Improving Social Justice in COVID-19 Health Research: Interim guidelines for reporting health equity in observational studies

The COVID-19 pandemic has highlighted the global imperative to address health inequities. Observational studies are a valuable source of evidence for real-world effects and impacts of implementing COVID-19 policies on the redistribution of inequities. We assembled a diverse global multi-disciplinary team to develop interim guidance for improving transparency in reporting health equity in COVID-19 observational studies. We identified 14 areas in the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist that need additional detail to encourage transparent reporting of health equity. We searched for examples of COVID-19 observational studies that analysed and reported health equity analysis across one or more social determinants of health. We engaged with Indigenous stakeholders and others groups experiencing health inequities to co-produce this guidance and to bring an intersectional lens. Taking health equity and social determinants of health into account contributes to the clinical and epidemiological understanding of the disease, identifying specific needs and supporting decision-making processes. Stakeholders are encouraged to consider using this guidance on observational research to help provide evidence to close the inequitable gaps in health outcomes

Health Care Access and Utilization by Young Mothers Experiencing Homelessness: A Bourdieusian Analysis with an Arts-Based Approach

Young mothers experiencing homelessness and their children have low economic and social resources and worse physical and mental health outcomes than their more resourced counterparts. Furthermore, their use of health care resources is constrained by social factors that remain understudied. Following a relational approach based on Bourdieuâ s theory of practice, this study aimed to explore and understand the relationships between the social position that these young mothers occupy and their health practices (access/use of healthcare resources and other behaviors). This study also sought the impact of an arts-based approach on community involvement. Through qualitative inquiry I used discursive montage and participatory graphic elicitation. The former consisted of an analysis of the media artifacts on young mothers experiencing homelessness, aiming to understand how they are socially positioned and how this relates to social structures. The graphic elicitation consisted of a semi-structured and an elicitation interview, the latter based on their artwork created during the study. The artwork created by young mothers, volunteers, and by myself was included in the analysis; it was also a tool for my reflexive process. All data were analyzed through a dynamic process of data abstraction using Bourdieuâ s concepts of habitus, capital, and field. Results showed an embodiment of the social values related to the conceptualization of youth that excludes young homeless mothers and sees them as deviant. Young mothers are portrait in the media as unskilled and immature, with a low chance of social success. The contradictions drawn from this social construction of youth and mothering affect not only their daily life but how they take care of their health and that of their children. Participants tended to avoid situations in which they may feel judged or brushed off, which resulted in them minimizing their encounters with healthcare providers. This study has identified a healthcare gap related to the adequacy of existing resources, as well as a need for creative approaches to connecting young mothers with providers.Ph.D

Development of a Core Outcome Set for Studies on Obesity in Pregnant Patients (COSSOPP): a study protocol

Abstract Background Maternal obesity is a risk factor for adverse maternal, fetal, and neonatal events. Numerous clinical trials are currently exploring the effectiveness of antenatal and peripartum interventions in improving pregnancy outcomes that can in future inform clinical practice. However, the heterogeneity in outcome reporting limits our ability to compare outcomes across studies, and there is a lack of stakeholder representation in outcome choice. A pragmatic solution to this problem is the development of a core outcome set (COS) that defines the minimum criteria for outcome reporting in clinical trials undertaken in this population, arrived at by the involvement of relevant stakeholders. Methods The development of a COS for studies on obesity in pregnant patients (COSSOPP) will comprise five steps. First, a systematic review of published literature will identify the long list of outcomes, their definitions and measurements if applicable, and outcome reporting quality. This will be followed by a meta-synthesis of qualitative studies with patients, and qualitative interviews in Toronto with patients, clinicians, researchers, hospital administrators, and policy-makers, to identify novel outcomes that were not obtained through systematic review. Third, the long list of outcomes will be narrowed down through online Delphi surveys involving an international group of patients and relevant stakeholders. This will be followed by a face-to-face consensus meeting with representatives of all stakeholder groups to arrive at a consensus on the final COS. Finally, in order to determine how the identified core outcomes should be measured, we will conduct another literature review and Delphi process. Discussion COSSOPP will engage patients, clinicians, researchers, and other relevant stakeholders in determining the core set of outcomes that should be reported and measured in order to harmonize outcome reporting in studies evaluating the effectiveness of antepartum and peripartum interventions in obese pregnant women. This protocol provides a detailed overview of the steps involved in the development of a COS, to guide researchers in developing COS within their areas of specialization. COMET Core Outcome Set Registration http://www.comet-initiative.org/studies/details/939

