Search Results (305)

Background/Objectives: Structural inequalities in access to healthcare persist even within systems that have achieved near-universal coverage, reflecting the enduring influence of social determinants of health on service utilization. This study examines horizontal inequity in rehabilitation and specialist care in Türkiye and investigates whether access inequality mediates the well-documented income–depression gradient. Methods: Analyzing the nationally representative 2022 Türkiye Health Survey (adults aged ≥15; N = 22,742), we employed Latent Profile Analysis (LPA) to construct people-centered, multidimensional bodily burden profiles, and assessed need-adjusted access using survey-weighted logistic regression, Erreygers-corrected concentration-index decomposition, Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA), and restricted cubic splines, with measurement-invariance and classification-uncertainty sensitivity analyses. Statistical mediation was examined with natural-effect models and E-value sensitivity analysis. Results: Although the system demonstrated responsiveness to need—78.8% of the highest-burden profile accessed specialist services—only 13.7% of this same group reached dedicated physiotherapy or rehabilitation, revealing a profound structural bottleneck in care coordination for marginalized populations with the greatest functional impairment. A persistent pro-rich gradient was confirmed by an Erreygers-corrected concentration index of 0.058 (95% CI 0.043–0.072), driven additively by income and education. Access did not mediate the income–depression pathway (natural indirect effect OR 1.001, 95% CI 1.0003–1.002). Conclusions: The mental health burden of low income operates through pathways that equitable healthcare access alone cannot address. These findings call for macroeconomic and people-centered health system reforms—including direct physiotherapy access, transportation subsidies, and social protection interventions—to advance health equity in rehabilitation utilization. Full article

Background/Objectives: Healthcare workforce shortages and the challenges facing healthcare professionals are among the most pressing issues confronting contemporary health systems. This study examines the social representations of public, private, and public–private partnership (PPP) healthcare organisational models and professional practice elicited from public-sector physicians and nurses in Portugal. Methods: A cross-sectional survey was conducted between October 2022 and May 2023 using a non-probability sample of 308 physicians and nurses classified as public-sector professionals. Participants completed a free-association task concerning the public, private, and PPP healthcare models and their professional practice. The evoked terms were examined using prototypical analysis within the structural approach to Social Representations Theory. The representation of the public healthcare sector included elements such as accessibility, universality, equity, slowness, disorganisation, and resource limitations. The private healthcare sector was characterised by elements including cost, profit, speed, organisation, inaccessibility, and service quality. Results: The representation of PPPs included better management, efficiency, profit, interests, and quality, alongside a relatively frequent “No opinion” response. Professional practice was characterised by elements including caring, dedication, empathy, resilience, exhaustion, perceived undervaluation, and remuneration. Conclusions: These findings describe the social representations elicited from the present sample of public-sector physicians and nurses and should not be interpreted as evidence of objective differences between healthcare organisational models or as direct measures of motivation, resilience, burnout, sector preference, or working conditions. The findings are exploratory and hypothesis-generating and may inform future comparative research involving professionals working across different healthcare settings, as well as studies using dedicated measures of professional and occupational outcomes. Full article

Health systems are fundamental to ensuring the right to health and maintaining the stability of welfare states. In this broad framework, this narrative review takes a look at Italy and China—two countries with very different historical backgrounds and institutional paths—as they deal with challenges like demographic aging, increasing chronic illnesses, and ongoing disparities in access to care. This paper aims to examine the most relevant peer-reviewed studies, as well as current legal and policy documents, in order to outline a comparative overview of the approaches to financing, coverage, and service provision in Italy and China, two very different countries. The Italian National Health Service, financed through general taxation and designed to be universal, aims to ensure equitable access to healthcare while having to contend with significant regional differences and financial difficulties. On the other hand, China, which operates with a mixed model, has rapidly expanded its insurance coverage using a variety of schemes and embracing technological advances, which has enabled large-scale access to healthcare, although considerable differences remain between urban and rural areas and provinces. When compared, each system shows particular strengths: Italy’s local care networks and focus on continuous services offer a model for inclusive welfare, while China’s use of digital tools demonstrates how innovation might help overcome obstacles in settings with limited resources and maintain continuity of care. There is a noticeable overlap in how both countries handle chronic diseases and their shared concern for equity in health policy. Considering these points, mixed approaches that combine universal coverage, financial viability, and flexible use of technology could provide useful ideas for crafting more fair, effective, and resilient health policies in various settings. Rather than proposing direct policy transfer, the comparison identifies context-dependent strategies that may inform future healthcare reforms. Full article

