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

Case managers’ reflections of a brief case management intervention in Canada

IntroductionAs demand for intensive case management services continues to outpace supply, community mental health agencies in Toronto, Ontario, introduced Short-Term Case Management (STCM).ObjectiveThis study sought to explore case managers’ perspectives and experiences with this new service delivery model.MethodsFocus groups were conducted with twenty-one case managers, and transcripts analyzed using thematic analysis.ResultsEmerging themes suggest that despite embracing a recovery approach, case managers expressed mixed views on the acceptability and appropriateness of this service delivery model as an intervention.ConclusionThe ideal population for this intervention are adults with mental health issues in need of system navigation, and those motivated to address their goals. Further research is needed to establish fidelity criteria

Public awareness of income-related health inequalities in Ontario, Canada

Abstract Introduction Continued action is needed to tackle health inequalities in Canada, as those of lower income continue to be at higher risk for a range of negative health outcomes. There is arguably a lack of political will to implement policy change in this respect. As a result, we investigated public awareness of income-related health inequalities in a generally representative sample of Ontarians in late 2010. Methods Data were collected from 2,006 Ontario adults using a telephone survey. The survey asked participants to agree or disagree with various statements asserting that there are or are not health inequalities in general and by income in Ontario, including questions pertaining to nine specific conditions for which inequalities have been described in Ontario. A multi-stage process using binary logistic regression determined whether awareness of health inequalities differed between participant subgroups. Results Almost 73% of this sample of Ontarians agreed with the general premise that not all people are equally healthy in Ontario, but fewer participants were aware of health inequalities between the rich and the poor (53%–64%, depending on the framing of the question). Awareness of income-related inequalities in specific outcomes was considerably lower, ranging from 18% for accidents to 35% for obesity. Conclusions This is the first province-wide study in Canada, and the first in Ontario, to explore public awareness on health inequalities. Given that political will is shaped by public awareness and opinion, these results suggest that greater awareness may be required to move the health equity agenda forward in Ontario. There is a need for health equity advocates, physicians and researchers to increase the effectiveness of knowledge translation activities for studies that identify and explore health inequalities

Poly-substance use among male and female street youth in Toronto, Canada

Street-involved youth experience high rates of alcohol and other drug use, which put them at risk for other health-related problems including substance dependence, infectious diseases, drug overdose and victimization. There is limited research on gender differences in poly-substance use among street-involved youth. In this study of 150 street youth in Toronto, Canada, we explore the effects of gender, health and social factors on alcohol and other drug use. Multivariate regression analyses were used to create models predicting the number of substances (alcohol and illicit drugs) used in the last 30 days before interview. The mean number of substances used by the female and male street youth was 2.1 and 2.5, respectively, with up to seven used in total. Multivariate analyses showed that different factors were associated with poly-substance use for female street youth compared to male street youth. These results highlight gender-specific factors to be considered in developing preventive approaches and supportive services for homeless youth with substance use problems

Public awareness of income-related health inequalities in Ontario, Canada

Abstract Introduction Continued action is needed to tackle health inequalities in Canada, as those of lower income continue to be at higher risk for a range of negative health outcomes. There is arguably a lack of political will to implement policy change in this respect. As a result, we investigated public awareness of income-related health inequalities in a generally representative sample of Ontarians in late 2010. Methods Data were collected from 2,006 Ontario adults using a telephone survey. The survey asked participants to agree or disagree with various statements asserting that there are or are not health inequalities in general and by income in Ontario, including questions pertaining to nine specific conditions for which inequalities have been described in Ontario. A multi-stage process using binary logistic regression determined whether awareness of health inequalities differed between participant subgroups. Results Almost 73% of this sample of Ontarians agreed with the general premise that not all people are equally healthy in Ontario, but fewer participants were aware of health inequalities between the rich and the poor (53%–64%, depending on the framing of the question). Awareness of income-related inequalities in specific outcomes was considerably lower, ranging from 18% for accidents to 35% for obesity. Conclusions This is the first province-wide study in Canada, and the first in Ontario, to explore public awareness on health inequalities. Given that political will is shaped by public awareness and opinion, these results suggest that greater awareness may be required to move the health equity agenda forward in Ontario. There is a need for health equity advocates, physicians and researchers to increase the effectiveness of knowledge translation activities for studies that identify and explore health inequalities.</p

The impact of a Housing First randomized controlled trial on substance use problems among homeless individuals with mental illness

Background: There is strong evidence that Housing First interventions are effective in improving housing stability and quality of life among homeless people with mental illness and addictions. However, there is very little evidence on the effectiveness of Housing First in improving substance use-related outcomes in this population. This study uses a randomized control design to examine the effects of scatter-site Housing First on substance use outcomes in a large urban centre. Methods: Substance use outcomes were compared between a Housing First intervention and treatment as usual group in a sample of 575 individuals experiencing homelessness and mental illness, with or without a co-occurring substance use problem, in the At Home/Chez Soi trial in Toronto, Canada. Generalized linear models were used to compare study arms with respect to change in substance use outcomes over time (baseline, 6, 12, 18 and 24 month). Results: At 24 months, participants in the Housing First intervention had significantly greater reductions in number of days experiencing alcohol problems and amount of money spent on alcohol than participants in the Treatment as Usual group. No differences between the study arms in illicit drug outcomes were found at 24 months. Conclusions: These findings show that a Housing First intervention can contribute to reductions in alcohol problems over time. However, the lack of effect of the intervention on illicit drug problems suggests that individuals experiencing homelessness, mental illness and drug problems may need additional supports to reduce use. Trial Registration: Current controlled trials ISRCTN42520374

How do people attribute income-related inequalities in health? A cross-sectional study in Ontario, Canada.

CONTEXT: Substantive equity-focused policy changes in Ontario, Canada have yet to be realized and may be limited by a lack of widespread public support. An understanding of how the public attributes inequalities can be informative for developing widespread support. Therefore, the objectives of this study were to examine how Ontarians attribute income-related health inequalities. METHODS: We conducted a telephone survey of 2,006 Ontarians using random digit dialing. The survey included thirteen questions relevant to the theme of attributions of income-related health inequalities, with each statement linked to a known social determinant of health. The statements were further categorized depending on whether the statement was framed around blaming the poor for health inequalities, the plight of the poor as a cause of health inequalities, or the privilege of the rich as a cause of health inequalities. RESULTS: There was high agreement for statements that attributed inequalities to differences between the rich and the poor in terms of employment, social status, income and food security, and conversely, the least agreement for statements that attributed inequalities to differences in terms of early childhood development, social exclusion, the social gradient and personal health practices and coping skills. Mean agreement was lower for the two statements that suggested blame for income-related health inequalities lies with the poor (43.1%) than for the three statements that attributed inequalities to the plight of the poor (58.3%) or the eight statements that attributed inequalities to the privilege of the rich (58.7%). DISCUSSION: A majority of this sample of Ontarians were willing to attribute inequalities to the social determinants of health, and were willing to accept messages that framed inequalities around the privilege of the rich or the plight of the poor. These findings will inform education campaigns, campaigns aimed at increasing public support for equity-focused public policy, and knowledge translation strategies

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

Abstract 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