Sociodemographic data collection for health equity measurement: a mixed methods study examining public opinions

Monitoring inequalities in healthcare is increasingly being recognized as a key first step in providing equitable access to quality care. However, the detailed sociodemographic data that are necessary for monitoring are currently not routinely collected from patients in many jurisdictions. We undertook a mixed methods study to generate a more in-depth understanding of public opinion on the collection of patient sociodemographic information in healthcare settings for equity monitoring purposes in Ontario, Canada. The study included a provincial survey of 1,306 Ontarians, and in-depth interviews with a sample of 34 individuals. Forty percent of survey participants disagreed that it was important for information to be collected in healthcare settings for equity monitoring. While there was a high level of support for the collection of language, a relatively large proportion of survey participants felt uncomfortable disclosing household income (67%), sexual orientation (40%) and educational background (38%). Variation in perceived importance and comfort with the collection of various types of information was observed among different survey participant subgroups. Many in-depth interview participants were also unsure of the importance of the collection of sociodemographic information in healthcare settings and expressed concerns related to potential discrimination and misuse of this information. Study findings highlight that there is considerable concern regarding disclosure of such information in healthcare settings among Ontarians and a lack of awareness of its purpose that may impede future collection of such information. These issues point to the need for increased education for the public on the purpose of sociodemographic data collection as a strategy to address this problem, and the use of data collection strategies that reduce discomfort with disclosure in healthcare settings

Magnitude of income-related disparities in adverse perinatal outcomes

BACKGROUND: To assess and compare multiple measurements of socioeconomic position (SEP) in order to determine the relationship with adverse perinatal outcomes across various contexts. METHODS: A birth registry, the Nova Scotia Atlee Perinatal Database, was confidentially linked to income tax and related information for the year in which delivery occurred. Multiple logistic regression was used to examine odds ratios between multiple indicators of SEP and multiple adverse perinatal outcomes in 117734 singleton births between 1988 and 2003. Models for after tax family income were also adjusted for neighborhood deprivation to gauge the relative magnitude of effects related to SEP at both levels. Effects of SEP were stratified by single- versus multiple-parent family composition, and by urban versus rural location of residence. RESULTS: The risk of small for gestational age and spontaneous preterm birth was higher across all the indicators of lower SEP, while risk for large for gestational age was lower across indicators of lower SEP. Higher risk of postneonatal death was demonstrated for several measures of lower SEP. Higher material deprivation in the neighborhood of residence was associated with increased risk for perinatal death, small for gestational age birth, and iatrogenic and spontaneous preterm birth. Family composition and urbanicity were shown to modify the association between income and some perinatal outcomes. CONCLUSIONS: This study highlights the importance of understanding the definitions of SEP and the mechanisms that lead to the association between income and poor perinatal outcomes, and broadening the types of SEP measures used in some cases

Personal activity centres and geosocial data analysis: Combining big data with small data

Understanding how people move and interact within urban settings has been greatly facilitated by the expansion of personal computing and mobile studies. Geosocial data derived from social media applications have the potential to both document how large segments of urban populations move about and use space, as well as how they interact with their environments. In this paper we examine spatial and temporal clustering of individuals’ geosocial messages as a way to derive personal activity centres for a subset of Twitter users in the City of Toronto. We compare the two types of clustering, and for a subset of users, compare to actual self-reported activity centres. Our analysis reveals that home locations were detected within 500 m for up to 53% of users using simple spatial clustering methods based on a sample of 16 users. Work locations were detected within 500 m for 33% of users. Additionally, we find that the broader pattern of geosocial footprints indicated that 35% of users have only one activity centre, 30% have two activity centres, and 14% have three activity centres. Tweets about environment were more likely sent from locations other than work and home, and when not directed to another user. These findings indicate activity centres defined from Twitter do relate to general spatial activities, but the limited degree of spatial variability on an individual level limits the applications of geosocial footprints for more detailed analyses of movement patterns in the city

A unified ecological framework for studying effects of digital places on well-being

Social media has greatly expanded opportunities to study place and well-being through the availability of human expressions tagged with physical location. Such research often uses social media content to study how specific places in the offline world influence well-being without acknowledging that digital platforms (e.g., Twitter, Facebook, Youtube, Yelp) are designed in unique ways that structure certain types of interactions in online and offline worlds, which can influence place-making and well-being. To expand our understanding of the mechanisms that influence social media expressions about well-being, we describe an ecological framework of person-place interactions that asks, “at what broad levels of interaction with digital platforms and physical environments do effects on well-being manifest?” The person is at the centre of the ecological framework to recognize how people define and organize both digital and physical communities and interactions. The relevance of interactions in physical environments depends on the built and natural characteristics encountered across modes of activity (e.g., domestic, work, study). Here, social interactions are stratified into the meso-social (e.g., local social norms) and micro-social (e.g., personal conversations) levels. The relevance of interactions in digital platforms is contingent on specific hardware and software elements. Social interactions at the meso-social level include platform norms and passive use of social media, such as observing the expressions of others, whereas interactions at the micro-level include more active uses, like direct messaging. Digital platforms are accessed in a physical location, and physical locations are partly experienced through online interactions; therefore, interactions between these environments are also acknowledged. We conclude by discussing the strengths and limitations of applying the framework to studies of place and well-being

A Realist Explanatory Case Study Investigating How Common Goals, Leadership, and Committed Staff Facilitate Health in All Policies Implementation in the Municipality of Kuopio, Finland