Background: Public health in Greece has undergone substantial changes since the COVID-19 pandemic, while challenges related to governance, workforce distribution, regional inequalities and service organization remain. This study aimed to map the current public health landscape in Greece by examining its institutional frameworks, stakeholder roles, policy implementation and public health data systems. Methods: A structured situation analysis combining a review of peer-reviewed and gray literature, policy analysis, and stakeholder mapping was conducted. PubMed, EMBASE, and CINAHL were searched for English- and Greek-language publications issued between 2005 and 2026, supplemented by reports, legislation, and policy documents from the Greek Ministry of Health, the World Health Organization, the Organisation for Economic Co-operation and Development, the European Commission, and other relevant institutions. Results: Public health responsibilities were distributed across multiple national, regional, and local institutions, creating challenges concerning coordination and accountability. Regional and socioeconomic inequalities continued to affect access to services, while workforce shortages and skill-mix imbalances constrained public health capacity. Public health information was dispersed across different institutions and data systems, with limitations concerning standardization, accessibility, and interoperability. Recent legislation, prevention programs, and digital-health initiatives indicated increased policy attention to prevention and population health, although publicly available evidence regarding their implementation and outcomes remained limited. Conclusions: Strengthening public health in Greece requires clearer institutional responsibilities, improved coordination across governance levels, sustainable workforce planning and interoperable data systems that support routine monitoring of program coverage, equity, and population-level outcomes. Full article

Background/Objectives: Infant male circumcision (IMC) is a long-established religious practice in Jewish, Muslim, and some Orthodox Christian communities. Since 2007, access to non-therapeutic request IMC in Australia has gradually shifted from the public healthcare system to the private sector. However, the equity implications of this shift, particularly for socio-economically disadvantaged religious families, have received limited scholarly attention. This study explores the potential equity impacts of this policy environment, with a focus on low-income families in the Greater Sydney region. Methods: A desk-based Equity-Focused Health Impact Assessment (EFHIA) was conducted using publicly accessible data from the Australian Bureau of Statistics (ABS) and Medicare Benefits Schedule (MBS). Suburbs in the Greater Sydney region with the highest proportion of Jewish, Muslim, and Orthodox Christians were identified and the proportion of households with children experiencing financial vulnerability were compared across these suburbs. Findings were discussed using an equity and healthcare-access lens. Results: Suburbs with higher proportions of Muslim residents consistently demonstrated a higher proportion of households living with financial vulnerability compared with suburbs with higher proportions of Jewish and Orthodox Christian households. These findings suggest greater potential exposure to financial barriers when accessing private IMC services among Muslim-majority suburbs. In turn, such barriers may increase reliance on lower-cost, unaccredited circumcision providers, with possible risk of complications. Conclusions: The privatisation of request IMC in Australia is likely to disproportionally affect socio-economically disadvantaged religious families, particularly within Muslim communities, potentially generating an inequitable barrier to safe circumcision. Policy responses should focus on mitigating access barriers and safety risks through accredited provider registries, standardised parental information, regulatory oversight, and targeted community-based financial support mechanisms. Full article

