To tailor an existing Person-Centred Integrated Care (PC-IC) approach to the needs of patients with low socioeconomic status (LSES) and chronic conditions in primary care.

While Disease Management Programs (DMPs) have been introduced to reduce the burden of chronic diseases, their effectiveness for patients with LSES remains uncertain due to insufficient attention to the individual context. A PC-IC approach may enhance patient outcomes by addressing patients’ cultural backgrounds, values, and health literacy needs, because these factors are particularly relevant for patients with LSES.

A qualitative study was conducted using three co-creation sessions with patients with LSES and chronic conditions, along with general practitioners and practice nurses, to adapt, develop, and test specific elements of the PC-IC approach. Participatory learning and action (PLA) techniques incorporating visual materials were employed to ensure meaningful engagement and input by all participants, including those with limited reading and language skills. Following these sessions, we conducted a validation check by patients on the draft materials.

In the co-creation sessions, an existing PC-IC approach was tailored to the needs of LSES patients with chronic conditions in primary care. The adapted PC-IC approach emphasized key elements as trust, being seen as a person in the social context, shared decision-making, and access to clear and easily understandable information. Existing materials needed to be adapted, resulting in a visual conversation tool. This tool covers the physical, social, and mental health domains as well as daily life, each domain with six to eight topics. It helps to get better insight into the patient’s daily life, wishes, and possibilities. It maps medical and psychosocial issues and supports the patient in gaining a better understanding. The adapted PC-IC approach with the conversation tool is being presented in a training for primary care professionals.

Multimorbidity is increasingly common among older adults in Sub-Saharan Africa (SSA), yet the role of social determinants in shaping its prevalence and outcomes remains underexplored.

This review aimed to (a) identify the prevalence, types, and patterns of multimorbidity among older adults in SSA; (b) examine the influence of social determinants such as income, education, healthcare access, and geographic location; (c) evaluate current approaches for prevention and management; and (d) propose directions for future research.

A systematic search of six databases (PubMed, EMBASE, PsycINFO, Google Scholar, CINAHL, and Global Index Medicus) was conducted to identify quantitative studies published between 2000 and 2024 on adults aged 50 and above. Of 841 records screened, 16 studies met inclusion criteria and passed quality appraisal. The review protocol was registered in PROSPERO (CRD42024607875).

Multimorbidity ranged from 5.4% in Botswana to 71% in Nigeria. Cardiometabolic conditions often co-occurred with infectious and mental disorders. Poverty and low education significantly increased risk (OR: 1.44–7.44). Rural residents faced limited healthcare access, while urban dwellers had higher risks from lifestyle factors. Obesity and food insecurity further heightened vulnerability, especially among women and older adults.

Findings indicate that social determinants critically shape multimorbidity risk and outcomes in SSA. Integrated care models, targeted interventions, and policies addressing structural inequalities are urgently needed. Future research should apply longitudinal and qualitative approaches to clarify causal pathways and inform context-sensitive strategies.

Social determinants of health (SDHs) exert a significant influence on various health outcomes and disparities. This study aimed to explore the associations between combined SDHs and mortality, as well as adverse health outcomes among adults with depression.

The research included 48,897 participants with depression from the UK Biobank and 7,771 from the US National Health and Nutrition Examination Survey (NHANES). By calculating combined SDH scores based on 14 SDHs in the UK Biobank and 9 in the US NHANES, participants were categorized into favourable, medium and unfavourable SDH groups through tertiles. Cox regression models were used to evaluate the impact of combined SDHs on mortality (all-cause, cardiovascular disease [CVD] and cancer) in both cohorts, as well as incidences of CVD, cancer and dementia in the UK Biobank.

In the fully adjusted models, compared to the favourable SDH group, the hazard ratios for all-cause mortality were 1.81 (95% CI: 1.60–2.04) in the unfavourable SDH group in the UK Biobank cohort; 1.61 (95% CI: 1.31–1.98) in the medium SDH group and 2.19 (95% CI: 1.78–2.68) in the unfavourable SDH group in the US NHANES cohort. Moreover, higher levels of unfavourable SDHs were associated with increased mortality risk from CVD and cancer. Regarding disease incidence, they were significantly linked to higher incidences of CVD and dementia but not cancer in the UK Biobank.

