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Building Integrated and Coordinated Health Systems: Addressing the Social Determinants...
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Building Integrated and Coordinated Health Systems: Addressing the Social Determinants of Health

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (20 October 2023) | Viewed by 19150

Special Issue Editors

Prof. Dr. Thilo Kroll

E-Mail Website
Guest Editor
School of Nursing, Midwifery and Health Systems, University College Dublin, D04 V1W8 Dublin, Ireland
Interests: disability; health systems; participatory research; environmental and service design
Special Issues, Collections and Topics in MDPI journals
Dr. Kate Frazer

E-Mail Website
Guest Editor
School of Nursing, Midwifery and Health Systems, University College Dublin, D04 V1W8 Dublin, Ireland
Interests: public health and social epidemiology specifically examining social determinants of health; inequalities in health; homelessness; integrated healthcare; health promotion focusing on tobacco control and secondhand smoke exposure, public and patient involvement (PPI), inclusion health
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues, 

Health systems struggle to provide integrated and timely healthcare at a population level. COVID-19 magnified the stark inequities in health and care globally, disproportionately impacting vulnerable groups, including people with disabilities, people from lower socio-economic groups, people who are homeless, migrants and refugees, and older people with limited mobility. All these groups carry greater risk for acute and chronic health challenges. They often fail to gain timely access to needed care, and integrated and continued, needs-matched support, especially in community and primary care settings.

Unrecognized social determinants of health (SDOH) account for many pressures. The World Health Organization (2022) acknowledges the role and influence of SDOH on unfair and unavoidable differences in health inequity and, in particular, their contribution to emergency and unscheduled hospital admissions.

This Special Issue aims to attract papers building the evidence base considering the social determinants of health in the development of integrated, accessible, affordable, and coordinated health provider systems for vulnerable groups.

We seek papers that contribute to the understanding of the existing focus on the social determinants of health, what data are being examined, and what the cumulative effect is.

We encourage the submission of a broad range of studies and evidence. This Special Issue invites researchers of any discipline who focus on health inequity, including but not limited to social science, public health, nursing, law, and medicine, to submit their work.

We will consider the following types of empirical studies: controlled trials, cohort studies, case-control studies, natural experiments, mixed-method evaluations, qualitative studies, policy studies, feasibility studies. We will consider papers reporting opinions with evidence, and papers presenting evidence from scoping reviews and systematic reviews.

We look forward to receiving your submissions.

Prof. Dr. Thilo Kroll
Dr. Kate Frazer
Guest Editors

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. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly 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 2500 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

  • social determinants of health
  • health systems
  • health inequity
  • primary care
  • community care
  • integrated care
  • disability
  • migrant health
  • homelessness
  • refugees
  • older people
  • inclusion health

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Published Papers (7 papers)