Digital ecosystems, misinformation exposure, mental-health vulnerability and unequal access to care create distinctive challenges for young people. Although youth participation in health governance is increasingly advocated internationally, structured evidence from youth deliberative processes remains limited in Portugal. This study synthesises priorities expressed in two Portuguese deliberative initiatives coordinated by the Sociedade Portuguesa de Literacia em Saúde: the Mini-Assemblies of Health 2022–2023, with particular attention to the 3rd Mini-Assembly on Fighting Health Misinformation, and the Youth Health Choices Forum 2024. Both processes used a structured nominal-group logic to support idea generation, clarification, recording and prioritisation. The analysis used low-inference cross-session thematic aggregation to preserve propositional integrity and remain close to participants’ formulations. Five priority domains were identified: digital health communication and information credibility; curriculum-integrated and peer-mediated health literacy; low-friction mental-health access and stigma reduction; equity and functional service accessibility and governance, accountability and youth participation. Participant quotations are retained, in translated form, to preserve youth voice and to show how recommendations emerged from concrete deliberative formulations. The findings suggest that nominal group technique (NGT)-based youth deliberation can generate operational recommendations for policy and practice, including credibility mechanisms for digital health information, school-based health-literacy integration, autonomy-preserving access routes for mental-health support, and permanent youth participation structures. The findings support recognising young people not only as vulnerable recipients of health information but also as interpreters of digital health ecosystems and contributors to the design of more responsive health governance. Full article

Point-of-care and near-patient diagnostics can shorten the time between testing and clinical or public-health action, but a technically effective test does not by itself create a sustainable diagnostic service. Evidence from diagnostic-access research, digitally connected point-of-care testing, human-centered design, and implementation science indicates that diagnostic technologies must be developed as components of wider service systems encompassing workflows, quality assurance, data governance, maintenance, supply chains, user trust, and linkage to care. Drawing on these bodies of literature, this Perspective introduces the I2Med digital infrastructure framework for point-of-care diagnostics in low-resource and infrastructure-constrained settings. These settings are defined functionally as clinical or public-health environments in which resource or infrastructure constraints can disrupt one or more stages between testing and appropriate action. The I2Med framework integrates six domains: (1) access and context of use; (2) the result-to-action diagnostic workflow; (3) digital interfaces and data governance; (4) quality, risk, usability, and design-control alignment; (5) sustainability, maintenance, and supply continuity; and (6) equity, trust, and community accountability. Operational tools—including a setting typology, a domain-to-artifact matrix, an evidence-to-scale maturity ladder, and a hypothetical application vignette—illustrate how the framework can guide development and implementation planning. The I2Med framework’s central contribution is to reposition the diagnostic device as one component of an interconnected service system and to provide academic, translational, and early-stage development teams with a common structure for identifying implementation dependencies, evidence gaps, and responsibilities. As a conceptual framework, it requires prospective application and evaluation across diverse settings before its utility and transferability can be established. Full article

Introduction: Globally, disabled individuals experience persistent social inequalities and health inequities, yet the health and wellbeing of Deaf, DeafBlind, blind, and partially sighted (DDBBPS) people remain profoundly under-researched and excluded from social science and health policy agendas. Existing studies narrowly focus on narratives of hearing and vision impairments within a medical model of disability, which pathologizes difference and obscures the biomedical origins of social inequalities and health inequities experienced by these groups. Methods: Drawing on critical disability studies and community-based literature, this narrative review introduces and applies the concept of medical violence to examine how systemic ableism, audism, and ocularcentrism shape DDBBPS people’s healthcare experiences. Results: We identify six interrelated manifestations of medical violence: denied interpreting services, inaccessible health communication, harmful interpersonal practices, health inequities and medical avoidance, absence of DDBBPS practitioners, and gaps in community-based care. Conclusions: These conditions reinforce a cycle of exclusion and misrepresentation, wherein DDBBPS persons are denied equitable access to healthcare and are simultaneously constructed as objects of cure rather than as knowledge holders. We argue for a community-based participatory research agenda led by and for DDBBPS communities to challenge ableist research paradigms and advance health equity. Full article