Combined unfavourable SDHs were associated with elevated risks of mortality and adverse health outcomes among adults with depression, which suggested that assessing the combined impact of SDHs could serve as a key strategy in preventing and managing depression, ultimately helping to reduce the burden of disease.

Low-income, publicly insured youth face numerous barriers to adequate mental health care, which may be compounded for those with multiple marginalized identities. However, no research has examined how identity and diagnosis may interact to shape the treatment experiences of under-resourced youth with psychiatric conditions. Applying an intersectional lens to treatment disparities is essential for developing targeted interventions to promote equitable care.

Analyses included youth ages 7–18 with eating disorders (EDs; n = 3,311), mood/anxiety disorders (n = 3,219), or psychotic disorders (n = 3,035) enrolled in California Medicaid. Using state billing records, we examined sex- and race and ethnicity-based disparities in receipt of core services – outpatient therapy, outpatient medical care, and inpatient treatment – in the first year after diagnosis and potential differences across diagnostic groups.

Many youth (50.7% across diagnoses) received no outpatient therapy, and youth with EDs were least likely to receive these services. Youth of color received fewer days of outpatient therapy than White youth, and Latinx youth received fewer therapy and medical services across outpatient and inpatient contexts. Sex- and race and ethnicity-based disparities were especially pronounced for youth with EDs, with particularly low levels of service receipt among boys and Latinx youth with EDs.

Results raise concerns for unmet treatment needs among publicly insured youth, which are exacerbated for youth with multiple marginalized identities and those who do not conform to historical stereotypes of affected individuals (e.g., low-income boys of color with EDs). Targeted efforts are needed to ensure equitable care.

Underrepresentation of diverse populations in medical research undermines generalizability, exacerbates health disparities, and erodes trust in research institutions. This study aimed to identify a suitable survey instrument to measure trust in medical research among Black and Latino communities in Baltimore, Maryland.

Based on a literature review, a committee selected two validated instruments for community evaluation: Perceptions of Research Trustworthiness (PoRT) and Trust in Medical Researchers (TiMRs). Both were translated into Spanish through a standardized process. Thirty-four individuals participated in four focus groups (two in English, two in Spanish). Participants reviewed and provided feedback on the instruments’ relevance and clarity. Discussions were recorded, transcribed, and analyzed thematically.

Initial reactions to the instruments were mixed. While 68% found TiMR easier to complete, 74% preferred PoRT. Key discussion themes included the relevance of the instrument for measuring trust, clarity of the questions, and concerns about reinforcing negative perceptions of research. Participants felt that PoRT better aligned with the research goal of measuring community trust in research, though TiMR was seen as easier to understand. Despite PoRT’s lower reading level, some items were found to be more confusing than TiMR items.

Community feedback highlighted the need to differentiate trust in medical research, researchers, and institutions. While PoRT and TiMR are acceptable instruments for measuring trust in medical research, refinement of both may be beneficial. Development and validation of instruments in multiple languages is needed to assess community trust in research and inform strategies to improve diverse participation in research.

Neurodevelopmental follow-up programmes for children with CHD help identify neurodevelopmental impairments and support the delivery of recommended interventions. The Cardiac Neurodevelopmental Outcome Collaborative, Diversity, Equity, and Inclusion Special Interest Group surveyed members to assess perceived patient barriers to neurodevelopmental follow-up, previous diversity and inclusion education, and confidence in caring for historically marginalised populations.

A link to a Redcap online survey was emailed to Cardiac Neurodevelopmental Outcome Collaborative members on 23 April 2022, with 4 weeks given to complete.

Eighty-four participants from 37 institutions in North America completed the survey. Respondents acknowledged that education on the importance of neurodevelopmental follow-up and frequent accommodations for cancellations or rescheduling clinic visits is essential. Language interpretation and written materials were available in languages other than English, but a limited number provided fully translated evaluation reports. Driving distance and the caregiver’s lack of understanding of the rationale for neurodevelopmental follow-up were the top perceived barriers to programme attendance. At the institutional level, training for cultural competency was typically provided, and most respondents felt comfortable caring for patients from diverse backgrounds. However, many agreed their programmes could do more to make evaluations accessible to historically marginalised/underserved populations.

