Introducción La anemia en mujeres en edad fértil sigue siendo un problema de salud pública a nivel mundial. Las intervenciones con enfoque biomédico no son suficientes para solucionar dicho problema, ya que también está ligada a los determinantes sociales. Objetivo Determinar la desigualdad en la distribución en prevalencia de anemia en mujeres en edad fértil a nivel mundial en los años 2000, 2005, 2010 y 2015. Métodos Se realizó un estudio ecológico a nivel mundial. Se utilizó la base de datos del Banco Mundial para los años 2000, 2005, 2010 y 2015; de donde se obtuvo la prevalencia de anemia en mujeres en edad fértil y los indicadores sociales gasto en salud per cápita y expectativa de vida al nacer. Se calcularon las métricas estándar de brecha y gradiente de desigualdad social en la prevalencia de anemia. Resultados La distribución en la prevalencia de anemia en mujeres en edad fértil a nivel mundial es desigual. La prevalencia es mayor en los países con menor expectativa de vida al nacer y gasto en salud. El 20% de países con menor expectativa de vida al nacer y gasto en salud per cápita concentran el 30% de la prevalencia de anemia en mujeres en edad fértil. Conclusiones La desigualdad en la prevalencia de anemia ha disminuido a nivel mundial. Es importante considerar los determinantes sociales, para seguir disminuyendo la desigualdad y por ende la prevalencia de anemia. Es importante mejorar las estrategias que se están tomando actualmente. / Introduction Anemia in women of childbearing age continues to be a public health problem worldwide. Interventions with a biomedical approach are not enough to solve this problem since it is also linked to social determinants. Objective To determine the inequality in the distribution in the prevalence of anemia in women of childbearing age worldwide in the years 2000, 2005, 2010 and 2015. Methods A worldwide ecological study was carried out. The World Bank database was used for the years 2000, 2005, 2010 and 2015; from which the prevalence of anemia in women of childbearing age and the social indicators for health expenditure per capita and life expectancy at birth were obtained. The standard metrics of gap and gradient of social inequality in the prevalence of anemia were calculated. Results The distribution in the prevalence of anemia in women of childbearing age is unequal worldwide. The prevalence is higher in countries with lower life expectancy at birth and health spending. The 20% of countries with the lowest life expectancy at birth and health spending per capita account for 30% of the prevalence of anemia in women of childbearing age. Conclusions Inequality in the prevalence of anemia has decreased worldwide. It is important to consider social determinants, to continue reducing inequality and therefore the prevalence of anemia. It is important to improve the strategies that are currently being taken. / Tesis

The Truth and Reconciliation Commission’s first call to action is to reduce the number of Indigenous children and youth in care, including keeping young people in culturally appropriate environments. While we work towards this goal, culturally appropriate resources are needed to support children and youth as evidence shows that when Indigenous youth have access to cultural teachings, they have improved physical, mental, emotional, and spiritual health outcomes. Our project focused on the protective qualities of Indigenous coming of age teachings. Together with our community partner Surrounded by Cedar Child and Family Services, we worked to develop resources that inform and advocate for a culturally-centered coming of age for urban Indigenous youth living in foster care in Victoria, British Columbia on Lekwungen Territory. This dissertation begins with a literature review to provide the social and historical context surrounding urban Indigenous youth-in-care’s access to coming of age teachings. This is followed by a description of the Indigenous research paradigm that guided our work, what it meant for us to do this project in a good way, and the methods that we used to develop three visual storytelling knowledge sharing tools. Three manuscripts are presented, two published and one submitted, that reflect a strength-based vision of coming of age shared by knowledge holders who participated in our community events. The first manuscript retells the events of the knowledge holder’s dinner, where community members shared their perspectives on four questions related to community engagement and youth support. An analysis of the event’s transcripts revealed key themes including the responsibility of creating safe-spaces for youth, that coming of age is a community effort, and the importance of youth self-determining their journey. A graphic recording and short story are used to illustrate and narrate the relationship between key themes and related signifiers. This manuscript highlights the willingness of the community to collectively support youth in their journeys to adulthood. The second manuscript focuses on our two youth workshops that had the objective of understanding what rites of passage youth in SCCFS’s care engage with and how they learn what cultural teachings were most important to them. The findings suggest that when youth experience environments of belonging, and know they are ‘part of something bigger’, qualities like self-determination, self-awareness, and empowerment are strengthened. The third manuscript focuses on how we translated our project findings into different storytelling modalities using an Indigenist arts-based methodological approach. The project findings provided the inspiration and content for a fictional story called Becoming Wolf, which was adapted into a graphic novel, and a watercolour infographic. These knowledge sharing media present our project findings in accessible and meaningful ways that maintain the context and essences of our learnings. This research illustrates how Indigenous coming of age is an experience of interdependent teachings, events, and milestones, that contribute to the wellness of the body, mind, heart, and spirit of youth and the Indigenous community more broadly. Through our efforts, we hope to create a shared awareness about the cultural supports available to urban Indigenous youth that can contribute to lifelong wellness. / Graduate