Background: Health in All Policies (HiAP) encompasses collaboration across government and the consideration of health in various governmental sector’s policies and decisions. Despite increasing advocacy, interest, and uptake in HiAP globally, empirical and evaluative studies are underrepresented in this growing literature, particularly literature on HiAP implementation at the local level. Finland has been a pioneer in and champion for HiAP. Methods: A realist explanatory case study design was used to test hypotheses about how HiAP is implemented in Kuopio, Finland. Semi-structured interviews with ten government employees from various sectors were conducted. Data from interviews and literature were analyzed with the aims of uncovering explanatory mechanisms in the form of context-strategy-mechanism-outcome (CSMO) configurations related to implementation strategies. Evidence was evaluated for quality based on triangulation of sources and strength of evidence. We hypothesized that having or creating a common goal between sectors and having committed staff and local leadership would facilitate implementation. Results: Strong evidence supports our hypothesis that having or creating a common goal can aid in positive implementation outcomes at the local level. Common goals can be created by the strategies of having a city mandate, engaging in cross-sectoral discussions, and/or by working together. Policy and political elite leadership led to HiAP implementation success because leaders supported HiAP work, thus providing justification for using time to work intersectorally. How and why the wellbeing committee facilitated implementation included by providing opportunities for discussion and learning, which led to understanding of how non-health decisions impact community wellbeing, and by acting as a conduit for the communication of wellbeing goals to government employees. Conclusion: At the municipal level, having or creating a common goal, leadership from policy and political elites, and the presence of committed staff can facilitate HiAP implementation. Inclusion of not only strategies for HiAP, but also the explanatory mechanisms, aids in elucidating how and why HiAP is successfully implemented in a local setting.publishedVersionPeer reviewe

Spatio-temporal distribution of negative emotions in New York City after a natural disaster as seen in social media

Disasters have substantial consequences for population mental health. We used Twitter to (1) extract negative emotions indicating discomfort in New York City (NYC) before, during, and after Superstorm Sandy in 2012. We further aimed to (2) identify whether pre- or peri-disaster discomfort were associated with peri- or post-disaster discomfort, respectively, and to (3) assess geographic variation in discomfort across NYC census tracts over time. Our sample consisted of 1,018,140 geo-located tweets that were analyzed with an advanced sentiment analysis called "Extracting the Meaning Of Terse Information in a Visualization of Emotion" (EMOTIVE). We calculated discomfort rates for 2137 NYC census tracts, applied spatial regimes regression to find associations of discomfort, and used Moran's I for spatial cluster detection across NYC boroughs over time. We found increased discomfort, that is, bundled negative emotions after the storm as compared to during the storm. Furthermore, pre- and peri-disaster discomfort was positively associated with post-disaster discomfort; however, this association was different across boroughs, with significant associations only in Manhattan, the Bronx, and Queens. In addition, rates were most prominently spatially clustered in Staten Island lasting pre- to post-disaster. This is the first study that determined significant associations of negative emotional responses found in social media posts over space and time in the context of a natural disaster, which may guide us in identifying those areas and populations mostly in need for care

Big data opportunities for social behavioral and mental health research

Big data opportunities for social behavioral and mental health researc

Ideas for Extending the Approach to Evaluating Health in All Policies in South Australia Comment on “Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia”

Abstract Since 2008, the government of South Australia has been using a Health in All Policies (HiAP) approach to achieve their strategic plan (South Australia Strategic Plan of 2004). In this commentary, we summarize some of the strengths and contributions of the innovative evaluation framework that was developed by an embedded team of academic researchers. To inform how the use of HiAP is evaluated more generally, we also describe several ideas for extending their approach, including: deeper integration of interdisciplinary theory (eg, public health sciences, policy and political sciences) to make use of existing knowledge and ideas about how and why HiAP works; including a focus on implementation outcomes and using developmental evaluation (DE) partnerships to strengthen the use of HiAP over time; use of systems theory to help understand the complexity of social systems and changing contexts involved in using HiAP; integrating economic considerations into HiAP evaluations to better understand the health, social and economic benefits and trade-offs of using HiA

Stresscapes: validating linkages between place and stress expression on social media

Understanding how individuals and groups perceive their surroundings and how different physical and social environments may influence their state-of-mind has intrigued re-searchers for some time. Much of this research has focused on investigating why certain natural and human-built places can engender specific emotive responses (e.g. fear, disgust, joy, etc.) and, by extension, how these responses can be considered in placemaking activities such as urban planning and design. Developing a better understanding of the linkages between place and emotional state is challenging in part because both cognitive processes and the concept of place are complex, dynamic and multi-faceted and are mediated by a confluence of contextual, individual and social processes. There is evidence to suggest that social media data produced by individuals in situ and in near real-time may provide novel insights into the nature and dynamics of individuals’ responses to their surroundings. The explosion of user-generated digital data and the sensorization of environments, especially in urban settings, provide opportunities to build knowledge of place and state-of-mind linkages that will inform the design and promotion of vibrant placemaking by individuals and communities. In this paper we present a novel study, to be undertaken this summer within the Greater Toronto area in Canada, with 140 recruited participants who are frequent, geo-tagging, Twitter users. The goal of the study will be to assess emotional, acute and chronic stress experienced in urban built-environments and as expressed during daily activities. An existing automated semantic natural language processing tool will be validated through this study, and it is hoped that the methodology developed can be extrapolated to other urban environments as well, with a second validation study already planned to take place next year in London, United Kingdom