Background: Dementia is a global health priority affecting more than 55 million people worldwide, with projections indicating this figure will rise to 139 million by 2050. People living with dementia (PLWD) face profound difficulties accessing primary care services—the critical gateway to dementia diagnosis, ongoing management, and coordinated specialist referral. Despite growing evidence on individual barriers, a comprehensive synthesis integrating patient, caregiver, and system-level perspectives is lacking. Objectives: This systematic review and meta-synthesis aimed to identify, appraise, and synthesize evidence on the barriers and facilitators experienced by PLWD and their caregivers when accessing primary care services, and to propose evidence-based recommendations to address inequities. Methods: A systematic search was conducted to identify relevant articles in six electronic databases: PubMed, MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Web of Science from January 2000 to December 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Qualitative, quantitative, and mixed-methods studies reporting barriers or facilitators to primary care access for PLWD were included. A convergent integrated synthesis and thematic meta-synthesis approach was applied. Quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Results: Forty-three studies from 18 countries met inclusion criteria. Barriers were categorized across five domains: (1) patient-level factors (stigma, denial, symptom normalization, and limited health literacy); (2) caregiver-level factors (burden, late symptom recognition, and cultural barriers); (3) provider-level factors (insufficient training, therapeutic nihilism, and time constraints); (4) system-level factors (fragmented care pathways, long waiting times, and poor care coordination); and (5) structural and societal factors (rurality, poverty, and ethnic minority status). Facilitators included caregiver advocacy, strong patient–GP relationships, dementia literacy campaigns, availability of memory clinics, and integrated care models. Disparities were consistently greater for ethnic minority groups, rural populations, and those with lower socioeconomic status. Conclusions: Barriers to primary care access in dementia are complex, overlapping, and mutually reinforcing. Effective strategies require multi-level interventions addressing individual, relational, provider, and system dimensions simultaneously. Full article

Background/Objectives: Members of the LGBTQ+ community often have poorer health outcomes and less access to health services than cisgender and heterosexual populations, and many healthcare professionals remain insufficiently aware of the barriers faced by these patients. Community nurses, given their skills and competencies, can help patients overcome barriers and achieve greater inclusion. The aim of this project is to identify the barriers and facilitators detected by the primary care nursing team of the Málaga-Valle del Guadalhorce Health District (MVGHD) when providing holistic care to LGBTQ+ individuals. Methods: A sequential explanatory mixed-methods design (DEXPLIS) will be employed to robustly combine a quantitative baseline of professional attitudes with an in-depth qualitative exploration of institutional discourses. Phase I consists of a pilot cross-sectional study with cluster allocation of questionnaire versions in which primary healthcare nursing staff in the MVGHD will complete the validated Sexuality Attitudes and Beliefs Survey (SABS) with one group completing a version framed around LGBTQ+ patients and the other around the general population. Phase II consists of a qualitative descriptive study based on discourse analysis (DA) using in-depth semi-structured interviews, analyzed with ATLAS.ti 23. Conclusions: This study protocol is expected to provide an empirical framework to identify potential institutional barriers and attitudinal biases in nursing care, highlighting the potential need for targeted training programmes in sexual and reproductive health. The resulting protocol aims to contribute to health equity by offering practical resources to optimize ongoing clinical education in primary care settings. Full article

(1) Background: Ambulatory services are the main interface between populations and health systems, yet their benefits are unevenly distributed due to structural inequalities—systemic differences rooted in the social, economic, and political organisation of society. Inequities in access and quality are well documented, but patient safety remains the least examined. (2) Methods: Following Joanna Briggs Institute methodology and PRISMA-ScR guidelines, PubMed/MEDLINE and Scopus were searched for studies published from 2010 to 2026. In total, 44 studies were included, predominantly from the USA (n = 31), and synthesised narratively. (3) Results: Inequalities operated through geographic maldistribution, financial barriers, exclusionary institutional cultures, and market-driven practices. Access and quality were each addressed by 17 studies, whereas only four examined patient safety directly; the limited safety evidence indicated disproportionate diagnostic errors, medication-safety failures, and care-coordination breakdowns among vulnerable groups. Evidence was concentrated in the USA. (4) Conclusions: Structural inequalities are well documented for access and quality but are markedly under-studied for patient safety—the principal evidence gap identified. Patient safety warrants treatment as an equity outcome, measured with stratification by structural disadvantage and addressed through system-level interventions. Full article