Calidad de vida de trabajadoras inmigrantes latinoamericanas como cuidadoras en España

Objetivo: Describir la calidad de vida percibida en trabajadoras latinoamericanas como cuidadoras en España y sus diferencias en relación a ciertas variables que les son comunes. Métodos: Se utilizó el cuestionario SF-36 para la medición de la calidad de vida percibida en 517 mujeres de Baleares, Cataluña, País Vasco, Canarias y Madrid. Se estudiaron diversas variables relacionadas con su perfil sociodemográfico y proceso migratorio, usando la prueba t de Student, el test ANOVA y modelos de regresión lineal. Resultados: Obtuvieron muy bajas puntuaciones en las dimensiones de rol físico y rol emocional. El trabajo como interna, la falta de contrato, las múltiples tareas, el estatus irregular y la edad más joven se relacionaron con una peor calidad de vida dentro del grupo. Conclusiones: Las condiciones laborales y los factores ligados al proceso migratorio son determinantes para explicar la vulnerabilidad de estas mujeres

Physicians’ perspectives on COVID-19 vaccinations for children: a qualitative exploration in Ontario, Canada

Objectives Parents’ decisions to vaccinate their children against COVID-19 are complex and often informed by discussions with primary care physicians. However, little is known about physicians’ perspectives on COVID-19 vaccinations for children or their experiences counselling parents in their decision-making. We explored physicians’ experiences providing COVID-19 vaccination recommendations to parents and their reflections on the contextual factors that shaped these experiences.Design We conducted an interpretive qualitative study using in-depth interviews. We analyzed the data using reflexive thematic analysis and a socioecological framework.Setting This study involved primary care practices associated with The Applied Research Group for Kids (TARGet Kids!) primary care research network in the Greater Toronto Area, Ontario, Canada.Participants Participants were 10 primary care physicians, including family physicians, paediatricians and paediatric subspecialists.Results Participants discussed elements at the individual level (their identity, role, and knowledge), the interpersonal level (their relationships with families, responsiveness to parents’ concerns, and efforts to build trust) and structural level (contextual factors related to the evolving COVID-19 climate, health system pandemic response, and constraints on care delivery) that influenced their experiences providing recommendations to parents. Our findings illustrated that physicians’ interactions with families were shaped by a confluence of their own perspectives, their responses to parents’ perspectives, and the evolving landscape of the broader pandemic.Conclusions Our study underscores the social and relational nature of vaccination decision-making and highlights the multiple influences on primary care physicians’ experiences providing COVID-19 vaccination recommendations to parents. Our findings offer suggestions for future COVID-19 vaccination programmes for children. Delivery of new COVID-19 vaccinations for children may be well suited within primary care offices, where trusting relationships are established, but physicians need support in staying knowledgeable about emerging information, communicating available evidence to parents to inform their decision-making and dedicating time for vaccination counselling

Calidad de vida de trabajadoras inmigrantes latinoamericanas como cuidadoras en España.

