HEALTH EQUITY

Please find below the presentation abstracts for this session's theme.

 

Use the links below to see the full presentation schedule and to vote for your favourite presentation for the "Students' Choice" prize!

Presentation 1

 

Barriers to Equality in Healthcare Faced by Sex Workers: A Systematic Review

Chloe Haynes | University of Warwick

 

Background
Sex workers (SWs) are generally regarded as a vulnerable population which often suffer from poor health and unsuitable access to healthcare. This paper aims to understand barriers to healthcare faced by SWs in the UK and has therefore focused on ‘Western’ cultures.
 

Methods
A search of PubMed, Embase, Web of Science and the International Journal of Equity in Health and reference/citation searches were conducted. The search focused on papers assessing barriers to healthcare experienced by SWs that met the following parameters: were published between 2015 and the present, focused on ‘Western’ cultures and were published in English. The barriers identified were classified using the Health Care Access Barriers (HCAB) Model and thematic analysis was then performed as described by Higginbottom et al.
 

Results
The search identified 29 paper originating from 11 countries and assessed female sex workers (FSW), male sex workers (MSW) and transgender sex workers (TSW) from a range of sexualities, ethnicities and migrant status’. Overwhelmingly, the most frequently identified barrier was occupational stigma (OS). Poor professional practise, mistrust of healthcare professionals, structural barriers within healthcare, health illiteracy and fears associated with seeking healthcare were also identified.
 

Key messages

Based on this review, this paper concludes that focusing on anti-discrimination training targeted at healthcare professionals will hopefully encourage the delivery of high-quality care that maximises respect for autonomy and positive health outcomes for SWs.

 

 

Presentation 2

 

Exploring the Use of a Clinical Ethics Service in an NHS Trust

Katie-Louise Berwick | University of Warwick

 

Background

At work, healthcare professionals regularly experience ethical dilemmas such as issues around capacity and consent, withdrawing treatment and making treatment decisions. To cope with such issues, clinicians utilize a variety of methods including individual reflection, discussions with colleagues or discussions at departmental meetings. However, more formal support services have been developed, such as clinical ethics forums. These exist in different forms internationally. In this specific NHS Trust, forum members include doctors, nurses, ethicists and lay members and it functions to provide ethical advice to clinicians regarding their dilemmas. Other roles of the forum are to provide ethical education and to consider Trust policies from an ethical perspective.

 

Methods

This aims of this research were to explore the use of the clinical ethics forum at the Trust from the perspectives of its users (clinical staff) and forum members, using a mixed methods approach (semi-structured interviews and a survey).

 

Results

The majority of healthcare professionals surveyed were aware of the existence of the clinical ethics forum, but the majority had not used it. Forum members described an underutilization of the forum; their perception was that the forum had a low profile within the Trust. Challenges included maintaining forum membership and a lack of protected time to deliver a satisfactory service. Barriers to the use of the forum were explored and suggestions were made as to how to increase clinician engagement with the forum, the most remarkable being to improve the profile of the forum and to provide a more timely and quality assured service.

 

Presentation 3

 

Experiences and Attitudes of the LGBTQ+ Community on Care/Nursing Homes

Laura Skeldon | University of Warwick

 

Background
Recent research has found that older lesbian, gay, bisexual, transgender and queer (LGBTQ+) people have a negative attitude towards care/nursing homes and are concerned about facing discrimination based on their sexuality and gender identity. This study aims to build upon current understanding by reviewing research into the LGBTQ+ communities’ perspectives and experiences of care/nursing homes. Additionally, I sought to explore the attitudes of care/nursing home staff towards providing care for LGBTQ+ residents. Based on these findings, recommendations for improvements will then be made.
 

Methods
A systematic review was conducted by carrying out a database search on Medline, Web of Science and Embase. The following terms were included in the search, “Sexual and Gender Minorities” OR “Homosexuality or Homosexuality, Female or Homosexuality, Male or Bisexuality or Transgender person or Transsexualism” OR (LGBTQ+ or lesbian or transgender or queer or bisexual or pansexual or gay) AND “Homes for Aged OR Nursing Homes OR Care Homes or Residential Facilities OR Long Term-Care” AND “Older or Elderly”. Following this, themes where identified by extracting and categorising the data.
 

