Mariya Lorke

Background: Evidence suggests that appropriately managed diversity in healthcare teams can enhance problem-solving, resilience, job satisfaction – all crucial for workforce retention. This scoping review aims to map evidence on how lived diversity experience is conceptualized and operationalized as an individual resource among care workers. Methods: An interdisciplinary approach across social anthropology, health sciences, and labor economics will be adopted. The databases to be searched include MEDLINE/PubMed, PsycINFO, Scopus and Web of Science and sources of grey literature. A two-stage screening process will be followed by systematic data extraction, with findings synthesized through descriptive numerical summaries and qualitative thematic analysis. Results: This scoping review is expected to shift the focus from organisational-level diversity research to research on how diversity contributes as an individual resource in care work contexts. It will map how diversity-as-resource is theoretically operationalized across disciplines, identifying existing measurement approaches and potentially revealing critical gaps in current assessment methods. Conclusion: By synthesizing evidence on how care workers’ lived diversity experiences are deployed as valuable competencies in care delivery, this review will provide foundational knowledge to inform workforce transformational strategies.

In recent years, there has been an increasing awareness of the importance of incorporating diversity into research projects, focusing on both how they are conducted and their content. Funding organizations have started to require that research applicants pay attention to inclusion and diversity by considering gender dimensions and other diversity factors in their project plans and ensuring gender equality during execution. Based on an extensive literature research and expert discussions on how to develop and implement diversity strategies in large collaborative research projects, we argue that there is a lack of practical advice in existing literature. Drawing from our own experiences in conceptualizing and implementing a Diversity Program across four universities in Germany, we propose a framework for effectively integrating diversity into collaborative research initiatives across various academic fields.

Zusammenfassung Regionale Gesundheitsmodelle stellen derzeit eine rege Entwicklung in der Gesundheitspolitik und im Gesundheitswesen dar. Fast wie selbstverständlich verbindet sich mit der „Regionalisierung von Gesundheit“ die feste, oft unhinterfragte Annahme, dass mit dieser Konjunktur subtile, aber essentielle Faktoren wie Diversitätsperspektiven, Einbezug des sog. Lai:innenwissens der Adressat:innen, lebensweltliches Erleben von Gesundheit/Krankheit etc. gleichermaßen berücksichtigt werden. Man könnte vermuten, dass es bei der Regionalisierung von Gesundheit im Kern auch um die Erschließung genau dieser Perspektiven geht. Die Berücksichtigung dieser Dimensionen ist jedoch keineswegs ein Selbstläufer. Vielmehr drohen sie erneut unter institutionellen Prozessen begraben zu werden. Worauf kommt es also an, damit diese Ebenen effektiv zur Geltung kommen?

This paper analyses diversity and intersectionality aspects in the R&D of wearable assistive and rehabilitation technologies (WEARTechs). We advocate for inclusive, innovative research that we hope will help bridge the gap between laboratories and the real world and reduce disparities in healthcare and technology development. We performed a systematic literature review of the intersections between assistive technologies and diversity and conducted a thematic analysis of the diversity factors identified in the literature. In addition, we carried out a supplementary literature search on WEARTechs to discover which, if any, diversity aspects are currently being reported on. Our findings indicate that diversity has not been addressed in the field of WEARTechs. There is not sufficient knowledge to determine, which diversity-related aspects researchers must consider when evaluating the performance of any specific WEARTech device. Nor about how these can be properly addressed in the R&D process. We, therefore, provide actionable recommendations on how to integrate diversity-relevant aspects at different R&D stages. We hope that our review will help scientists rethink and reformulate approaches to the R&D of WEARTechs and build the way towards more inclusive solutions. It is our belief that this will spark innovation and enhance discovery potential in the field.

Aim: This contribution empirically analyses and theoretically reflects health literacy (HL) and shared decision-making (SDM) in the context of predictive medicine, taking in the perspective of healthcare professionals (HCPs). The aim is to identify ways to promote HL of persons dealing with disease risk, and to support SDM in predictive consultations. Methods: The perspectives of HCPs consulting patients at early prediction centers and advising them with respect to preventive therapies or further diagnostic procedures were examined using semi-structured, qualitative expert interviews and a complementary survey. Results: The data reveal resources and challenges regarding risk communication and the empowerment of patients for informed and health-literate decisions upon their disease risk. They also show potentially useful communication strategies and prerequisites for demand-oriented decision-making in the predictive setting. Furthermore, the findings highlight that risk communication and patient information in predictive medicine are considered to be underrepresented in medical education and training. Therefore, this contribution provides implications and suggestions for educational concepts and practical tools for medical education and predictive practice. Conclusion: We emphasize communication and interaction between HCPs and patients as crucial for health-literate decision-making in the specific context of predictive medicine. This study’s results indicate relevant aspects of social and communicational skills that need to be considered in consultation guides and integrated into medical education and training, to provide individual-sensitive consultation and HL promotion for people at risk.