This community-engaged qualitative study co-defined digital health and artificial intelligence (AI) priorities with First Nations communities in Manitoba, Canada, including those with disabilities. Grounded in Indigenous research methodologies and community-based participatory research, the project responded to persistent inequities in rehabilitation and health service access shaped by geography, colonial legacies, and jurisdictional fragmentation. These inequities are especially important in the context of aging, as older adults and Elders may experience compounded barriers related to disability, chronic conditions, mobility limitations, and digital exclusion. Over approximately 12 months, an interdisciplinary team consisting of First Nations scholars and partners, disability organizations, clinicians, and researchers conducted relationship-building visits and meetings with First Nations leadership, Elders/Knowledge Keepers, health providers, and community members to inform the design of a Gathering focused on disability, digital health, and AI. A one-day community-engaged Gathering was held on Treaty 1 and 2 Territory in Winnipeg and convened approximately 70 participants from multiple First Nations communities and disability/health organizations. Five facilitated roundtables explored: (1) health and research priorities for First Nations persons with disabilities; (2) primary care and disabilities; (3) digital access and cultural safety; (4) culturally safe and ethical AI use; and (5) health system challenges, disability, and digital health. Data consisted of facilitator-produced, de-identified table summaries, facilitator reflection forms, and participant-validated plenary notes; no recordings or individual sociodemographic data were collected. Using qualitative description and team-based content analysis, three interrelated domains emerged: (1) relationships, identity, trust, and cultural safety; (2) system, infrastructure, and equity conditions required for accessible care and digital inclusion (e.g., connectivity “dead zones,” device access, transport, and culturally safe services); and (3) opportunities, risks, and governance principles for AI and data use (e.g., AI literacy, privacy, bias, Indigenous data sovereignty, and Nation-specific governance). Findings emphasize that equitable digital health and AI must be relational, disability-informed, culturally safe, and led under First Nations authority, with AI positioned to support, rather than replace, human care relationships. The findings also highlight the importance of designing digital health and AI initiatives that remain accessible and trustworthy for older adults and Elders, particularly where aging, disability, and rural or remote living intersect. Full article

Background/Objectives: Evacuation policies for childbirth in Nunavut, Canada, continue to profoundly shape the lives of Inuit women, their families, and communities. The evacuation policy is known to disrupt kinship networks and contribute to the erosion of Inuit birthing knowledge. Addressing a gap in Inuit-led understandings of sexual and reproductive health priorities, this paper presents findings from research conducted in 2024 with Kivallirmiut women (‘People of’ in Inuktitut is miut; Kivallirmiut means people of the Kivalliq Region. Nunavummiut means people of Nunavut, and Arviarmiut means people of Arviat, Nunavut, Canada). The study took place in two communities in the Kivalliq Region of Nunavut. Methods: Employing a highly participatory, community-based Indigenous methodology, this study was underpinned by Inuit Qaujimajatuqangit, Indigenous feminist and postcolonial and decolonial theories, and principles of health equity. Data from a survey were generated to identify needs and priorities related to perinatal health and care. Results: Findings identify that Inuit women in these communities hold an interest in accessing perinatal information and support, with a strong desire for learning from Inuit Elders, as well as support via peer networks. Participants also emphasized a desire for more information concerning travelling for birth (medical evacuation), breastfeeding, and healing after birth. Different models for delivery of this information and perinatal support were also identified. Conclusions: Collectively, the priorities of Inuit women in this survey offer insights concerning a structural misalignment between existing perinatal care supports and services that rely on evacuation-based perinatal care and the needs and priorities within Kivalliq communities. This disconnection reveals enduring colonial assumptions embedded within current healthcare systems. The findings suggest a need for perinatal supports that centre culture, kinship, and relational forms of support. Full article