Multiple barriers exist to cardiac neurodevelopmental follow-up, particularly for patients from under-represented minorities and for those whose primary language is not English. Surveying families will be valuable to understand how we may overcome these barriers. Further education about the importance of neurodevelopmental follow-up programmes continues to be essential.

In recent years, there has been a growth in awareness of the importance of equity and community engagement in clinical and translational research. One key limitation of most training programs is that they focus on change at the individual level. While this is important, such an approach is not sufficient to address systemic inequities built into the norms of clinical and translational research. Therefore, it is necessary to provide training that addresses changing scientific norms and culture to ensure inclusivity and health equity in translational research.

We developed, implemented, and assessed a training course that addressed how research norms are based on histories and legacies of white supremacy, colonialism, and patriarchy, ultimately leading to unintentional exclusionary and biased practices in research. Additionally, the course provides resources for trainees to build skills in how to redress this issue and improve the quality and impact of clinical and translational research. In 2022 and 2023, the course was offered to cohorts of pre and postdoctoral scholars in clinical and translational research at a premier health research Institution.

The efficacy and immediate impact of three training modules, based on community engagement, racial diversity in clinical trials, and cancer clusters, were evaluated with data from both participant feedback and assessment from the authors. TL1 scholars indicated increased new knowledge in the field and described potential future actions to integrate community voices in their own research program.

Results indicate that trainings offered new perspectives and knowledge to the scholars.

Despite one-third of patients with cancer using cannabis for symptom management, little is known about their access to and usage of cannabis. Community Engagement (CE) studios involving community experts with chronic health conditions were used to inform a qualitative study on access to and use of cannabis products among patients with cancer.

We conducted two 2-hour CE studios with residents from Western NY (WNY) (N = 18). Our sample primarily included White and Black residents (56% vs. 39%). After a researcher-led 10-minute presentation, a community facilitator led the discussion, which focused on questions about challenges to cannabis use, recommendations for providers when discussing cannabis with patients, and community factors influencing use.

Community experts reported that state legalization of cannabis made it easier to access cannabis, but the costs of cannabis and distance to dispensaries hindered their ability to obtain it. Discrimination was also a key barrier to medical cannabis receipt. There were differences in the perceived safety of where to obtain cannabis (dispensaries vs. friends). Community experts wanted providers to be more informed and less biased about recommending cannabis. Community experts recommended conducting focus groups for the subsequent study to ask questions about cannabis use.

The CE studios encouraged us to switch formats from qualitative interviews to focus groups and provided guidance on question topics for the subsequent study. Incorporating community expert’s feedback through CE studios is an effective strategy to design more impactful studies.

Disparities in access to palliative care persist, particularly among underserved populations. We elicited recommendations for integrating community health workers (CHWs) into clinical care teams, by exploring perspectives on potential barriers and facilitators, ultimately aiming to facilitate equitable access to palliative care.

Twenty-five stakeholders were recruited for semi-structured interviews through purposive snowball sampling at three enrollment sites in the USA. Interviews were conducted to understand perspectives on the implementation of a CHW palliative care intervention for African American patients with advanced cancer. After transcription, primary and secondary coding were conducted. Framework analysis was utilized to refine the data, clarify themes, and generate recommendations for integrating CHWs into palliative care teams.

Our sample comprised 25 key informants, including 6 palliative care providers, 6 oncologists, 5 cancer center leaders, 2 cancer care navigators, and 6 CHWs. Thematic analysis revealed five domains of recommendations: (1) increasing awareness and understanding of the CHW role, (2) improving communication and collaboration, (3) ensuring access to resources, (4) enhancing CHW training, and (5) ensuring leadership support for integration. Informants shared barriers, facilitators, and recommendations within each domain based on their experiences.

Barriers to CHW integration within palliative care teams included limited awareness of the CHW role and inadequate training opportunities, alongside practical and logistical challenges. Conversely, promoting CHW engagement, providing adequate training, and ensuring support from leadership have the potential to aid integration.

Academic-community research partnerships focusing on addressing the social determinants of health and reducing health disparities have grown substantially in the last three decades. Early-stage investigators (ESIs), however, are less likely to receive grant funding from organizations like the National Institutes of Health, and we know little about the facilitators and barriers they face on their career journeys or the best ways to support them and their community research partnerships. This study examines ESIs’ experiences with a program that funded and supported their community-partnered pilot health disparities research.