Hypertension, a medical condition, predisposes to other cardiovascular diseases, and can be impacted by the social determinants of health (SDOH). Self-measured blood pressure monitoring (SMBP) is an evidence-based approach to hypertension control, but not much is known about the influence of SDOH on SMBP. This dissertation aims to: 1) highlight the SDOH factors whose relationship with SMBP have been explored in research studies; 2) examine the relationship between SDOH and SMBP among United States (U.S.) adults with high blood pressure; and 3) examine the current state of SMBP in the U.S., highlight policy implications from the empirical study and provide recommendations. Aims 1 and 2 were informed by an adapted SDOH framework, which comprised of upstream structural determinants, and downstream intermediary determinants. Aim 1 was achieved via a scoping review of studies across three databases following the PRISMA-SCR checklist. Aim 2 was achieved via a cross-sectional analysis of data from adult respondents to the 2019 Behavioral Risk Factor Surveillance System, with self-reported hypertension. Bivariate and Multiple Logistic regression analyses were conducted. Aim 3 involved a literature scan on policy concerning SMBP, highlighting the policy implications of findings from the empirical study, and providing recommendations for policy/practice. For aim 1, findings suggest that research studies examined the relationship of relatively more structural determinants, than the few, but highly significant intermediary determinants, with SMBP. For aim 2, looking at the structural determinants, males and those who identify as Black and other minority racial groups were more likely to report SMBP. For intermediary determinants, respondents who consumed fruits, vegetables, and exercised were likely to report SMBP, while those who smoke, who drink, and those with poor mental health days were less likely to report SMBP. Respondents with health coverage and whose provider recommended SMBP were likely to report SMBP use. Those ≥65 years were more likely to report SMBP. For aim 3, I recommend that the Centers for Medicare and Medicaid Services lead policy efforts on SMBP reimbursements. Also, healthcare practices should strengthen their technological infrastructure e.g., telehealth to promote access, and Electronic Health Records to promote efficient data collection and tracking.

