International Journal of Environmental Research and Public Health

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12 pages, 318 KiB

Open AccessArticle

Kurdish Refugee Beliefs about Mental Health and Help-Seeking: A Community-Engaged Research Study in Tennessee

by Leah S. Branam, Ismail Yigit, Sipal Haji, Jennifer Clark and Jessica M. Perkins

Int. J. Environ. Res. Public Health 2023, 20(2), 1224; https://doi.org/10.3390/ijerph20021224 - 10 Jan 2023

Cited by 2 | Viewed by 3659

Abstract

Refugee populations exhibit high rates of PTSD, anxiety, depression, and psychological distress, but are less likely to receive care than the general population. Perceptions among the Kurdish refugee community about causes and consequences of mental illness symptoms and perceived barriers to help-seeking are [...] Read more.

Refugee populations exhibit high rates of PTSD, anxiety, depression, and psychological distress, but are less likely to receive care than the general population. Perceptions among the Kurdish refugee community about causes and consequences of mental illness symptoms and perceived barriers to help-seeking are understudied. This community-engaged research study conducted in-depth interviews with Kurdish refugees from Iraq to explore their beliefs about drivers of mental illness and seeking help for mental health. Iterative thematic analysis of transcripts from ten participants indicated four key themes: (1) social network loss due to resettlement causes poor mental health; (2) socioeconomic status loss due to unrecognized professional qualifications puts strain on mental health; (3) social stigma about mental health and fears about disclosure of mental health issues within community and subsequent negative gossip prevent help-seeking; and (4) social interaction may alleviate mental illness symptoms. Overall, Kurdish refugees perceived social factors as major drivers of mental illness symptoms and barriers to help-seeking in their community. However, while participants believed that the general community attitude was against help-seeking, most participants personally expressed support of anyone in their community needing to see a mental health professional. Future research should assess the extent to which perceived community norms differ from aggregated personal help-seeking attitudes and behaviors among Kurdish refugees from Iraq in the United States. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

20 pages, 1174 KiB

Open AccessArticle

Driving for Success in Family Reunification—Professionals’ Views on Intervention

by Diana N. Teixeira, Isabel Narciso and Margarida R. Henriques

Int. J. Environ. Res. Public Health 2022, 19(24), 16594; https://doi.org/10.3390/ijerph192416594 - 10 Dec 2022

Cited by 2 | Viewed by 2487

Abstract

Family reunification is a complex process and is consensually considered the best solution for children in care, as soon as the family has changed the dysfunctional patterns that prevent child safety and well-being. Intervention throughout the entire process is crucial to the success [...] Read more.

Family reunification is a complex process and is consensually considered the best solution for children in care, as soon as the family has changed the dysfunctional patterns that prevent child safety and well-being. Intervention throughout the entire process is crucial to the success of family reunification. This study aimed to explore and understand child protection professionals’ views on factors influencing (un)successful family reunification trajectories. Using a qualitative design, 33 Portuguese child protection professionals participated in five focus groups. The thematic analysis revealed a set of influential factors within three different systemic levels: child, family, and child welfare system. The latter level was clearly predominant, pointing to the powerful role of the intervention as a vehicle for successful family reunification. The results showed the relevance attributed by the professionals to some main intervention guidelines, children–professionals’ relationships, multisystemic assessment and intervention, coordinated work of intervention teams, and sufficient time between the court decision and the child’s re-entry into the family home. The need for early intervention and its continuity after the child’s reintegration into the home also emerged as relevant factors. This study provides in-depth knowledge of professionals’ views on the intervention process, thus contributing to a comprehensive understanding of (un)successful family reunification trajectories. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

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10 pages, 342 KiB

Open AccessArticle

Exposure to Childhood Healthcare Discrimination and Healthcare Avoidance among Transgender and Gender Independent Adults during a Global Pandemic

by Kyle Liam Mason, Shelby A. Smout, Catherine S. J. Wall, B. Ethan Coston, Paul B. Perrin and Eric G. Benotsch

Int. J. Environ. Res. Public Health 2022, 19(12), 7440; https://doi.org/10.3390/ijerph19127440 - 17 Jun 2022

Cited by 5 | Viewed by 2422

Abstract

Transgender and gender-independent individuals (TGI) encounter myriad barriers to accessing affirming healthcare. Healthcare discrimination and erasure exposure among TGI individuals is vital to understanding healthcare accessibility, utilization behaviors, and health disparities in this population. Exposure to gender identity-related healthcare discrimination and erasure in [...] Read more.

Transgender and gender-independent individuals (TGI) encounter myriad barriers to accessing affirming healthcare. Healthcare discrimination and erasure exposure among TGI individuals is vital to understanding healthcare accessibility, utilization behaviors, and health disparities in this population. Exposure to gender identity-related healthcare discrimination and erasure in childhood may contribute to TGI adults’ healthcare utilization behaviors. The commonality of childhood exposure to gender identity-related healthcare discrimination and its relationship to healthcare avoidance during the early months of the COVID-19 pandemic among TGI adults were explored. TGI adults aged 18 to 59 (N = 342) in the United States were recruited online during the summer of 2020. Among individuals who reported childhood exposure to gender identity-related healthcare discrimination, 51% reported experiencing two or more distinct forms of discrimination. Hierarchical logistic regression indicated that exposure to healthcare discrimination in childhood significantly increased the odds of healthcare avoidance during the early months of the COVID-19 pandemic, after accounting for demographic factors and self-reported COVID-19 symptoms (odds ratio = 1.30, 95% confidence interval = 1.10, 1.54). These findings suggest that childhood exposure to gender identity-related healthcare discrimination is a prominent barrier to the utilization of healthcare for TGI adults, even during a global pandemic. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

13 pages, 658 KiB

Open AccessArticle

Street Clinics and the Healthcare of Vulnerable Homeless Communities in Brazil: A Qualitative Study

by Giulia Romano Bombonatti, Maria Giovana Borges Saidel, Fernanda Mota Rocha and Débora de Souza Santos

Int. J. Environ. Res. Public Health 2022, 19(5), 2573; https://doi.org/10.3390/ijerph19052573 - 23 Feb 2022

Cited by 5 | Viewed by 2787

Abstract

(1) Background: homeless people are characterized by serious social vulnerability and difficulty in accessing health services worldwide. In Brazil, this population is supported by the Street Clinic teams who are challenged to establish intersectoral networks to expand access and promote unique and humanized [...] Read more.