Fourteen ESIs from five cohorts of pilot investigators participated in in-depth focus groups between April 2020 and February 2024. Two reviewers independently identified significant quotes and created codes. Thematic analysis was used to develop relevant themes.

The overarching theme was that the program was a launch pad for the ESIs’ research careers. Four distinct sub-themes contributing to the launch pad theme were: (1) ESI Growth & Adaptation; (2) Community and Support; (3) The Value of Collaboration and Partnership; (4) Need for Effective Mentorship. The results suggest the program offered ESIs and community partners substantial, unique support and resources, but challenges remained.

Future programs helping ESIs who conduct community-engaged research to launch their research careers should consider implementing tailored support while offering strategies to eliminate or reduce institutional barriers, including strengthening mentoring.

Persistent discrimination and identity threats contribute to adverse health outcomes in minoritized groups, mediated by both structural racism and physiological stress responses.

This study aims to evaluate the feasibility of recruiting African American volunteers for a pilot study of race-based stress, the acceptability of a mindfulness intervention designed to reduce racism-induced stress, and to evaluate preliminary associations between race-based stress and clinical, psychosocial, and biological measures.

A convenience sample of African Americans aged 18–50 from New York City’s Tri-state area underwent assessments for racial discrimination using the Everyday Discrimination Scale (EDS) and Race-Based Traumatic Stress Symptom Scale. Mental health was evaluated using validated clinical scales measuring depression, anxiety, stress, resilience, mindfulness, resilience, sleep, interpersonal connection, and coping. Biomarkers were assessed through clinical laboratory tests, allostatic load assessment, and blood gene expression analysis.

Twenty participants (12 females, 8 males) completed assessments after consent. Elevated EDS scores were associated with adverse lipid profiles, including higher cholesterol/high-density lipoprotein (HDL) ratios and lower HDL levels, as well as elevated inflammatory markers (NF-kB activity) and reduced antiviral response (interferon response factor). Those with high EDS reported poorer sleep, increased substance use, and lower resilience. Mindfulness was positively associated with coping and resilience but inversely to sleep disturbance. 90% showed interest in a mindfulness intervention targeting racism-induced stress.

This study demonstrated an association between discrimination and adverse health effects among African Americans. These findings lay the groundwork for further research to explore the efficacy of mindfulness and other interventions on populations experiencing discrimination.

Race/ethnicity and sleep disturbances are associated with dementia risk.

To explore racial–ethnic disparities in sleep disturbances, and whether race/ethnicity moderates the relationship between sleep disturbances and dementia risk among older adults.

We analysed ten annual waves (2011–2020) of prospective cohort data from the National Health and Aging Trends Study, a nationally representative USA sample of 6284 non-Hispanic White (n = 4394), non-Hispanic Black (n = 1311), Hispanic (n = 342) and non-Hispanic Asian (n = 108) community-dwelling older adults. Sleep disturbances were converted into three longitudinal measures: (a) sleep-initiation difficulty (trouble falling asleep within 30 min), (b) sleep-maintenance difficulty (trouble falling asleep after waking up early) and (c) sleep medication usage (taking medication to sleep). Cox proportional hazards models analysed time to dementia, after applying sampling weights and adjusting for sociodemographic characteristics and health.

Black, Hispanic and Asian respondents exhibited higher frequencies of sleep-initiation and sleep-maintenance difficulties, but had less sleep medication usage, compared with White older adults. Among Hispanic respondents, sleep-initiation difficulty was associated with significantly decreased dementia risk (adjusted hazard ratio (aHR) = 0.34, 95% CI 0.15–0.76), but sleep-maintenance difficulty was associated with increased dementia risk (aHR = 2.68, 95% CI 1.17–6.13), compared with White respondents. Asian respondents using sleep medications had a significantly higher dementia risk (aHR = 3.85, 95% CI 1.64–9.04). There were no significant interactions for Black respondents.

Sleep disturbances are more frequent among older Black, Hispanic and Asian adults, and should be considered when addressing dementia disparities. Research is needed to explore how certain sleep disturbances may elevate dementia risk across different racial and ethnic subgroups.