanding of the concept within the framework of previous traumatic events and adverse pregnancy outcomes in LMICs. The eight-step method approach proposed by Walker and Avant was utilized for this concept analysis. Several defining attributes were identified in the analysis including social adaptation, support system, optimistic approach, and mindfulness. This analysis contributes to knowledge advancement regarding maternal resilience and provides nurses and other healthcare professionals with a clear understanding of the concept of maternal resilience to help promote resilience among mothers. Full article

(This article belongs to the Special Issue Research into Women's Health and Care Disparities)

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