(1) Background: homeless people are characterized by serious social vulnerability and difficulty in accessing health services worldwide. In Brazil, this population is supported by the Street Clinic teams who are challenged to establish intersectoral networks to expand access and promote unique and humanized care from the perspective of harm reduction. The study aimed to analyze the practices of professionals working at the Street Clinic in a city in the interior of São Paulo, Brazil, to tackle the vulnerabilities of the homeless population and expand access to the health care network. (2) Methods: a qualitative study was conducted with a social approach in which we interviewed eight workers from the Street Clinic. Data were analyzed using the thematic content analysis tool. (3) Results: three nuclei of meaning were built: stigma and prejudice as the main barriers to accessing services, harm reduction as a humanized care practice and valuing autonomy, and Street Clinic as a gateway to the health system and main interlocutor with other services. (4) Conclusions: the articulation with network services is marked by contradictory relationships, of conflict and trust, signaling the need for greater investment in educational qualifications and working conditions for professionals at all levels of care to expand access to health care. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

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13 pages, 333 KiB

Open AccessArticle

Sexual Victimization, Self-Efficacy to Refuse Sex While Drinking, and Regretting Alcohol-Involved Sex among Underserved Youth in Kampala, Uganda

by Monica H. Swahn, Rachel E. Culbreth, Amanda K. Gilmore, Dominic J. Parrott, Leah E. Daigle, Rogers Kasirye and Paul Bukuluki

Int. J. Environ. Res. Public Health 2022, 19(4), 1915; https://doi.org/10.3390/ijerph19041915 - 9 Feb 2022

Cited by 5 | Viewed by 2951

Abstract

The purposes of this study were to determine whether youth who have experienced sexual victimization (SV) have lower self-efficacy to refuse sex and to identify intervention strategies for rape survivors to mitigate further health-risks and harm. Cross-sectional data from the 2014 Kampala Youth [...] Read more.

The purposes of this study were to determine whether youth who have experienced sexual victimization (SV) have lower self-efficacy to refuse sex and to identify intervention strategies for rape survivors to mitigate further health-risks and harm. Cross-sectional data from the 2014 Kampala Youth Survey (n = 1134) of youth aged 12 to 18 years recruited from Uganda Youth Development Link drop-in centers were used to conduct the analyses. Multivariable statistics were computed to determine the correlates (i.e., sex, education, homelessness, problem drinking, and SV) for (1) self-efficacy to refuse sex, (2) self-efficacy to refuse sex while drinking, and (3) regretting sex due to alcohol use. Among participants, 16.9% reported SV (79% were female and 21% were male). In the final adjusted model, self-efficacy to refuse sex while drinking was only associated with homelessness (OR: 0.52; 95% CI: 0.36, 0.74). Previous SV was not associated with lower self-reports of self-efficacy to refuse sex compared to those who had not experienced SV. Additionally, SV was not associated with increased reports of regrets for sex attributed to alcohol use. Alcohol prevention strategies for the most at-risk youth, including homeless youth, are warranted to improve self-efficacy to refuse sex among youth living in the slums of Kampala. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

15 pages, 392 KiB

Open AccessArticle

Assessing the Determinants of Quality of Life and the Impact on HIV Prevention Measures among HIV-Negative and Status-Unknown Young Men Who Have Sex with Men: A Study in Two U.S. Metropolitan Areas

by Yu Liu, Savanah Russ, Jason Mitchell, Sarahmona Przybyla and Chen Zhang

Int. J. Environ. Res. Public Health 2022, 19(2), 726; https://doi.org/10.3390/ijerph19020726 - 10 Jan 2022

Cited by 7 | Viewed by 2839

Abstract

Young men who have sex with men (YMSM) in the United States (U.S.) are disproportionally burdened by HIV and experience adverse social determinants of health. Minimal research has examined quality of life (QoL) and psychosocial/behavioral determinants among HIV-negative or status-unknown YMSM. We conducted [...] Read more.

Young men who have sex with men (YMSM) in the United States (U.S.) are disproportionally burdened by HIV and experience adverse social determinants of health. Minimal research has examined quality of life (QoL) and psychosocial/behavioral determinants among HIV-negative or status-unknown YMSM. We conducted a study with YMSM from two U.S. cities to assess their QoL scores, and whether specific QoL domains (e.g., physical, psychological, social, and environment) were associated with their demographics, psychosocial determinants, behavioral risk factors, and HIV prevention measures. Black YMSM, YMSM of low socioeconomic status (below high school education, income < $20,000, and lack of health insurance), and YMSM who did not disclose their sexual orientation had the lowest QoL scores across all domains. Substance use and unprotected anal intercourse were negatively associated with men’s physical/psychosocial health. Housing/food instability and perceived stress were among the strongest predictors of lower QoL in all domains. Higher physical/psychological and environment QoL scores were associated with a higher likelihood of HIV testing and PrEP use. The identification of YMSM within these demographic, behavioral, and psychosocial sub-groups is important for targeted intervention to enhance their well-being and engagement with HIV prevention. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

21 pages, 2408 KiB

Open AccessArticle

Implementation of a Mobile DBT App and Its Impact on Suicidality in Transitional Age Youth with Borderline Personality Disorder: A Qualitative Study

by Tobias Schiffler, Radhika Seiler-Ramadas, Siniša Štefanac, Sandra Haider, Hanna M. Mües and Igor Grabovac

Int. J. Environ. Res. Public Health 2022, 19(2), 701; https://doi.org/10.3390/ijerph19020701 - 8 Jan 2022

Cited by 10 | Viewed by 6240

Abstract

Contemporary performance and accessibility are features that enable mobile devices to be increasingly beneficial in the context of optimizing the treatment of psychiatric disorders. Smartphones have the potential to effectively support psychotherapeutic interventions among adolescents and young adults who require them. In the [...] Read more.