Introducción: El no uso de los servicios formales de la salud es un punto prioritario para la sociedad, dado que pone en evidencia las debilidades de la capacidad de atención del sistema de salud e insta su mejora, más aún en la población gineco-obstétrica y pediátrica. No se conoce con exactitud la influencia de los determinantes sociales de la salud en esta conducta en las poblaciones estudiadas. Objetivos: Evaluar la asociación y distribución del no uso de servicios formales de salud en la población gineco-obstétrica y pediátrica y los determinantes sociales de la salud. Materiales y métodos: El presente estudio es un transversal analítico, a partir de los datos del estudio poblacional ENDES 2019. Las variables de resultado fue el NUSFS para atención prenatal y atención de parto en mujeres en edad fértil. Asimismo, se evaluó este comportamiento en la búsqueda de atención para menores de 5 años que presentaron diarrea y fiebre y/o tos en los 14 días. Las variables de exposición fueron los determinantes sociales de la salud, tanto estructurales como intermedios. Se reportaron razones de prevalencia crudas y ajustadas, se tomó en cuenta la estructura compleja de la muestra. Resultados: Se encontró asociación del NUSFS para atención prenatal con estado civil conviviente (RPa=5.23 IC95%=1.34-20.39), estar afiliada al SIS (RPa=4.09 IC95%=1.08-15.41) y que perciba ingresos (RPa=3.33 IC95%=1.16-9.56). El NUSFS para atención de parto, se vieron asociados la edad de la madre comprendida entre los 35 a 49 años (RPa=0.62 IC95%=0.44-0.87), que la mujer se autorreconozca como “Mestiza” (RPa=0.53 IC95%=0.35-0.80), residir en zonas rurales (RPa=1.92 IC95%=1.48-2.48) y tener 4 o más niños nacidos (“4 hijos” RPa=1.53 IC95%=1.08-2.16). El NUSFS para diarrea en menores de 5 años se asocia la edad del jefe del hogar entre 30 y 39 años (RPa=0.71 IC95%=0.54-0.93), que la madre hable una lengua amazónica (RPa=1.97 IC95%=1.01-4.30) y que resida en la selva (RPa=1.55 IC95%=1.02-2.35). Por último, el NUSFS para la atención de fiebre/tos se asoció a la edad de la madre (“25 a 34 años” RPa=0.79 IC95%=0.68-0.93, “35 a 49 años” RPa=0.63 IC95%=0.51-0.77), pertenecer al quintil “Pobre” (RPa=1.27 IC95%= 1.07-1.50) y residir en una zona rural (RPa=0.73 IC95%=0.62-0.86). Conclusiones: Existe asociación entre el no uso de los servicios formales de la salud en las poblaciones gineco-obstétricas y pediátricas y los determinantes sociales de la salud. / Introduction: The non-use of formal health services (NUFHS) is a priority for society, since it highlights the weaknesses in the capacity of the health system and urges its improvement, even more so in the gynecological-obstetric and pediatric populations. The influence of the social determinants of health on this behavior in the populations studied is not exactly known. Objectives: To evaluate the association and distribution of the non-use of formal health services in the gynecological-obstetric and pediatric population and the social determinants of health. Materials and methods: This study is a cross-sectional analysis, based on data from the ENDES (NHS) 2019 population study. The outcome variables were the NUFHS for prenatal care and delivery in women of childbearing age. Likewise, this behavior was evaluated in seeking care for children under 5 years of age who had diarrhea and fever and/or cough within 14 days. The exposure variables were the social determinants of health, both structural and intermediate. Crude and adjusted prevalence ratios were reported, taking into account the complex structure of the sample. Results: Association of the NUFHS was found for prenatal care with cohabiting marital status (aPR=5.23 CI95%=1.34-20.39), being affiliated with SIS (aPR=4.09 CI95%=1.08-15.41) and receiving income (aPR=3.33 CI95 %=1.16-9.56). The NUFHS for delivery care was associated with the age of the mother between 35 and 49 years (aPR=0.62 CI95%=0.44-0.87), that the woman is self-recognized as "Mestiza" (aPR=0.53 CI95%= 0.35 -0.80), resides in rural areas (aPR=1.92 CI95%=1.48-2.48) and has 4 or more children born (“4 children” aPR=1.53 CI95%=1.08-2.16). The NUFHS for diarrhea in children under 5 years of age is associated with the age of the head of the household between 30 and 39 years (aPR=0.71 CI95%=0.54-0.93), that the mother speaks an Amazonian language (aPR=1.97 CI95%=1.01- 4.30) and lives in the jungle (aPR=1.55 CI95%=1.02-2.35). Finally, the NUFHS for fever/cough care was associated with the mothers age (“25 to 34 years old” aPR=0.79 CI95%=0.68-0.93, “35 to 49 years” aPR=0.63 CI95%=0.51 -0.77), belonging to the “Poor” quintile (aPR=1.27 95% CI= 1.07-1.50) and residing in a rural area (aPR=0.73 95% CI=0.62-0.86). Conclusions: There is an association between the non-use of formal health services in the gynecological-obstetric and pediatric populations and the social determinants of health. / Tesis