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Research

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11 pages, 338 KiB  
Article
Give until It Hurts: An Exploratory Analysis of Mental Health Workers’ Wellness
by Marin G. Olson, Karly M. Pyles and Danielle Kristen Nadorff
Int. J. Environ. Res. Public Health 2023, 20(20), 6925; https://doi.org/10.3390/ijerph20206925 - 14 Oct 2023
Viewed by 2298
Abstract
Background: The well-being of mental health professionals has been of growing concern due to the increasing rates of reported stress and burnout. Previous research suggests that the quality of life for mental health workers (MHWs) is at an increased risk due to clinical [...] Read more.
Background: The well-being of mental health professionals has been of growing concern due to the increasing rates of reported stress and burnout. Previous research suggests that the quality of life for mental health workers (MHWs) is at an increased risk due to clinical load, salary concerns, and lack of time for self-care activities outside of work. There is a lack of research regarding the wellness of MHWs (i.e., psychology graduate students, academic faculty, psychiatrists, and mental health counselors) and its relation to the workplace environment. This study examined job-related factors that impacted participants’ social, emotional, and professional well-being. Methods: Participants were recruited via professional organization listservs and answered questions about their psychological health (Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9), support systems (Multidimensional Scale of Perceived Social Support), and three qualitative questions about what they enjoy or find challenging about their work and any barriers to engaging in self-care activities. Results: An inductive qualitative analysis of the qualitative questions and descriptive statistics are presented to provide context for their qualitative responses. Conclusions: Institutions can better support their workers by creating outlets to teach their staff self-care strategies and practice these strategies at work. Full article
(This article belongs to the Special Issue Building Integrated and Coordinated Health Systems: Addressing the Social Determinants of Health)
13 pages, 646 KiB  
Article
“It Comes in Steps and Stages”: Experiences of People Living with HIV in Achieving Employment
by Serena Rajabiun, Joseph S. Lightner, Marena Sullivan, Jessica Flaherty, Chau Nguyen, Joseph Ramirez-Forcier and Janet J. Myers
Int. J. Environ. Res. Public Health 2023, 20(18), 6778; https://doi.org/10.3390/ijerph20186778 - 18 Sep 2023
Viewed by 1488
Abstract
People living with HIV who are seeking jobs experience unique barriers to obtaining employment at the individual, group, and community levels. Traditional employment assistance programs can provide support but may not be tailored to some people living with HIV who often experience barriers [...] Read more.
People living with HIV who are seeking jobs experience unique barriers to obtaining employment at the individual, group, and community levels. Traditional employment assistance programs can provide support but may not be tailored to some people living with HIV who often experience barriers to work related to their social needs (such as housing instability) or their lack of consistent engagement in the workforce. To understand how people living with HIV return to work, in-depth interviews were conducted with 43 participants enrolled in interventions coordinating HIV care with housing and employment services at eight sites across the US. Four themes emerged on strategies to increase employment: (1) assessing and responding to employment needs that align with their socio-economic environment; (2) using social networks among family and friends for referrals and support; (3) engaging with navigators who are able to connect clients to skills building opportunities and job resources; and (4) addressing the system barriers such as helping with unmet basic needs (e.g. transportation), finding employers who can accommodate workers with income limits associated with public benefits, and helping immigrants, transgender individuals, and people experiencing homelessness secure legal documentsthat facilitate entry into employment by reducing stigmatized identities. Full article
(This article belongs to the Special Issue Building Integrated and Coordinated Health Systems: Addressing the Social Determinants of Health)
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14 pages, 368 KiB  
Article
Health Promotion in Debate: The Role of Women Leaders in the Favelas of Rio de Janeiro, Brazil
by Nilza Rogéria de Andrade Nunes, Dais Rocha and Andréa Rodriguez
Int. J. Environ. Res. Public Health 2023, 20(11), 5926; https://doi.org/10.3390/ijerph20115926 - 23 May 2023
Viewed by 1724
Abstract
This study aimed to discuss the actions of women leaders in favelas in Rio de Janeiro, Brazil, regarding the health promotion of people residing in territories affected by urban violence and inequalities. The understanding of social determinants of health (SDH) is not unequivocal [...] Read more.
This study aimed to discuss the actions of women leaders in favelas in Rio de Janeiro, Brazil, regarding the health promotion of people residing in territories affected by urban violence and inequalities. The understanding of social determinants of health (SDH) is not unequivocal and challenges us to expand our practices in health promotion and equity. A mixed-methods study was conducted with 200 women living in 169 favelas of Rio de Janeiro between 2018 and 2022. Questionnaires and semi-structured face-to-face interviews followed by thematic analysis were conducted. The analysis focused on the socio-demographic profile, community activism, and health promotion strategies undertaken by these groups, expanding knowledge on the experiences of these leaders in confronting social injustices. Results showed that participants performed health promotion actions in their communities by 1. strengthening popular participation and human rights, 2. creating environments favorable to health, and 3. developing personal skills towards social participation in policy design through mobilizing health services and third-sector organizations. With the limited presence of government public agents in these spaces, participants assumed roles as managers of local demands, and, by means of resistance, intersectionality, and solidarity, they transformed this micro-power into the potential for social transformation. Full article