Contemporary performance and accessibility are features that enable mobile devices to be increasingly beneficial in the context of optimizing the treatment of psychiatric disorders. Smartphones have the potential to effectively support psychotherapeutic interventions among adolescents and young adults who require them. In the present study, the use and subjective influence of a smartphone app with content from dialectical behavior therapy (DBT) was investigated among transitional age youth (TAY) with borderline personality disorder, focusing on suicidality and non-suicidal self-injury (NSSI), in a natural setting. A longitudinal qualitative approach was used by means of individual semi-structured interviews, where participants were asked about their experiences and associated emotions before and after a testing period of 30 days. A total of 13 TAY with a diagnosed borderline personality disorder between the ages of 18 and 23 were included. Six overarching themes were identified through qualitative text analysis: (1) experiences with DBT skills, (2) phenomenon of self-harm, (3) feelings connected with self-harm, (4) dealing with disorder-specific symptoms, (5) prevention of self-harm, and (6) attitude toward skills apps. In general, the provision of an app with DBT content achieved a positive response among participants. Despite a small change in the perception of suicidality and NSSI, participants could imagine its benefits by integrating their use of the app as a supportive measure for personal psychotherapy sessions. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

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11 pages, 816 KiB

Open AccessArticle

Relationships of Sexual Orientation Microaggression with Anxiety and Depression among Lesbian, Gay, and Bisexual Taiwanese Youth: Self-Identity Disturbance Mediates but Gender Does Not Moderate the Relationships

by Jung-Sheng Chen, Yu-Te Huang, Chung-Ying Lin, Cheng-Fang Yen, Mark D. Griffiths and Amir H. Pakpour

Int. J. Environ. Res. Public Health 2021, 18(24), 12981; https://doi.org/10.3390/ijerph182412981 - 9 Dec 2021

Cited by 17 | Viewed by 3524

Abstract

The aims of this cross-sectional survey study were to examine the association between sexual orientation microaggression and anxiety and depression among young adult lesbian, gay, and bisexual (LGB) individuals in Taiwan, as well as to examine the mediating effect of self-identity disturbance and [...] Read more.

The aims of this cross-sectional survey study were to examine the association between sexual orientation microaggression and anxiety and depression among young adult lesbian, gay, and bisexual (LGB) individuals in Taiwan, as well as to examine the mediating effect of self-identity disturbance and the moderating effect of gender. In total, 1000 self-identified LGB individuals participated in the study. The experience of sexual orientation microaggression was assessed using the Sexual Orientation Microaggression Inventory, self-identity disturbance was assessed using the Self-Concept and Identity Measure, anxiety was assessed using the State subscale on the Chinese version of the State-Trait Anxiety Inventory, and depression was assessed using the Center for Epidemiological Studies-Depression Scale. Structural equation modeling (SEM) was used to examine relationships between the variables. The SEM results demonstrated that sexual orientation microaggression was directly associated with increased anxiety and depression, as well as being indirectly associated with increased anxiety and depression via the mediation of self-identity disturbance among young adult LGB individuals. Gender did not moderate the relationships between any of the variables. Both sexual orientation microaggression and self-identity disturbance warrant program interventions for enhancing mental health among LGB individuals. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

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9 pages, 655 KiB

Open AccessArticle

Kenyan Women Bearing the Cost of Climate Change

by Elizabeth M. Allen, Leso Munala and Julie R. Henderson

Int. J. Environ. Res. Public Health 2021, 18(23), 12697; https://doi.org/10.3390/ijerph182312697 - 2 Dec 2021

Cited by 14 | Viewed by 6767

Abstract

Climate change-induced crises can aggravate intimate partner violence (IPV); the loss of income when weather affects the agricultural industry can exacerbate violence at home. In Kenya, climate change has increased precipitation during the rainy season and raised temperatures during the dry season, resulting [...] Read more.

Climate change-induced crises can aggravate intimate partner violence (IPV); the loss of income when weather affects the agricultural industry can exacerbate violence at home. In Kenya, climate change has increased precipitation during the rainy season and raised temperatures during the dry season, resulting in floods and droughts. For 75% of Kenyans, agricultural activities are their primary source of income. This research aims to assess patterns in IPV and severe weather events (SWE). We examined Integrated Public Use Microdata Series-Demographic Health Survey (IPUMS-DHS) data from 2008 and 2014 for IPV severity and frequency. We used Emergency Events Database (EM-DAT) data along with GPS coordinates to identify SWEs (defined as any flood >10 days) by county in Kenya. Overall, women were more likely to experience IPV if their spouse worked in agriculture (Odds Ratio (OR) = 1.22, 95% Confidence Interval (CI): 1.10–1.36). There was a 60% increase in the odds of reporting IPV in counties that experienced an SWE as compared to counties that did not experience an SWE (OR = 1.60, 95% CI: 1.35–1.89). This analysis further supports the growing body of research that suggests a relationship between climate change-related weather events and violence against women. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

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16 pages, 813 KiB

Open AccessArticle

Health Inequities in LGBT People and Nursing Interventions to Reduce Them: A Systematic Review

by Jorge Medina-Martínez, Carlos Saus-Ortega, María Montserrat Sánchez-Lorente, Eva María Sosa-Palanca, Pedro García-Martínez and María Isabel Mármol-López

Int. J. Environ. Res. Public Health 2021, 18(22), 11801; https://doi.org/10.3390/ijerph182211801 - 10 Nov 2021

Cited by 93 | Viewed by 31922

Abstract

Background: Lesbian, gay, bisexual, and transgender (LGBT) people present poorer mental and physical health results compared to the heterosexual and cisgender population. There are barriers in the healthcare system that increase these health inequities. Objective: To synthesise the available evidence on how nurses [...] Read more.