Background: Patients with newly diagnosed lung cancer have one of the highest rates of psychosocial distress which may be reduced by identifying factors associated with psychosocial distress. This dissertation examined the association of neighborhood-level Social Determinants of Health (SDOH) and delay in treatment initiation with psychosocial distress. It also qualitatively explored perceptions and practices of the lung cancer care team regarding psychosocial distress screening. Methods: Sociodemographic, clinical, and SDOH data of patients newly diagnosed with lung cancer between 2017 and 2021 was analyzed via logistic regression. Thematic analysis was done for interviews conducted with the lung cancer care team. Results: SDOH and delay in treatment were not significantly associated with psychosocial distress. However, a high deprivation level of SDOH was associated with delay in treatment initiation. Qualitatively, four principal themes emerged: (1) Timing and frequency of screening: Multiple screenings at different time points may be more effective; (2) Training needs: All staff would benefit from training; (3) Staffing needs: More psychologists and social workers are needed to address identified patient psychosocial distress and; (4) Opportunity for holistic patient care: Consistent communication of distress screening information to physicians and surgeons may enhance a holistic care model for patients. Conclusions: The lung cancer care team valued psychosocial distress screening and identified opportunities for improving screening processes. The finding of association of high deprivation level of SDOH with greater delay in treatment initiation suggests that targeted interventions to reduce delay in treatment initiation, focusing on economically marginalized groups may be warranted.

No description available.

This dissertation presents in the form of two distinct chapters conceptually related in nature. The first chapter integrates literature from various fields such as indigenous, womanist, and feminist lenses to propose nine principles when working with Muslim women. The purpose of the second chapter is to examine Muslim women’s experiences in therapy at university counseling centers. The study explores women’s experiences from a social determinants of health perspective and a narrative inquiry method—namely, how intrapersonal, interpersonal, institutional, community, and policy factors inform women’s experiences. Qualitative analysis from interviews with six women suggests Muslim women navigate multiple systems which inform their beliefs about health and their experiences in therapy.

The maternal mortality rate in the USA is the highest in the industrialized world. Black women in the USA are three times more likely to die due to pregnancy and childbirth-related health issues than their white counterparts. According to 2017–2019 data from the CDC, 80% of these deaths are preventable.The purpose of this thesis is to understand how women’s bodily autonomy is both racialized and politicized. Key questions here are: What is the relationship between access to healthcare and reproductive rights? How are reproductive rights racialized? How is bodily autonomy racialized and politicized?This research is based on a literature review and a case study of the documentary Aftershock, released in July 2022. Aftershock charts the deaths of two young Black American women after they gave birth and shows how their partners and families stood together and became effective activists determined to fight the Black maternal mortality epidemic in the US, and thereby increase awareness and bring about change in society.

No description available.

