Self-reported oral health among a community sample of people experiencing social and health inequities: Implications for the primary health care sector. Wallace et al. (2015)

Wallace, B., Browne, A. J., Varcoe, C., Ford-Gilboe, M., Wathen, C. N., Long, P. M., & Parker, J. (2015). Self-reported oral health among a community sample of people experiencing social and health inequities: Implications for the primary health care sector BMJ Open, 5(e009519)

Abstract from authors:

This paper describes the self-reported oral health issues among a community sample of primary care clients experiencing socioeconomic disadvantages. As part of a larger mixed-methods, multiple case study evaluating an equity-oriented primary healthcare intervention, we examined the oral health of a sample of 567 people receiving care at four clinics that serve marginalised populations in two Canadian provinces. The prevalence of self-rated poor oral health was high, and significant relationships were observed between poor oral health and vulnerabilities related to mental health, trauma and housing instability. Our findings suggest that the oral health of some Canadian populations may be dramatically worse than what is reported in existing population health surveys.

 

Article can be found here.

EQUIP Healthcare: An overview of a multi-component intervention to enhance equity-oriented care in primary health care settings. Browne et al. (2015)

Browne, A. J., Varcoe, C., Ford-Gilboe, M., & Wathen, N. on behalf of the EQUIP Research Team (2015). EQUIP Healthcare: An overview of a multi-component intervention to enhance equity-oriented care in primary health care settings. International Journal for Equity in Health, 14(152).

Abstract from authors:

This paper provides an overview of an innovative multi-component, organizational-level intervention designed to enhance the capacity of PHC clinics to provide equity-oriented care, particularly for marginalized populations. The intervention, known as EQUIP, is being implemented in Canada in four diverse PHC clinics serving populations who are impacted by structural inequities. We discuss the evidence and theory that provide the basis for the intervention, describe the intervention components, and discuss the methods used to evaluate the implementation and impact of the intervention in diverse contexts.

Article can be found here.

Closing the health equity gap: Evidence-based strategies for primary health care organizations. – Browne, Annette J., Varcoe, Colleen M., Wong, Sabrina T., Smye, Victoria L., Lavoie, Josée G., Littlejohn, Doreen, . . . Lennox, Scott. (2012).

Browne, Annette J., Varcoe, Colleen M., Wong, Sabrina T., Smye, Victoria L., Lavoie, Josée G., Littlejohn, Doreen, . . . Lennox, Scott. (2012). Closing the health equity gap: Evidence-based strategies for primary health care organizations. International Journal for Equity in Health, 11(59), 1-15. doi: 10.1186/1475-9276-11-59

Abstract from Authors:

Introduction

International evidence shows that enhancement of primary health care (PHC) services for disadvantaged populations is essential to reducing health and health care inequities. However, little is known about how to enhance equity at the organizational level within the PHC sector. Drawing on research conducted at two PHC Centres in Canada whose explicit mandates are to provide services to marginalized populations, the purpose of this paper is to discuss (a) the key dimensions of equity-oriented services to guide PHC organizations, and (b) strategies for operationalizing equity-oriented PHC services, particularly for marginalized populations.

Methods

The PHC Centres are located in two cities within urban neighborhoods recognized as among the poorest in Canada. Using a mixed methods ethnographic design, data were collected through intensive immersion in the Centres, and included: (a) in-depth interviews with a total of 114 participants (73 patients; 41 staff), (b) over 900 hours of participant observation, and (c) an analysis of key organizational documents, which shed light on the policy and funding environments.

Results

Through our analysis, we identified four key dimensions of equity-oriented PHC services: inequity-responsive care; trauma- and violence-informed care; contextually-tailored care; and culturally-competent care. The operationalization of these key dimensions are identified as 10 strategies that intersect to optimize the effectiveness of PHC services, particularly through improvements in the quality of care, an improved ‘fit’ between people’s needs and services, enhanced trust and engagement by patients, and a shift from crisis-oriented care to continuity of care. Using illustrative examples from the data, these strategies are discussed to illuminate their relevance at three inter-related levels: organizational, clinical programming, and patient-provider interactions.

Conclusions

These evidence- and theoretically-informed key dimensions and strategies provide direction for PHC organizations aiming to redress the increasing levels of health and health care inequities across population groups. The findings provide a framework for conceptualizing and operationalizing the essential elements of equity-oriented PHC services when working with marginalized populations, and will have broad application to a wide range of settings, contexts and jurisdictions. Future research is needed to link these strategies to quantifiable process and outcome measures, and to test their impact in diverse PHC settings.

Article can be found here