Street Posyandu: Early reproductive health promotion services and media for people in street situations

The phenomenon of children on the streets is currently a severe problem in several cities in Indonesia. Women and children are the most vulnerable groups in the street community during the pandemic. Due to the complexity of people's health problems in street situations that are influenced by social and economic factors, this community service is expected to bridge the barriers to health access, especially reproductive health. This program aims to provide initial health services for people in street situations. Street Posyandu is expected to be a role model for the government and private sectors in dealing with people's health problems in street situations. The Street Posyandu program uses a persuasive approach. The technology used to support the Street Posyandu is the creation of a monitoring system and recording of maternal and child health conditions for street community. Posyandu Jalanan is realized by continuing to prioritize promotive and preventive services without neglecting curative (treatment) and rehabilitative (health restoration) aspects. The specific suggestion to be conveyed in this program is that the stakeholders need to redesign the form of health services aimed at communities in street situations.

Transportation barriers to care among frequent health care users during the COVID pandemic

Objective: To investigate transportation barriers to accessing health care services during the COVID-19 pandemic among high-frequency health care users.Data Sources: Between June 21 and July 23, 2021, primary survey data were collected for a sample of patients in North Carolina.Study Design: The study analyzed the prevalence of arriving late to, delaying, or missing medical care and examined how transportation barriers contributed to negative health care outcomes. Data Collection Methods: A web-based survey was administered to North Carolina residents aged 18 and older in the UNC Health system who were enrolled in Medicaid or Medicare and had at least six outpatient medical appointments in the past year. 323 complete responses were analyzed to investigate the prevalence of reporting transportation barriers that resulted in having arrived late to, delayed, or missed care, as well as relationships between demographic and other independent variables and transportation barriers. Qualitative analyses were performed on text response data to explain transportation barriers.Principal Findings: Approximately 1 in 3 respondents experienced transportation barriers to health care between June 2020 and June 2021. Multivariate logistic regressions indicate individuals aged 18–64 were significantly more likely to encounter transportation barriers. Costs of traveling for medical appointments and a lack of driver or car availability emerged as major transportation barriers; however, respondents explained that barriers were often complex, involving circumstantial problems related to one’s ability to access and pay for transportation as well as to personal health.Conclusions: To address transportation barriers, we recommend more coordination between transportation and health professionals and the implementation of programs that expand access to and improve patient awareness of health care mobility services. We also recommend transportation and health entities direct resources to address transportation barriers equitably, as barriers disproportionately burden younger adults under age 65 enrolled in public insurance programs.

Worker perspectives on the impact of non-standard workdays on worker and family well-being: A qualitative study

Background Non-standard work schedules (NSWSs), occurring outside of regular and predictable daytime hours, may negatively affect worker and family health. This qualitative study sought to understand worker perspectives on the health and well-being impacts of NSWSs among full-time, transportation maintainers, correctional, and manufacturing workers. Methods Forty-nine workers participated in 8 focus groups. Data were transcribed and analyzed with ATLAS.ti, using the constant comparative method to identify themes and sub-themes. Results Workers reported that long work hours and irregular and unpredictable schedules posed the biggest obstacles to their well-being. Workers reported that NSWSs were associated with behavior impacts (poor family and social connections, poor eating, poor sleep, lack of exercise recovery), physical health impacts (exhaustion, weight gain) and extended work exposures (increased stress, increased accidents). Conclusions This highlights the importance of developing and implementing effective workplace interventions to address these barriers to health and health behaviors.

Major disparities in COVID-19 test positivity for patients with non-English preferred language even after accounting for race and social factors in the United States in 2020

Background The COVID-19 pandemic has further exposed inequities in our society, demonstrated by disproportionate COVID-19 infection rate and mortality in communities of color and low-income communities. One key area of inequity that has yet to be explored is disparities based on preferred language. Methods We conducted a retrospective cohort study of 164,368 adults tested for COVID-19 in a large healthcare system across Washington, Oregon, and California from March – July 2020. Using electronic health records, we constructed multi-level models that estimated the odds of testing positive for COVID-19 by preferred language, adjusting for age, race/ethnicity, and social factors. We further investigated interaction between preferred language and both race/ethnicity and state. Analysis was performed from October–December 2020. Results Those whose preferred language was not English had higher odds of having a COVID-19 positive test (OR 3.07, p < 0.001); this association remained significant after adjusting for age, race/ethnicity, and social factors. We found significant interaction between language and race/ethnicity and language and state, but the odds of COVID-19 test positivity remained greater for those whose preferred language was not English compared to those whose preferred language was English within each race/ethnicity and state. Conclusions People whose preferred language is not English are at greater risk of testing positive for COVID-19 regardless of age, race/ethnicity, geography, or social factors – demonstrating a significant inequity. Research demonstrates that our public health and healthcare systems are centered on English speakers, creating structural and systemic barriers to health. Addressing these barriers are long overdue and urgent for COVID-19 prevention.