Background: The significance of medical implants goes beyond technical functioning and reaches into everyday life, with consequences for individuals as well as society. Ethical aspects associated with the everyday use of implants are relevant for individuals’ lifeworlds and need to be considered in implant care and in the course of technical developments. Methods: This scoping review aimed to provide a synthesis of the existing evidence regarding ethically relevant psychosocial and cultural aspects in cochlear, glaucoma and cardiovascular implants in patient-centered empirical research. Systematic literature searches were conducted in EBSCOhost, Philpapers, PsycNET, Pubmed, Web of Science and BELIT databases. Eligible studies were articles in German or English language published since 2000 dealing with ethically relevant aspects of cochlear, glaucoma and passive cardiovascular implants based on empirical findings from the perspective of (prospective) implant-wearers and their significant others. Following a descriptive-analytical approach, a data extraction form was developed and relevant data were extracted accordingly. We combined a basic numerical analysis of study characteristics with a thematically organized narrative synthesis of the data. Results: Sixty-nine studies were included in the present analysis. Fifty were in the field of cochlear implants, sixteen in the field of passive cardiovascular implants and three in the field of glaucoma implants. Implant-related aspects were mainly found in connection with autonomy, freedom, identity, participation and justice, whereas little to no data was found with regards to ethical principles of privacy, safety or sustainability. Conclusions: Empirical research on ethical aspects of implant use in everyday life is highly relevant, but marked by ambiguity and unclarity in the operationalization of ethical terms and contextualization. A transparent orientation framework for the exploration and acknowledgment of ethical aspects in “lived experiences” may contribute to the improvement of individual care, healthcare programs and research quality in this area. Ethics-sensitive care requires creating awareness for cultural and identity-related issues, promoting health literacy to strengthen patient autonomy as well as adjusting healthcare programs accordingly. More consideration needs to be given to sustainability issues in implant development and care according to an approach of ethics-by-design.

In the process of developing and implementing innovative implant technologies the consideration of patient preferences can be beneficial for patients, doctors and developers. Nevertheless, in existing literature, there is still scarce knowledge of patients’ perspectives on long-term implant care. In this study, three discrete choice experiments (DCEs) were conducted in the context of cochlear implants (CI, n = 92), glaucoma implants (GI, n = 21) and cardiovascular implants (CVI, n = 23), examining the relative importance of attributes of long-term implant care from the patients’ perspective. The participants chose between differently shaped options for implant-related care. The attributes of these care options were generated and selected based on previous literature reviews, group discussions and a diary study with patients. The choice data were analyzed via binary logit regression. In CI-DCE, the technological compatibility of the implant with newer implant models, accessories or devices from other manufacturers was highly valued by participants, whereas in GI-DCE the (in)dependency on glaucoma medication post-implantation had the greatest influence on participants’ choice behavior. In CVI-DCE, the attribute with the highest relative importance related to the means of securing long-term treatment success. In all three DCE, shared decision making was relatively important for participants. Our results emphasized the importance of an adequate transfer of technological advancements in implant care for promoting patient benefits, such as the availability of comprehensible, understandable, high-quality information about current developments. Similarly, promoting technological health literacy and further pushing the technological compatibility, durability and safety of implants are directions for future implant development in accordance with patients’ preferences. Therefore, the participation of implant wearers in the development process is encouraged.

Progress in predictive medicine has increased the challenges to navigating complex risk information for patients and healthcare professionals. This contribution investigates how people facing the risk of developing Alzheimer’s dementia perceive risk, what aspects are relevant to their health literacy, and how to promote individual health literacy in predictive medicine. We conducted a qualitative study analyzing narrative interviews, body maps, and sociodemographic data from persons who had undergone early predictive procedures in a memory clinic. We understand the promotion of health literacy as an ethical task in predictive medicine and argue for (1) emphasizing personal resources to promote subjective health literacy, (2) reframing communication and decision-making about disease risk, and (3) teaching skills for value-sensitive, individualized risk communication.