Aaron Koay

Introduction: Intersectionality is increasingly applied in health policy analysis, but its operationalisation has not been systematically examined. Methods: Following JBI guidance, this scoping review aimed to map the application of intersectionality in health policy analysis. Six bibliographic databases were systematically searched, supplemented by Google Scholar and backward citation searching. Two reviewers independently screened the retrieved records. Data were extracted using a bespoke theory-informed framework, examining six dimensions: conceptual clarity, analytical modality, categorical complexity, epistemic diversity, positionality and reflexivity, and transformative potential. Results: Of 131 included records, 78.6% were published from 2020 onwards. Among classifiable records, 81.4% of first authors were coded as women (105/129), and 78.7% were affiliated with institutions in high-income economies (100/127). Analyses were overwhelmingly retrospective (96.9%) and only 9.2% drew on theories of policy processes, governance, or political economy. Although 89.3% cited intersectionality scholarship, only 71.8% explicitly defined intersectionality and 20.6% applied a named intersectionality-informed policy analysis approach. Most records examined intersectional disadvantage without considering relative privilege (62.6%). Gender/sex was the axis most frequently selected a priori (80.0%) and most often given primacy. Reporting of participatory engagement (23.7%), positionality (33.6%), and deliberate reflexivity practices (8.4%) were uncommon. Most proposed policy or practice recommendations (88.5%), but only 29.3% of these explicitly called for liberation from oppression. Few reported challenges in applying intersectionality (9.2%) or proposed methodological improvements (6.9%). Conclusion: Overall, the adoption of intersectionality in health policy analysis has not been matched by consistent theoretical and methodological integration. Guidance is provided to support methodological application that is more theoretically grounded and oriented towards the redistribution of power and privilege.

BACKGROUND Digital services are increasingly used in healthcare; however, access to these services may be hindered by several factors. People residing in rural areas may face additional challenges. Rural digital healthcare access is a complex and interdisciplinary topic; to what extent this complexity is captured and theorised in extant research remains unclear. OBJECTIVE We aimed to review the theoretical approaches used in previous studies on digital healthcare access in rural areas, specifically to identify the frameworks used and the application of intersectionality. METHODS We searched MEDLINE, Embase, CINAHL Plus, and Scopus for literature related to digital health access in rural areas in high-income countries. Search results were screened, extracted, and analysed with basic content analysis. RESULTS We included 101 studies in the analysis. Conceptual frameworks came from research fields of technology acceptance, healthcare access, and implementation research. The most used frameworks were the Technology Acceptance Model, the Unified Theory of Acceptance and Use of Technology, Andersen’s behavioural model, Levesque’s patient-centred framework, and the Consolidated Framework for Implementation Research. Forty-two studies focused on populations with some intersecting inequities, but none mentioned intersectionality specifically. CONCLUSIONS All frameworks have their own limitations, especially when crossing disciplines in the specific rural context. We urge researchers to acknowledge these limitations and consider interdisciplinary frameworks. There is a need to theoretically approach the issue of inequity in this topic, and we recommend using equity-based frameworks for a comprehensive and intersectional understanding.

Background: Digital services are increasingly used in healthcare; however, access to these services may be hindered by several factors. People residing in rural areas may face additional challenges. Rural digital healthcare access is a complex and interdisciplinary topic; to what extent this complexity is captured and theorised in extant research remains unclear. Aim: We aimed to review the theoretical approaches used in previous studies on digital healthcare access in rural areas, specifically to identify the frameworks used and the application of intersectionality. Methods: We searched MEDLINE, Embase, CINAHL Plus, and Scopus for literature related to digital health access in rural areas in high-income countries. Search results were screened, extracted, and analysed with basic content analysis. Results: We included 101 studies in the analysis. Conceptual frameworks came from research fields of technology acceptance, healthcare access, and implementation research. The most used frameworks were the Technology Acceptance Model, the Unified Theory of Acceptance and Use of Technology, Andersen’s behavioural model, Levesque’s patient-centred framework, and the Consolidated Framework for Implementation Research. Forty-two studies focused on populations with some intersecting inequities, but none mentioned intersectionality specifically. Conclusion: All frameworks have their own limitations, especially when crossing disciplines in the specific rural context. We urge researchers to acknowledge these limitations and consider interdisciplinary frameworks. There is a need to theoretically approach the issue of inequity in this topic, and we recommend using equity-based frameworks for a comprehensive and intersectional understanding.