A Qualitative Exploratory Study in Health Information and Health Communication Leadership in the Age of the COVID-19 Pandemic

Low health literacy is a public health scourge. Health information and health literacy around COVID-19 is a miscalculated public health conundrum. Zarocostas referred to the COVID-19 not as a pandemic, but an info-demic because of the need for patients to be more health literate when they are being bombarded by inaccurate or misleading information from social media, public officials, and family. During a global pandemic, the need to understand and explore the nuances of health literacy has never been more pressing. This qualitative exploratory study uses the expertise of subject matter experts on health literacy to classify the barriers to health information literacy, the best practices for improving health information literacy, and the additional measures taken by medical providers during the COVID-19 outbreak ensure that patients have the most accurate and useful health information.

Transportation barriers to health care and mortality risk among the U.S. adults with history of cancer.

121 Background: Lack of transportation delayed medical care for approximately 6 million Americans in 2017. Prior studies showed cancer survivors tend to have more healthcare service use, higher medical cost, and adverse clinical outcomes. It is important to understand the prevalence of, risk factors for, and long-term health consequences of transportation barrier to health care among cancer survivors. Methods: We identified cohorts of adult with history of cancer (n = 25,317) and adults without history of cancer (n = 422,797) from the 2000-2014 National Health Interview Survey (NHIS). Transportation barriers were measured as medical care delay due to lack of transportation in the past 12 months using a survey question. The prevalence of transportation barriers was estimated using multivariable logistic models. Risk of mortality estimated with weighted Cox’s proportional hazards models with age as the time scale, adjusting for sex, race/ethnicity, educational attainment, marital status, region, comorbidities, and survey year. All analyses accounted for complex survey design using SAS statistical software, version 9.4 (SAS Institute Inc.), and SAS callable SUDAAN 11.0.3. Results: After adjustment for sociodemographic factors and comorbidities, the prevalence of transportation barrier were significantly higher among cancer survivors than among respondents without cancer history (2.1% vs 1.6%, p = 0.001, adjusted odd ratio [OR], 1.22; 95% confidence interval (95CI): 1.10-1.35). Cancer survivors with transportation barrier were more likely to be younger, female, Hispanic or Asian/Pacific Islander, less educated, unmarried, public insurance beneficiary or uninsured, and with more comorbidities. Among all participants, cancer survivors with transportation barrier had the highest adjusted mortality risk (hazard ratio [HR]: 2.12, 95CI: 1.81-2.49); followed by cancer survivors without transportation barrier (HR: 1.53, 95CI: 1.42-1.65); and adults without a cancer history with transportation barrier (HR: 1.50; 95CI: 1.45-1.55) compared with adults with neither a cancer history nor transportation barrier. Conclusions: Transportation barriers to health care had a disproportionate impact on cancer survivors, especially those who are underserved, and who have more medical needs. Increased risk of mortality was observed among adults with and without a cancer history who delayed care due to lack of transportation. It highlights the need for efforts to mitigate transportation barriers to medical care during a time of rapid change in transportation and telehealth technology.

Mobilizing Interference as Methodology and Metaphor in Disability Arts Inquiry

This article interrogates the limits and possibilities of interference as methodology and metaphor in video-based research aiming to disrupt ableist understandings of disability that create barriers to health care. We explore the overlapping terrain of diffractive and interference methodologies, teasing apart the metaphorical-material uses and implications of interference for video-makers in our project. Using the digital/multimedia stories created and an interview as research artifacts, we illuminate how interference manifested in disabled makers’ lives, how interference operated through the research apparatus, and how the videos continue to hold agency through their durability in the virtual realm. Drawing on feminist post-philosophies of matter (Barad) and use (Ahmed), we argue that the videos disrupt the gaze that fetishizes disabled bodies, thereby interfering with cultural-clinical processes that abnormalize disability. The research apparatus interfered with makers’ subjectivities yet also brought people together to generate something new—a community that creates culture and contests its positioning as marginal.