L’objectif de la présente thèse est de générer des connaissances sur les contributions possibles d’une formation continue à l’évolution des perspectives et pratiques des professionnels de la santé buccodentaire. Prônant une approche centrée sur le patient, la formation vise à sensibiliser les professionnels à la pauvreté et à encourager des pratiques qui se veulent inclusives et qui tiennent compte du contexte social des patients. L’évaluation de la formation s’inscrit dans le contexte d’une recherche-action participative de développement d’outils éducatifs et de transfert des connaissances sur la pauvreté. Cette recherche-action aspire à contribuer à la lutte contre les iniquités sociales de santé et d’accès aux soins au Québec; elle reflète une préoccupation pour une plus grande justice sociale ainsi qu’une prise de position pour une santé publique critique fondée sur une « science des solutions » (Potvin, 2013). Quatre articles scientifiques, ancrés dans une philosophie constructiviste et dans les concepts et principes de l’apprentissage transformationnel (Mezirow, 1991), constituent le cœur de cette thèse. Le premier article présente une revue critique de la littérature portant sur l’enseignement de l’approche de soins centrés sur le patient. Prenant appui sur le concept d’une « épistémologie partagée », des principes éducatifs porteurs d’une transformation de perspective à l’égard de la relation professionnel-patient ont été identifiés et analysés. Le deuxième article de thèse s’inscrit dans le cadre du développement participatif d’outils de formation sur la pauvreté et illustre le processus de co-construction d’un scénario de court-métrage social réaliste portant sur la pauvreté et l’accès aux soins. L’article décrit et apporte une réflexion, notamment sur la dimension de co-formation entre les différents acteurs des milieux académique, professionnel et citoyen qui ont constitué le collectif À l’écoute les uns des autres. Nous y découvrons la force du croisement des savoirs pour générer des prises de conscience sur soi et sur ses préjugés. Les outils développés par le collectif ont été intégrés à une formation continue axée sur la réflexion critique et l’apprentissage transformationnel, et conçue pour être livrée en cabinet dentaire privé. Les deux derniers articles de thèse présentent les résultats d’une étude de cas instrumentale évaluative centrée sur cette formation continue et visant donc à répondre à l’objectif premier de cette thèse. Le premier consiste en une analyse des transformations de perspectives et d’action au sein d’une équipe de 15 professionnels dentaires ayant participé à la formation continue sur une période de trois mois. L’article décrit, entre autres, une plus grande ouverture, chez certains participants, sur les causes structurelles de la pauvreté et une plus grande sensibilité au vécu au quotidien des personnes prestataires de l’aide sociale. L’article comprend également une exploration des effets paradoxaux dans l’apprentissage, notamment le renforcement, chez certains, de perceptions négatives à l’égard des personnes prestataires de l’aide sociale. Le quatrième article fait état de barrières idéologiques contraignant la transformation des pratiques professionnelles : 1) l’identification à l’idéologie du marché privé comme véhicule d’organisation des soins; 2) l’attachement au concept d’égalité dans les pratiques, au détriment de l’équité; 3) la prédominance du modèle biomédical, contraignant l’adoption de pratiques centrées sur la personne et 4) la catégorisation sociale des personnes prestataires de l’aide sociale. L’analyse des perceptions, mais aussi de l’expérience vécue de ces barrières démontre comment des facteurs systémiques et sociaux influent sur le rapport entre professionnel dentaire et personne prestataire de l’aide sociale. Les conséquences pour la recherche, l’éducation dentaire, le transfert des connaissances, ainsi que pour la régulation professionnelle et les politiques de santé buccodentaire, sont examinées à partir de cette perspective. / This thesis aims to generate knowledge on how a continuing education course might contribute to the evolution of oral health professionals’ perspectives and practices. Promoting patient centered care, the course aims to sensitize professionals to poverty issues and to encourage socially inclusive practices that take into account the social context of patients. The course evaluation is nested within a participatory action research project aimed at developing educational and knowledge transfer tools to sensitize oral health professionals to poverty issues and Our research strives to contribute to the fight against social inequities in health and in access to care in Québec; it is grounded in our intent for greater social justice and reflects our belief in the importance of a critical public health founded on a « science of solutions » (Potvin, 2013). Four scientific articles, grounded in constructivism and in the concepts and principles of transformative learning theory (Mezirow, 1991), constitute the heart of this thesis. The first presents a critical review of the literature on health professional education for patient-centered care. We focus on the concept of shared epistemology as a foundation for patient-centered care and determine and analyse the educational principles allowing for its development in students and practitioners. Our second article, located within the participatory developmental process, delves into the co-construction of a social realist screenplay portraying poverty and issues of access to dental care. The article examines and reflects on the participatory processes, in particular the co-learning that took place among the partners involved in writing the screenplay and in producing the educational tools on poverty. We discover the potency of shared knowledge among professionals, citizens, educators and academics for enhancing reflection on bias and perspective taking. The educational tools developed have been integrated into an onsite credited continuing education course on poverty and oral health, privileging critical reflection, founded on transformative learning theory, and integrating dimensions of person-centered care. The results of an instrumental case study among the 15 members of a dental team having participated in the course constitute the last two articles of the thesis. The first describes and analyzes the new meanings and actions among course participants, emphasizing shifts in thinking about the causes of poverty, about life on welfare, about certain patient behaviors and about the participants themselves. New actions refer to changes made in verbal and non-verbal communication and appointment giving policy. The article also examines unanticipated and paradoxical effects of learning, such as the reinforcement of certain beliefs. The final thesis article presents the case study results in terms of the participants’ experience of their workplace ideologies and how these constitute obstacles or objections to learning or to making practice or policy changes. These ideologies include 1) identification with a for-profit and private market oral health care system; 2) “equal treatment”, a belief constraining concern for equity and the recognition of discriminatory practices; 3) a predominantly biomedical orientation to care; and 4) stereotypical categorization of publically insured patients into « deserving » vs. « non-deserving » poor. This knowledge contributes to our understanding of systemic influences on professionals’ practices and interactions with patients living on welfare. We discuss implications for research, dental education and knowledge translation, as well as in terms of oral health policy and oral health professional regulation.