Results
The LGBTQ+ community had a negative perception of care/nursing homes. They were concerned that they would have to conceal their identity, experience abuse and become socially isolated. This could be tackled by introducing initiatives to promote inclusivity. Most staff had a positive attitude towards LGBTQ+ residents, but there were significant exceptions to this. Despite their positive attitude, staff often lacked awareness on LGBTQ+ issues.
 

Key messages

Care/nursing homes are not welcoming for LGBTQ+ people as they perceived to be heterosexual environments. Staff require more training on LGBTQ+ issues to adequately support their LGBQT+ residents. Additional training would encourage staff to engage their residents in conversations about sexuality and gender identity.

 

Presentation 4

 

Are Female Patients More Satisfied with Female Doctors? A Systematic Review

Jennifer Shone | University of Warwick

 

Background
Gender bias in biomedical research and the clinical environment has led to health inequalities between men and women, potentially leading to poorer clinical outcomes for female patients. In some cases, female doctors have been seen to improve clinical outcomes for female patients. Therefore, is it possible that patient satisfaction also improves when women are treated by doctors of the same gender?

 

Methods
A literature search was performed and articles were included if published in a peer-reviewed journal, focused on measuring the impact of a doctor’s gender on patient satisfaction, disaggregated patient data by gender, and were available in English. 16 papers were included for data extraction.
 

Results
The areas of patient satisfaction measured by the included manuscripts were global satisfaction, trust, communication skills, non-verbal and organisation skills, giving and understanding information, and clinical skills. Study findings were mixed with authors observing both satisfaction and dissatisfaction with female doctors.

 

Key messages

The findings of this review neither support nor discount the hypothesis that female patients are more satisfied when treated by female doctors. However, the highest quality studies showed that women were more satisfied with female doctors compared to male doctors. A standardised tool is required that can accurately measure the experiences of women from different backgrounds within a variety of clinical settings. Additionally, the gender gap in certain medical specialities must be addressed so women have an equal opportunity to be treated by a female or male doctor.

 

 

Presentation 5

 

Facilitators and Barriers to Pre-Exposure Prophylaxis (PrEP) Acceptability among Ethnic Minority Men-who-have-Sex-with-Men (EMMSM): A Systematic Review

Adrian McGrath | University of Warwick

 

Background
Ethnic Minority Men-who-have-Sex-with-Men (EMMSM) are at disproportionately high risk of HIV infection. Racial disparities also exist in the use of Pre-Exposure Prophylaxis (PrEP), an intervention highly effective at reducing the risk of HIV acquisition. This systematic review aims to identify the facilitators and barriers to PrEP use in EMMSM and provide recommendations to improve uptake.
 

Methods
A systematic search of nine databases identified primary research published in English after 2000 exploring the acceptability of PrEP among EMMSM in high-income countries. Studies were screened independently by two review authors; data was extracted, and methodological quality was appraised using standardised forms. Facilitators and barriers to PrEP uptake in EMMSM were categorised using a socio-ecological model and analysed by narrative review.
 

Results
54 studies were included for review. Facilitators and barriers were mapped to the individual, interpersonal, community, institutional and structural level. Common facilitators included its perceived benefit to serodiscordant relationships, the psychological reassurance it offers, and a self-perceived high risk of HIV infection. Common barriers to PrEP use were associated with social stigma, fear of side-effects and poor relationships with healthcare providers.
 

Key messages

A broad consensus was found in the extant literature, with well-established facilitators and barriers to PrEP use in EMMSM which were mapped and described using a socio-ecological model. We identified key areas of interest and gave recommendations to improve PrEP uptake and optimisation. Future efforts should focus on improving cultural competency in healthcare providers, and developing multi-level strategies to improve PrEP awareness, education, and outreach to EMMSM communities.