Background: Lesbian, gay, bisexual, and transgender (LGBT) people present poorer mental and physical health results compared to the heterosexual and cisgender population. There are barriers in the healthcare system that increase these health inequities. Objective: To synthesise the available evidence on how nurses can intervene in reducing health inequities in LGBT people, identifying their specific health needs and describing their experiences and perceptions of the barriers they face in the healthcare system. Methods: Systematic review. Between March and April 2021, a bibliographic search was carried out in the Cuiden, LILACS, PubMed, Dialnet, SciELO, Trip Database, and Web of Science databases and metasearch engines. Inclusion criteria: Articles published in the last 5 years that address the specific health needs of LGBT people, their experiences and perceptions, or interventions in this group in which nurses may engage. Results: A total of 16 articles were selected. Health disparities were detected in the LGBT community, which exhibited higher rates of mental health problems, substance abuse, risky sexual behaviours, self-harm, and suicide. These inequalities were related to minority stress, and each of them differently impacted individual populations within the broader LGBT community depending on their sexual orientations and gender identities. The impact of these factors was, in turn, modified by the intersections of race/ethnicity, geographic region, and socioeconomic factors. LGBT people described discriminatory experiences by health professionals, as well as their distrust and fear in this setting. Nurses can carry out interventions such as inclusive education about sex and sexual and gender diversity and bullying and suicide prevention programmes, and can provide gender-affirming and family-centred care. Conclusions: LGBT people experience health inequities and discrimination in the healthcare system. Nurses can implement diverse interventions to reduce these problems and, moreover, these health professionals are obliged to acquire cultural competence regarding LGBT health. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

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13 pages, 637 KiB

Open AccessArticle

A Formative Assessment of Social Determinants of Health Related to Early Childhood Caries in Two American Indian Communities

by Kristan Elwell, Carolyn Camplain, Christine Kirby, Katharine Sanderson, Gloria Grover, Gerlinda Morrison, Amy Gelatt and Julie A. Baldwin

Int. J. Environ. Res. Public Health 2021, 18(18), 9838; https://doi.org/10.3390/ijerph18189838 - 18 Sep 2021

Cited by 7 | Viewed by 2815

Abstract

In the United States, children from diverse ethnic groups and those with low socioeconomic status are at a significantly increased risk for early childhood caries. Despite the efforts focused on decreasing early childhood caries in American Indian (AI) populations, these children have the [...] Read more.

In the United States, children from diverse ethnic groups and those with low socioeconomic status are at a significantly increased risk for early childhood caries. Despite the efforts focused on decreasing early childhood caries in American Indian (AI) populations, these children have the highest incidence of dental caries of any ethnic group, with four times the cases of untreated dental caries compared to white children. This qualitative formative assessment was conducted in two AI communities. Semi-structured interviews (n = 57) were conducted with caregivers and providers to understand the social and community contexts in which oral health behaviors and practices occur from the perspective of the caregivers, oral health care providers, and social service providers in the communities. The analysis was informed by the social determinants of health framework. The key social determinants of pediatric oral health relevant to our study communities included limited access to: oral health promoting nutritious foods, transportation for oral health appointments, and pediatric specialty care. This formative assessment provided locally and contextually relevant information to shape the development of an oral health clinical trial intervention to address early childhood caries in these two communities. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

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15 pages, 1262 KiB

Open AccessArticle

Can the Unified Theory of Acceptance and Use of Technology (UTAUT) Help Explain Subjective Well-Being in Senior Citizens due to Gateball Participation?

by Chia-Chien Hsu, Brian Sandford, Chia-Ju Ling and Ching-Torng Lin

Int. J. Environ. Res. Public Health 2021, 18(17), 9015; https://doi.org/10.3390/ijerph18179015 - 26 Aug 2021

Cited by 5 | Viewed by 3607

Abstract

Promoting successful aging strategies through well-reasoned caregiving programs is, and should be, one of the main objectives of many government policies and their implementing agencies. Well-being has been considered an important indicator of successful aging. Leisure is a key life domain and a [...] Read more.

Promoting successful aging strategies through well-reasoned caregiving programs is, and should be, one of the main objectives of many government policies and their implementing agencies. Well-being has been considered an important indicator of successful aging. Leisure is a key life domain and a core ingredient for overall well-being. Yet, within well-being research, few studies have made the connection between leisure participation as accepted behavior and subjective well-being in senior citizens. This study proposed to examine the applicability of the Unified Theory of Acceptance and Use of Technology (UTAUT) in explaining senior citizens’ decision-making processes in terms of leisure participation behavior and the effect of such behavioral engagement on subjective well-being. The respondents were senior citizens in Taiwan who played gateball and were aged 60 years or older. A total of 595 usable responses were obtained and used to answer the research question. The empirical results indicate that performance expectancy, social influence, and facilitating conditions are positively and significantly related to senior citizens’ gateball participation behavior. In addition, gateball participation behavior had a positive and significant effect on respondents’ subjective well-being. The results of this study not only extend the application of UTAUT in terms of participation behavior in leisure activities, but also can provide gateball associations and government entities a theoretical model for developing and promoting gateball programs which serve or involve the elderly, as well as helping older adults to pursue satisfactory levels of wellbeing. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

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10 pages, 813 KiB

Open AccessArticle

Health Literacy and Frailty in Community-Dwelling Older Adults: Evidence from a Nationwide Cohort Study in South Korea

by Hye-Ri Shin, Eun-Young Choi, Su-Kyung Kim, Hee-Yun Lee and Young-Sun Kim

Int. J. Environ. Res. Public Health 2021, 18(15), 7918; https://doi.org/10.3390/ijerph18157918 - 27 Jul 2021

Cited by 11 | Viewed by 3012

Abstract

Health literacy is closely associated with poor health outcomes and mortality. However, only a handful of studies have examined the association between health literacy and frailty status. The current study used data from a nationwide sample of Korean adults aged 70–84 collected from [...] Read more.