(This article belongs to the Special Issue Building Integrated and Coordinated Health Systems: Addressing the Social Determinants of Health)
22 pages, 508 KiB  
Article
How Does Living in Temporary Accommodation and the COVID-19 Pandemic Impact under 5s’ Healthcare Access and Health Outcomes? A Qualitative Study of Key Professionals in a Socially and Ethnically Diverse and Deprived Area of London
by Diana Margot Rosenthal, Antoinette Schoenthaler, Michelle Heys, Marcella Ucci, Andrew Hayward, Ashlee Teakle, Monica Lakhanpaul and Celine Lewis
Int. J. Environ. Res. Public Health 2023, 20(2), 1300; https://doi.org/10.3390/ijerph20021300 - 11 Jan 2023
Cited by 1 | Viewed by 4318
Abstract
Background: Children < 5 years living in temporary accommodation (U5TA) are vulnerable to poor health outcomes. Few qualitative studies have examined service provider perspectives in family homelessness; none have focused on U5TA with a cross-sector approach. This study explored professionals’ perspectives of the [...] Read more.
Background: Children < 5 years living in temporary accommodation (U5TA) are vulnerable to poor health outcomes. Few qualitative studies have examined service provider perspectives in family homelessness; none have focused on U5TA with a cross-sector approach. This study explored professionals’ perspectives of the barriers and facilitators, including pandemic-related challenges, experienced by U5TA in accessing healthcare and optimising health outcomes, and their experiences in delivering services. Methods: Sixteen semi-structured online interviews were conducted. Professionals working in Newham (London) with U5TA families were recruited from non-profit organisations, the health sector, and Local Authority. A thematic analysis was conducted. Findings: Professionals described barriers including poor parental mental health; unsuitable housing; no social support; mistrust of services; immigration administration; and financial insecurity. Digital poverty, language discordance, and the inability to register and track U5TA made them even less visible to services. Professionals tried to mitigate barriers with improved communication, and through community facilitators. Adverse pandemic effects on U5TA health included delay and regression in developmental milestones and behaviours. In-person services were reduced, exacerbating pre-existing barriers. Interpretation: COVID-19 further reduced the ability of professionals to deliver care to U5TA and significantly impacted the lives of U5TA with potential life-long risks. Innovative and tailored cross-sector strategies are needed, including co-production of public health services and policies focusing on early development, mental health support, employment training, and opportunities for parents/carers. Full article
(This article belongs to the Special Issue Building Integrated and Coordinated Health Systems: Addressing the Social Determinants of Health)
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15 pages, 354 KiB  
Article
A Qualitative Study on the Position and Role of Volunteers in Integrated Care—An Example of Palliative Care in Croatia
by Dorja Vočanec, Karmen Lončarek, Maja Banadinović, Slavica Sović and Aleksandar Džakula
Int. J. Environ. Res. Public Health 2022, 19(13), 8203; https://doi.org/10.3390/ijerph19138203 - 5 Jul 2022
Cited by 1 | Viewed by 2206
Abstract
Volunteers have been present in palliative care since its inception. With the development of palliative care systems, their role and position are changing. Given growing long-term care needs and limited resources in health and social care, volunteers are becoming an important resource in [...] Read more.
Volunteers have been present in palliative care since its inception. With the development of palliative care systems, their role and position are changing. Given growing long-term care needs and limited resources in health and social care, volunteers are becoming an important resource in meeting these needs. In Croatia, palliative care has been developing as an integrated care model since 2014. To assess the position and the role of volunteers, we analyzed legislative documents from healthcare and social care and conducted a focus group with volunteers in palliative care. We found that volunteers provide support from the social aspect of care, for the patient and the family. The formal palliative care system involves them as partners in the provision of care, even though this cooperation is informal. The main determinants of their activities are an individualized approach, flexibility, a community presence, and project funding. In conclusion, these determinants allow them to react quickly to identified needs, but with them come some uncertainties of their sustainability. Their activities could indicate what needs to be integrated between health and social care and in what areas. Volunteers both fill in gaps in the system and are ahead of the system, and by doing this they develop new processes around identified unmet needs. Full article
(This article belongs to the Special Issue Building Integrated and Coordinated Health Systems: Addressing the Social Determinants of Health)