During the COVID-19 pandemic, there were months of delay in deploying community pharmacies for the National COVID-19 Vaccination Programme in Ireland. We aimed to explore what may have accounted for this delay between 15th December 2020 (publication of policies) and 14th June 2021 (commencement of community pharmacy–based vaccination). We carried out a multi-method qualitative case study that involved engaging with 11 stakeholders, reviewing 246 documents, and conducting semi-structured interviews with 11 policy elites. Using reflexive thematic analysis, we developed three themes. The first provides evidence that the delay was, in part, due to operational barriers related to the logistical and safety aspects of the Programme. The second, on the other hand, presents a perspective that the delay was unreasonable as it was based on perceived deficits in community pharmacies. Finally, the third highlights the inability of the pharmacy profession to influence health policy due to a lack of strategic and cohesive leadership and the dominance of the medical profession. Overall, we argue that the delay can be explained by a complex interplay between technical, socio-political, institutional, and regulatory factors, underpinned by a chronic lack of strategic direction for pharmacy in the Irish health system.

The increasing importance of identifying lesbian, gay, bisexual and transgender (LGBT+) populations is a key driver in changes to demographic data collection in representative surveys of youth. While such population-based data are rare, Growing Up in Ireland (GUI), an Irish, government-funded, longitudinal survey, includes sexual orientation and gender identity (SOGI) measurements. This qualitative study responds to a query from the GUI study team and aims to identify how best to collect SOGI data in future waves of GUI. A university Human Research Ethics Committee granted approval for online consultations with LGBT+ youth (n = 6) with experiential expertise in policy making. The research is underpinned by rights-based public patient involvement (PPI) with recorded discussions, which were transcribed and imported into NVivo 12, generating the theme “recognition in research, policy and society”. This co-created article, with the LGBT+ young PPI Panel members, commends the inclusion of SOGI data in GUI and recommends changes in question placement and phrasing. Aligning with best practice, the PPI members provide a template for wording on consecutive sex and gender questions, expanded sexual orientation identity categories and maintaining the existing well-phrased transgender question from GUI. This offers potential to improve the quality of the SOGI data collected and the experience of those completing the questionnaire. These findings extend beyond GUI, with relevance for surveys with youth populations. This paper underscores the potential and benefits of participatory approaches to research with youth and views their role beyond simply as sources of data.

Background: Healthcare is increasingly delivered closer to the patients’ homes, which increases the level of responsibility that patients and informal carers take for managing their medication-taking, although this is associated with hazards. Medication self-management has been conceptualised as work taking place in non-formal settings (e.g., households), which are complex systems. Human factors and ergonomics (HFE) models provide a framework for studying such systems. The Systems Engineering Initiative for Patient Safety (SEIPS) is one framework that considers work system elements and how they interact with each other to shape processes that lead to outcomes (e.g., safety). Given the increasing amount of diverse research on patient and carer work and on system-shaping factors, the objectives of this review are to: (i) identify available evidence in a structured and systems-oriented way, (ii) explore approaches that have been applied and (iii) highlight research gaps. Methods: An evidence-informed patient, public and carer involvement (PPCI) approach will be implemented at all post-protocol stages to ensure the relevance, uptake and translation of the scoping review. The review will systematically search MEDLINE, Embase, PsycInfo, CINAHL and Web of Science to identify relevant qualitative studies. The methodological approach will be guided by Johanna Briggs Institute methodology and will be reported according to the PRISMA-ScR standards. Data charting and qualitative content analysis directed by SEIPS will explore how the work system and its constituting elements have been described in the literature and identify specific gaps and opportunities for future research. Borrowing from realist approaches, included studies will be assessed in terms of richness and relevance to our review question. Discussion: Strengths of this scoping review include PPCI and a converging focus on medication safety, medication self-management and HFE. Ultimately, this approach will advance our understanding of this complex system and guide opportunities to broaden and strengthen the evidence base.