Health literacy is closely associated with poor health outcomes and mortality. However, only a handful of studies have examined the association between health literacy and frailty status. The current study used data from a nationwide sample of Korean adults aged 70–84 collected from 10 cities, each of which represents a different region of South Korea (n = 1521). We used the propensity score matching (PSM) method to minimize the potential selection bias and confounding factors that are present in observational studies. After PSM, demographic and health-related characteristics between the limited health literacy (n = 486) and the nonlimited health literacy (n = 486) groups were not significantly different. Multinomial logistic regression analyses were conducted for the PSM-matched sample to examine the association between health literacy and frailty outcomes, where the robust group was set as a reference. Limited health literacy significantly increased the risk of pre-frailty (RRR = 1.45, p = 0.02) and frailty (RRR = 2.03, p = 0.01) after adjusting for demographic and health-related factors. Our findings underscore the need to foster health literacy programs and provide preliminary evidence to inform tailored intervention programs so that we might attenuate the risk of frailty in the older population. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

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14 pages, 356 KiB

Open AccessArticle

Access to Healthcare for Migrant Patients in Europe: Healthcare Discrimination and Translation Services

by Alejandro Gil-Salmerón, Konstantinos Katsas, Elena Riza, Pania Karnaki and Athena Linos

Int. J. Environ. Res. Public Health 2021, 18(15), 7901; https://doi.org/10.3390/ijerph18157901 - 26 Jul 2021

Cited by 45 | Viewed by 6803

Abstract

Background: Discrimination based on ethnicity and the lack of translation services in healthcare have been identified as main barriers to healthcare access. However, the actual experiences of migrant patients in Europe are rarely present in the literature. Objectives: The aim of this study [...] Read more.

Background: Discrimination based on ethnicity and the lack of translation services in healthcare have been identified as main barriers to healthcare access. However, the actual experiences of migrant patients in Europe are rarely present in the literature. Objectives: The aim of this study was to assess healthcare discrimination as perceived by migrants themselves and the availability of translation services in the healthcare systems of Europe. Methods: A total of 1407 migrants in 10 European Union countries (consortium members of the Mig-HealthCare project) were surveyed concerning healthcare discrimination, access to healthcare services, and need of translation services using an interviewer-administered questionnaire. Migrants in three countries were excluded from the analysis, due to small sample size, and the new sample consisted of N = 1294 migrants. Descriptive statistics and multivariable regression analyses were conducted to investigate the risk factors on perceived healthcare discrimination for migrants and refugees in the EU. Results: Mean age was 32 (±11) years and 816 (63.26%) participants were males. The majority came from Syria, Afghanistan, Iraq, Nigeria, and Iran. Older migrants reported better treatment experience. Migrants in Italy (0.191; 95% CI [0.029, 0.352]) and Austria (0.167; 95% CI [0.012, 0.323]) scored higher in the Discrimination Scale to Medical Settings (DMS) compared with Spain. Additionally, migrants with better mental health scored lower in the DMS scale (0.994; 95% CI [0.993, 0.996]), while those with no legal permission in Greece tended to perceive more healthcare discrimination compared with migrants with some kind of permission (1.384; 95% CI [1.189, 1.611]), as opposed to Austria (0.763; 95% CI [0.632, 0.922]). Female migrants had higher odds of needing healthcare assistance but not being able to access them compared with males (1.613; 95% CI [1.183, 2.199]). Finally, migrants with chronic problems had the highest odds of needing and not having access to healthcare services compared with migrants who had other health problems (3.292; 95% CI [1.585, 6.837]). Conclusions: Development of culturally sensitive and linguistically diverse healthcare services should be one of the main aims of relevant health policies and strategies at the European level in order to respond to the unmet needs of the migrant population. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

22 pages, 2131 KiB

Open AccessArticle

The Ecology of Unsheltered Homelessness: Environmental and Social-Network Predictors of Well-Being among an Unsheltered Homeless Population

by Mary-Catherine Anderson, Ashley Hazel, Jessica M. Perkins and Zack W. Almquist

Int. J. Environ. Res. Public Health 2021, 18(14), 7328; https://doi.org/10.3390/ijerph18147328 - 8 Jul 2021

Cited by 21 | Viewed by 8710

Abstract

People experiencing homelessness (PEH) face extreme weather exposure and limited social support. However, few studies have empirically assessed biophysical and social drivers of health outcomes among unsheltered PEH. Social network, health, and outdoor exposure data were collected from a convenience sample of unsheltered [...] Read more.