Review

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19 pages, 1200 KiB  
Review
COVID-19 Public Health Measures and Patient and Public Involvement in Health and Social Care Research: An Umbrella Review
by Negin Fouladi, Nedelina Tchangalova, Damilola Ajayi, Elizabeth Millwee, Corinne Lovett, Alana Del Sordi, Samantha Liggett, Malki De Silva, Laura Bonilla, Angel Nkwonta, Leah Ramnarine, Allyssa Munoz, Kate Frazer and Thilo Kroll
Int. J. Environ. Res. Public Health 2023, 20(6), 4887; https://doi.org/10.3390/ijerph20064887 - 10 Mar 2023
Cited by 6 | Viewed by 3059
Abstract
An umbrella review of previously published systematic reviews was conducted to determine the nature and extent of the patient and public involvement (PPI) in COVID-19 health and social care research and identify how PPI has been used to develop public health measures (PHM). [...] Read more.
An umbrella review of previously published systematic reviews was conducted to determine the nature and extent of the patient and public involvement (PPI) in COVID-19 health and social care research and identify how PPI has been used to develop public health measures (PHM). In recent years, there has been a growing emphasis on PPI in research as it offers alternative perspectives and insight into the needs of healthcare users to improve the quality and relevance of research. In January 2022, nine databases were searched from 2020–2022, and records were filtered to identify peer-reviewed articles published in English. From a total of 1437 unique records, 54 full-text articles were initially evaluated, and six articles met the inclusion criteria. The included studies suggest that PHM should be attuned to communities within a sociocultural context. Based on the evidence included, it is evident that PPI in COVID-19-related research is varied. The existing evidence includes written feedback, conversations with stakeholders, and working groups/task forces. An inconsistent evidence base exists in the application and use of PPI in PHM. Successful mitigation efforts must be community specific while making PPI an integral component of shared decision-making. Full article
(This article belongs to the Special Issue Building Integrated and Coordinated Health Systems: Addressing the Social Determinants of Health)
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Other

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6 pages, 314 KiB  
Brief Report
How to Better Integrate Social Determinants of Health into Primary Healthcare: Various Stakeholders’ Perspectives
by Catherine Hudon, Olivier Dumont-Samson, Mylaine Breton, Yann Bourgueil, Christine Cohidon, Hector Falcoff, Nicolas Senn, Thérèse Van Durme, Émilie Angrignon-Girouard and Sarah Ouadfel
Int. J. Environ. Res. Public Health 2022, 19(23), 15495; https://doi.org/10.3390/ijerph192315495 - 22 Nov 2022
Cited by 3 | Viewed by 2341
Abstract
This paper aims to identify challenges and opportunities related to the integration of social determinants of health (SDH) into primary healthcare at an international symposium in Orford, Quebec, Canada. A descriptive qualitative approach was conducted. Three focus groups on different topics were led [...] Read more.
This paper aims to identify challenges and opportunities related to the integration of social determinants of health (SDH) into primary healthcare at an international symposium in Orford, Quebec, Canada. A descriptive qualitative approach was conducted. Three focus groups on different topics were led by international facilitators. Two research team members took notes during the focus groups. All the material was analyzed using a thematic analysis according to an inductive method. Many challenges were identified, leading to the identification of potential opportunities: integrate the concept of SDH in all phases of the training curriculum for health professionals to foster interprofessional and intersectoral collaboration and sociocultural skills; organize healthcare for better outreach to vulnerable populations; organize local and regional committees to develop management frameworks to produce and use territory-specific data; develop dashboards for primary healthcare providers describing the composition of their territory’s population; work collaboratively, rallying primary healthcare providers, community organization delegates, patient partners, citizens, and municipality representatives around common projects. Discussions prompted new directions for further primary healthcare research, among which are building on best practices in the literature and in the field, and engaging various stakeholders in research, including vulnerable populations, while focusing on patient experience. Full article
(This article belongs to the Special Issue Building Integrated and Coordinated Health Systems: Addressing the Social Determinants of Health)
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