[eng]tObjective: To describe perceived quality of life in Latin American caregivers working in Spain and how itvaries in relation to certain variables shared by this group.Methods: We used the SF-36 to measure perceived quality of life in 517 women residing in five Spanishregions: the Balearic Islands, Catalonia, the Basque Country, the Canary Islands, and Madrid. Severalvariables related to the socio-demographic profile and migration process were studied using Student's ttest, ANOVA and linear regression models.Results: The participants scored very low on the dimensions of physical and emotional roles. The factorsassociated with lower quality of life scores within the group were working as a live-in caregiver, lack ofcontract, multitasking, irregular status, and younger age.Conclusions: The vulnerability of these women can be explained by poor working conditions and otherfactors related to the migratory process. [spa]Objetivos: Describir la calidad de vida percibida en trabajadoras latinoamericanas como cuidadoras en España y sus diferencias en relación a ciertas variables que les son comunes. Métodos: Se utilizó el cuestionario SF-36 para la medición de la calidad de vida percibida en 517 mujeres de Baleares, Cataluña, País Vasco, Canarias y Madrid. Se estudiaron diversas variables relacionadas con su perfil sociodemográfico y proceso migratorio usando la prueba de t de Student, el test ANOVA y modelos de regresión lineal. Resultados: Obtuvieron muy bajas puntuaciones en las dimensiones de rol físico y rol emocional. El trabajo como interna, la falta de contrato, las múltiples tareas, el estatus irregular y la edad más joven se relacionaron con una peor calidad de vida dentro del grupo. Conclusiones: Las condiciones laborales y factores ligados al proceso migratorio son determinantes para explicar la vulnerabilidad de estas mujeres

Improving social justice in observational studies : protocol for the development of a global and Indigenous STROBE-equity reporting guideline

Altres ajuts: Canadian Institutes of Health Research (CIHR), grant number 173269.Background: Addressing persistent and pervasive health inequities is a global moral imperative, which has been highlighted and magnified by the societal and health impacts of the COVID-19 pandemic. Observational studies can aid our understanding of the impact of health and structural oppression based on the intersection of gender, race, ethnicity, age and other factors, as they frequently collect this data. However, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline, does not provide guidance related to reporting of health equity. The goal of this project is to develop a STROBE-Equity reporting guideline extension. Methods: We assembled a diverse team across multiple domains, including gender, age, ethnicity, Indigenous background, disciplines, geographies, lived experience of health inequity and decision-making organizations. Using an inclusive, integrated knowledge translation approach, we will implement a five-phase plan which will include: (1) assessing the reporting of health equity in published observational studies, (2) seeking wide international feedback on items to improve reporting of health equity, (3) establishing consensus amongst knowledge users and researchers, (4) evaluating in partnership with Indigenous contributors the relevance to Indigenous peoples who have globally experienced the oppressive legacy of colonization, and (5) widely disseminating and seeking endorsement from relevant knowledge users. We will seek input from external collaborators using social media, mailing lists and other communication channels. Discussion: Achieving global imperatives such as the Sustainable Development Goals (e.g., SDG 10 Reduced inequalities, SDG 3 Good health and wellbeing) requires advancing health equity in research. The implementation of the STROBE-Equity guidelines will enable a better awareness and understanding of health inequities through better reporting. We will broadly disseminate the reporting guideline with tools to enable adoption and use by journal editors, authors, and funding agencies, using diverse strategies tailored to specific audiences

A scoping review establishes need for consensus guidance on reporting health equity in observational studies

Objective To evaluate the support from the available guidance on reporting of health equity in research for our candidate items and to identify additional items for the STROBE (Strengthening Reporting of Observational studies in Epidemiology)-Equity extension. Study design and setting We conducted a scoping review by searching Embase, MEDLINE, CINAHL, Cochrane Methodology Register, LILACS, and Caribbean Centre on Health Sciences Information up to January 2022. We also searched reference lists and grey literature for additional resources. We included guidance and assessments (hereafter termed “resources”) related to conduct and/or reporting for any type of health research with or about people experiencing health inequity. Results We included thirty-four resources, which supported one or more candidate items or contributed to new items about health equity reporting in observational research. Each candidate item was supported by a median of six (range: 1 - 15) resources. In addition, 12 resources suggested 13 new items, such as “report the background of investigators”. Conclusions Existing resources for reporting health equity in observational studies aligned with our interim checklist of candidate items. We also identified additional items that will be considered in the development of a consensus- and evidence-based guideline for reporting health equity in observational studies