People experiencing homelessness (PEH) face extreme weather exposure and limited social support. However, few studies have empirically assessed biophysical and social drivers of health outcomes among unsheltered PEH. Social network, health, and outdoor exposure data were collected from a convenience sample of unsheltered PEH (n = 246) in Nashville, TN, from August 2018–June 2019. Using multivariate fixed-effects linear regression models, we examined associations between biophysical and social environments and self-reported general health and emotional well-being. We found that study participants reported the lowest general health scores during winter months—Nashville’s coldest season. We also found a positive association between the number of nights participants spent indoors during the previous week and general health. Participants who spent even one night indoors during the past week had 1.8-point higher general health scores than participants who spent zero nights indoors (p < 0.01). Additionally, participants who experienced a conflict with a social contact in the past 30 days had lower emotional well-being scores than participants who experienced no conflict. Finally, women had worse general health and emotional well-being than men. Ecologically framed research about health and well-being among PEH is critically needed, especially as climate change threatens to increase the danger of many homeless environments. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

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10 pages, 348 KiB

Open AccessArticle

Explicit and Intrinsic Intention to Receive COVID-19 Vaccination among Heterosexuals and Sexual Minorities in Taiwan

by Yen-Ju Lin, Yu-Ping Chang, Wen-Jiun Chou and Cheng-Fang Yen

Int. J. Environ. Res. Public Health 2021, 18(14), 7260; https://doi.org/10.3390/ijerph18147260 - 7 Jul 2021

Cited by 7 | Viewed by 2527

Abstract

The present study compared the levels of explicit and intrinsic intention to receive COVID-19 vaccination among sexual minority and heterosexual individuals and examined the association of explicit and intrinsic intentions with sexual orientation. We enrolled 171 sexual minority and 876 heterosexual individuals through [...] Read more.

The present study compared the levels of explicit and intrinsic intention to receive COVID-19 vaccination among sexual minority and heterosexual individuals and examined the association of explicit and intrinsic intentions with sexual orientation. We enrolled 171 sexual minority and 876 heterosexual individuals through a Facebook advertisement. The participants’ explicit and intrinsic intentions to receive COVID-19 vaccination and their risk perception of COVID-19 were measured. We discovered that sexual minority individuals had higher levels of explicit and intrinsic intention to receive vaccination relative to heterosexual individuals. Intrinsic intention was positively associated with explicit intention after the effects of demographic characteristics and risk perception of COVID-19 were controlled for. Sexual orientation did not moderate the association between explicit and intrinsic intentions. The present study determined the relationship between sexual orientation and intention to receive COVID-19 vaccination. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

13 pages, 346 KiB

Open AccessArticle

Experiences and Interactions with the Healthcare System in Transgender and Non-Binary Patients in Austria: An Exploratory Cross-Sectional Study

by Lovro Markovic, Daragh T. McDermott, Sinisa Stefanac, Radhika Seiler-Ramadas, Darina Iabloncsik, Lee Smith, Lin Yang, Kathrin Kirchheiner, Richard Crevenna and Igor Grabovac

Int. J. Environ. Res. Public Health 2021, 18(13), 6895; https://doi.org/10.3390/ijerph18136895 - 27 Jun 2021

Cited by 15 | Viewed by 4308

Abstract

Medical care of transgender and non-binary (TNB) patients if often a complex interdisciplinary effort involving a variety of healthcare workers (HCWs) and services. Physicians not only act as gatekeepers to routine or transitioning therapies but are also HCWs with the most intimate and [...] Read more.

Medical care of transgender and non-binary (TNB) patients if often a complex interdisciplinary effort involving a variety of healthcare workers (HCWs) and services. Physicians not only act as gatekeepers to routine or transitioning therapies but are also HCWs with the most intimate and time-intensive patient interaction, which influences TNB patients’ experiences and health behaviors and healthcare utilization. The aim of this study was to investigate the physician–patient relationship in a sample of TNB individuals within the Austrian healthcare system, and explore its associations with sociodemographic, health-, and identity-related characteristics. A cross-sectional study utilizing an 56-item online questionnaire, including the Patient-Doctor Relationship Questionnaire 9 (PDRQ-9), was carried out between June and October 2020. The study involved TNB individuals 18 or older, residing in Austria, and previously or currently undergoing medical transition. In total, 91 participants took part, of whom 33.0% and 25.3% self-identified as trans men and trans women, respectively, and 41.8% as non-binary. Among participants, 82.7% reported being in the process of medical transitioning, 58.1% perceived physicians as the most problematic HCWs, and 60.5% stated having never or rarely been taken seriously in medical settings. Non-binary participants showed significantly lower PDRQ-9 scores, reflecting a worse patient–physician relationship compared to trans male participants. TNB patients in Austria often report negative experiences based on their gender identity. Physicians should be aware of these interactions and reflect potentially harmful behavioral patterns in order to establish unbiased and trustful relations. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

7 pages, 503 KiB

Open AccessArticle

Direct and Inverse Correlates of Post-Traumatic Stress Disorder among School-Age Autistic Boys

by Vicki Bitsika and Christopher F. Sharpley

Int. J. Environ. Res. Public Health 2021, 18(10), 5285; https://doi.org/10.3390/ijerph18105285 - 16 May 2021

Cited by 2 | Viewed by 2325

Abstract

Young people with autism are often bullied at school, a potential direct correlate of Post-Traumatic Stress Disorder (PTSD). This may be compounded by their difficulties in social interaction. Alternately, some of these young people may develop ‘coping strategies’ against bullying that may have [...] Read more.

Young people with autism are often bullied at school, a potential direct correlate of Post-Traumatic Stress Disorder (PTSD). This may be compounded by their difficulties in social interaction. Alternately, some of these young people may develop ‘coping strategies’ against bullying that may have an inverse association with PTSD. As a vulnerable population for PTSD, a sample of 71 young males with autism were surveyed for their self-reported experiences of being bullied at school, their coping strategies for dealing with this bullying, and their own evaluations of the severity of two of the key diagnostic criteria for PTSD. Their mothers also provided a rating of the severity of the three major diagnostic criteria for autism for these boys. Over 80% of this sample had been bullied, and there was a significant direct correlation between this and PTSD score, and between their mother-rated severity of the boys’ social interaction difficulties, but also a significant inverse correlation between their coping strategies and PTSD score. There were differences in these relationships according to whether the boys attended elementary or secondary school. These findings hold implications for the identification, assessment and support of autistic youth at risk of PTSD. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

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26 pages, 374 KiB

Open AccessArticle

Development of Measures of Perceived Neighborhood Environmental Attributes Influencing, and Perceived Barriers to Engagement in, Healthy Behaviors for Older Chinese Immigrants to Australia

by Ester Cerin, Shiyuan Yin, Wing Ka Choi, Winsfred Ngan, Rachel Tham and Anthony Barnett

Int. J. Environ. Res. Public Health 2021, 18(9), 4531; https://doi.org/10.3390/ijerph18094531 - 24 Apr 2021

Cited by 1 | Viewed by 2662

Abstract

Environmental correlates, barriers, and facilitators of physical activity, healthy eating, and socializing are understudied in older immigrants to developed countries. This study developed/adapted and validated measures of perceived barriers and neighborhood environmental characteristics related to these health-enhancing behaviors appropriate for older Chinese immigrants [...] Read more.