Background: Osteoporosis is a major public health concern, and early detection through dual-energy X-ray absorptiometry (DXA) has been pivotal. However, evidence on how insurance coverage relates to the distribution of patients receiving DXA examinations in Saudi Arabia remains limited. This study examines the distribution of patients receiving DXA examinations across different insurance types and healthcare settings among adult patients in Saudi Arabia. Methods: This retrospective observational study used de-identified electronic health record data from a public tertiary academic center and a large private healthcare system in Saudi Arabia between 1 January 2023 and 28 February 2026. Dual-energy X-ray absorptiometry (DXA) was employed as an imaging method used to measure bone mineral density and support osteoporosis diagnosis and fracture-risk assessment. Adult patients aged ≥18 years with completed DXA examinations recorded in radiology service records were included. This study assessed the distribution of patients receiving DXA examinations across insurance types, healthcare setting, ordering department, and year of service. Insurance type was categorized as government coverage, private insurance, or self-pay. Descriptive statistics, chi-square tests, one-way ANOVA, Cramér’s V, and standardized residuals were used to compare distribution patterns across groups. Results: The data of 8930 DXA recipients were analyzed. Clear differences were observed in the distribution of patients by insurance type and healthcare setting (p < 0.001). Privately insured patients were predominantly treated in private facilities, whereas government-insured and self-pay patients were primarily concentrated in public healthcare facilities. Significant variations were also observed across healthcare departments and over time, demonstrating strong system-level and financial stratification in the distribution of patients receiving DXA examinations. Conclusions: The findings of this study demonstrate significant differences in the distribution of patients receiving DXA examinations according to insurance type and healthcare setting. Notably, self-pay patients were predominantly managed in public healthcare facilities, whereas privately insured patients primarily received DXA examinations in private healthcare settings. These observed patterns suggest that differences in healthcare organization and insurance financing may be associated with where patients receive DXA examinations; however, because this study included only individuals who underwent DXA examinations, the findings should not be interpreted as measures of screening uptake, access, or equity among all patients eligible for osteoporosis screening. Future healthcare strategies should focus on strengthening equitable insurance coverage, improving coordination between public and private healthcare sectors, standardizing referral pathways, and supporting integrated preventive care in line with Saudi Arabia’s Vision 2030 healthcare transformation. Full article

Objective: This study aimed to identify priority areas, social vulnerability, and healthcare capacity and networks while considering hospitalization and mortality rates due to Severe Acute Respiratory Syndrome (SARS) caused by COVID-19 during the public health emergency period. Materials and Methods: A spatiotemporal analysis was performed to assess hospitalization, mortality, and case fatality rates among hospitalized patients due to severe COVID-19 across the municipalities of the Metropolitan Region of Belo Horizonte (MRBH), Brazil, between 2020 and 2022. The findings were contextualized by considering the social vulnerability of the population as well as the healthcare infrastructure and organizational characteristics of municipalities and health regions. Results: Municipalities located in the central area of the MRBH showed higher hospitalization rates, corresponding to areas with a greater concentration of healthcare infrastructure. However, mortality and case fatality rates among hospitalized patients were higher in municipalities with more limited healthcare infrastructure and greater social vulnerability. Conclusion: The spatiotemporal disparities in hospitalization and mortality risks suggest health inequities that seem to be influenced by social determinants and healthcare system vulnerabilities. These findings emphasize the imperative for public health emergency responses to prioritize the strengthening of health system organization and the establishment of effective care pathways to enhance access and service delivery, particularly in municipalities exhibiting higher levels of social vulnerability. Full article