Environmental correlates, barriers, and facilitators of physical activity, healthy eating, and socializing are understudied in older immigrants to developed countries. This study developed/adapted and validated measures of perceived barriers and neighborhood environmental characteristics related to these health-enhancing behaviors appropriate for older Chinese immigrants to Australia and similar Western countries. Older Chinese immigrants living in Melbourne (Australia) were recruited from neighborhoods varying in walkability and percentage of Chinese residents. Versions of the Neighborhood Environment for Healthy Aging–Chinese Immigrants to Australia (NEHA-CIA) questionnaire (20 subscales) and the Perceived Barriers to Health-Enhancing Behaviors questionnaire (four subscales) were developed from extant validated scales and information collected in formative qualitative research. Thirty-one participants took part in cognitive interviews aimed to pilot-test and refine the questionnaires. The modified questionnaires were administered to 52 participants twice, two weeks apart. Test-retest reliability (intraclass correlation coefficients), internal consistency (Cronbach’s α), and construct validity (associations with theoretically-relevant constructs) were examined. Most items and subscales of both questionnaires had good test-retest reliability and internal consistency, while the NEHA-CIA also showed good construct validity. Future studies need to further examine the construct validity of the questionnaire of perceived barriers and determine the factorial validity of both measures on large representative samples. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

Review

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30 pages, 1007 KiB

Open AccessReview

A Scoping Review of the Health Impact of the COVID-19 Pandemic on Persons Experiencing Homelessness in North America and Europe

by Julia Corey, James Lyons, Austin O’Carroll, Richie Stafford and Jo-Hanna Ivers

Int. J. Environ. Res. Public Health 2022, 19(6), 3219; https://doi.org/10.3390/ijerph19063219 - 9 Mar 2022

Cited by 15 | Viewed by 5714

Abstract

Persons experiencing homelessness (PEH) are at heightened risk for infection, morbidity, and mortality from COVID-19. However, health consequences of the pandemic extend far beyond those directly caused by the virus. This scoping review aimed to explore the impacts of the COVID-19 pandemic on [...] Read more.

Persons experiencing homelessness (PEH) are at heightened risk for infection, morbidity, and mortality from COVID-19. However, health consequences of the pandemic extend far beyond those directly caused by the virus. This scoping review aimed to explore the impacts of the COVID-19 pandemic on the health and well-being of PEH in North America and Europe. A systematic search of academic and grey literature was conducted in September 2021. To be included, studies had to include primary data related to the impact of the pandemic on health or well-being of PEH and be written in English. All potentially relevant references were independently screened by two reviewers, and minor conflicts were settled with input of a third reviewer. A total of 96 articles met criteria for inclusion. Data extraction was completed for all included studies, and findings synthesised and presented thematically. Numerous health impacts of the pandemic on PEH were identified, including SARS-CoV-2 infection, morbidity, mortality, and hospitalisation, fear of infection, access to housing, hygiene, PPE, food, as well as mental health, substance use, other health-related outcomes and treatment services. Gaps in the literature relating to persons using alcohol, access to mental health support, and violence were also identified. Implications for future research are discussed. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

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10 pages, 473 KiB

Open AccessReview

Health Care for Refugees in Europe: A Scoping Review

by Anna Christina Nowak, Yudit Namer and Claudia Hornberg

Int. J. Environ. Res. Public Health 2022, 19(3), 1278; https://doi.org/10.3390/ijerph19031278 - 24 Jan 2022

Cited by 27 | Viewed by 5340

Abstract

Background: Accessing and using health care in European countries pose major challenges for asylum seekers and refugees due to legal, linguistic, administrative, and knowledge barriers. This scoping review will systematically describe the literature regarding health care for asylum seekers and refugees in high-income [...] Read more.

Background: Accessing and using health care in European countries pose major challenges for asylum seekers and refugees due to legal, linguistic, administrative, and knowledge barriers. This scoping review will systematically describe the literature regarding health care for asylum seekers and refugees in high-income European countries, and the experiences that they have in accessing and using health care. Methods: Three databases in the field of public health were systematically searched, from which 1665 studies were selected for title and abstract screening, and 69 full texts were screened for eligibility by the main author. Of these studies, 44 were included in this systematic review. A narrative synthesis was undertaken. Results: Barriers in access to health care are highly prevalent in refugee populations, and can lead to underusage, misuse of health care, and higher costs. The qualitative results suggest that too little attention is paid to the living situations of refugees. This is especially true in access to care, and in the doctor-patient interaction. This can lead to a gap between needs and care. Conclusions: Although the problems refugees and asylum seekers face in accessing health care in high-income European countries have long been documented, little has changed over time. Living conditions are a key determinant for accessing health care. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

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25 pages, 2480 KiB

Open AccessFeature PaperReview

Engaging People and Co-Producing Research with Persons and Communities to Foster Person-Centred Care: A Meta-Synthesis

by Beatriz Vallina Acha, Estrella Durá Ferrandis, Mireia Ferri Sanz and Maite Ferrando García

Int. J. Environ. Res. Public Health 2021, 18(23), 12334; https://doi.org/10.3390/ijerph182312334 - 24 Nov 2021

Cited by 4 | Viewed by 2971

Abstract

Introduction: Engagement and co-production in healthcare research and innovation are crucial for delivering person-centred interventions in underserved communities, but the knowledge of effective strategies to target this population is still vague, limiting the provision of person-centred care. Our research aimed to identify essential [...] Read more.

Introduction: Engagement and co-production in healthcare research and innovation are crucial for delivering person-centred interventions in underserved communities, but the knowledge of effective strategies to target this population is still vague, limiting the provision of person-centred care. Our research aimed to identify essential knowledge to foster engagement and co-production. Materials and Methods: A meta-synthesis research design was used to compile existing qualitative research papers on health communication, engagement, and empowerment in vulnerable groups in high-income countries (HICs) from 2008 to 2018. A total of 23 papers were selected and analysed. Results: ‘Design and recruitment’ and ‘engagement and co-production’ thematic areas are presented considering the factors related to researcher–communities attunement and the strategical plans for conducting research. The insights are discussed in light of the literature. Long-term alliances, sustainable structures, and strengthened bonds are critical factors for producing real long-term change, empowering persons and communities, and paving the way to person-centred care. Conclusions: The enhancement of the recruitment, involvement, and empowerment of traditionally disengaged communities and individuals depends on the awareness and analysis of social determinants, power differentials and specific tactics, and the capacity of researchers and individuals to apply all these principles in real-world practice. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

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11 pages, 1845 KiB

Open AccessReview

Laparoscopy in Low-Income Countries: 10-Year Experience and Systematic Literature Review

by Damiano Pizzol, Mike Trott, Igor Grabovac, Mario Antunes, Anna Claudia Colangelo, Simona Ippoliti, Cristian Petre Ilie, Anne Carrie, Nicola Veronese and Lee Smith

Int. J. Environ. Res. Public Health 2021, 18(11), 5796; https://doi.org/10.3390/ijerph18115796 - 28 May 2021

Cited by 10 | Viewed by 4068

Abstract

Laparoscopy is a procedure that ultimately reduces hospital stay time and speeds up post-operative recovery. It is mainly performed in high-income countries but its implementation in many low- and middle-income countries (LMICs) is increasing. However, no aggregate data exist regarding the outcomes of [...] Read more.

Laparoscopy is a procedure that ultimately reduces hospital stay time and speeds up post-operative recovery. It is mainly performed in high-income countries but its implementation in many low- and middle-income countries (LMICs) is increasing. However, no aggregate data exist regarding the outcomes of this procedure in resource-limited settings. We retrospectively reviewed all cases of laparoscopy recorded from January 2007 to March 2017 at the Department of Surgery of Beira to assess the related outcomes. Moreover, we performed a systematic review of the laparoscopic practices and outcomes in low-income countries. Data from the Department of Surgery of Beira identified 363 laparoscopic procedures, mainly relating to gynecological diseases, cholelithiasis, and appendicectomy with only a 1.6% complication rate (6 cases) and a 1.9% conversion rate (7 cases) to open surgery. The systematic review showed a pooled risk of overall complications significantly lower in laparoscopic vs. open appendicectomy (OR = 0.43; 95% CI 0.19–0.97; I² = 85.7%) and a significantly lower risk of infection (OR = 0.53; 95% CI 0.43–0.65; I² = 0.00%). The pooled SMD in operation duration in laparoscopic vs. open appendectomy was 0.58 (95% CI −0.00; 1.15; I² = 96.52), while the pooled SMD in hospitalization days was −1.35 (95% CI −1.87; −0.82; I² = 96.41). Laparoscopy is an expensive procedure to adopt as it requires new equipment and specialized trained health workers. However, it could reduce post-operative costs and complications, especially in terms of infections. It is crucial to increase its accessibility, acceptability, and quality particularly in LMICs, especially during this COVID-19 era when the reduction of patient hospitalization is essential. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

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Other

Jump to: Research, Review

14 pages, 912 KiB

Open AccessSystematic Review

Characteristics and Effectiveness of Co-Designed Mental Health Interventions in Primary Care for People Experiencing Homelessness: A Systematic Review

by Tobias Schiffler, Ali Kapan, Alina Gansterer, Thomas Pass, Lisa Lehner, Alejandro Gil-Salmeron, Daragh T. McDermott and Igor Grabovac

Int. J. Environ. Res. Public Health 2023, 20(1), 892; https://doi.org/10.3390/ijerph20010892 - 3 Jan 2023

Cited by 7 | Viewed by 4806

Abstract

People experiencing homelessness (PEH) face a disproportionately high prevalence of adverse mental health outcomes compared with the non-homeless population and are known to utilize primary healthcare services less frequently while seeking help in emergency care facilities. Given that primary health services are more [...] Read more.

People experiencing homelessness (PEH) face a disproportionately high prevalence of adverse mental health outcomes compared with the non-homeless population and are known to utilize primary healthcare services less frequently while seeking help in emergency care facilities. Given that primary health services are more efficient and cost-saving, services with a focus on mental health that are co-designed with the participation of users can tackle this problem. Hence, we aimed to synthesize the current evidence of such interventions to assess and summarize the characteristics and effectiveness of co-designed primary mental healthcare services geared towards adult PEH. Out of a total of 10,428 identified records, four articles were found to be eligible to be included in this review. Our findings show that co-designed interventions positively impacted PEH’s mental health and housing situation or reduced hospital and emergency department admissions and increased primary care utilization. Therefore, co-designed mental health interventions appear a promising way of providing PEH with continued access to primary mental healthcare. However, as co-designed mental health interventions for PEH can improve overall mental health, quality of life, housing, and acute service utilization, more research is needed. Full article

(This article belongs to the Special Issue Health and Well-Being in Vulnerable Communities)

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