Precision medicine, which is based on the idea of tailoring health care for individual genetic, environmental, and lifestyle factors, is rapidly revolutionizing biomedical research and clinical practice across the world. Despite the progress across the world, Africa only has a limited representation in precision medicine research and implementation. This view looks at where Africa stands today in the precision medicine sphere and identifies gaps in genomic data, infrastructure, workforce capacity, and policy frameworks. It examines the implications of these gaps for health equity globally the potential dangers of growing health disparities if African populations are not included in research and innovation. Furthermore, it outlines the strategies to enhance Africa's involvement in precision medicine, such as capacity building, regional partnerships, investment in bioinformatics, and research policies to ensure inclusivity. Strengthening Africa's role in precision medicine is crucial not only for improving health at the local level but also for ensuring equitable health outcomes across the globe.
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Refugee women face barriers to reproductive health care, including limited English proficiency, transportation challenges, inconsistent insurance coverage, socioeconomic instability, and prevalence of trauma-related mental health conditions. This study describes the characteristics, diagnoses, and health care utilization of refugee women receiving care at the Refugee Women's Health Clinic (RWHC) of Valleywise Health (VH), a safety net health care system in the southwestern United States. Further, it examines the role of an integrated cultural health navigator (CHN) program in addressing access and care barriers for refugee women. Study objectives were to characterize demographics, health diagnoses, reproductive health care utilization, and the scope of CHN service delivery. We conducted a retrospective cohort study using electronic medical record data from 21,062 refugee-identified patients seen at VH from 2009 to 2024, with a focused descriptive analysis of 7,504 women who received care at the RWHC. Analyses of CHN service delivery were conducted among a subset of 1,581 patients with available CHN flowsheet documentation. Patients originated from >100 countries, demonstrating extensive racial, linguistic, and religious diversity. Among RWHC patients, 48.1% experienced at least one pregnancy; 93.2% received prenatal care, and 55.3% initiated care in the first trimester. Mental health diagnoses were common, including anxiety (10.0%) and depression (9.8%). Preventive services were widely utilized, including sexually transmitted infection screening (43.1%) and contraceptive counseling (32.2%). CHNs supported approximately 5,000 patient encounters annually, with services focused on appointment adherence, enhanced interpretation and transportation access, and linkage to behavioral health and supportive services. The RWHC and its integrated CHN program represent a community-based, equity-focused model of reproductive health care delivery for refugee women in a safety-net setting. Embedding CHN programs within clinical settings may mitigate socioeconomic, linguistic, and mental health-related care barriers by strengthening care coordination and access. This model offers a framework for advancing reproductive health equity among resettled refugee women.
Coloniality continues to define knowledge, culture, relationships and health outcomes for Indigenous peoples around the world. Health systems are shaped by coloniality, influencing access to health care and the quality of care. Decolonization, although pluralistic in understanding, provides a theoretical foundation for health system transformation. The aim of this scoping review was to explore what is known about decolonization, Indigenous health, and equity in publicly funded health systems, and to identify gaps in existing literature. This research is grounded in an Indigenous methodology and positioning, providing a critical structural analytical framework. Scoping review methods developed by the Joanna Briggs Institute and PRISMA-ScR were situated within a Kaupapa Māori framework to identify decolonization approaches and characteristics in publicly funded health systems within Aotearoa New Zealand, Australia and Canada. Data sources included four databases and an Aotearoa New Zealand-focused gray literature search. Sixteen texts were included with more than three-quarters published between 2019 and 2021. The majority of approaches were at the level of the system or health professional and exploratory in nature. Implementation and outcome measurement were scarce. Characteristics of decolonization in health systems were categorized as Addressing Coloniality, Transformation, Relationships and Indigeneity. This review provides a novel synthesis of decolonization in the context of publicly funded health systems, identifying an emergent research area, and disconnect between theory and practice. Decolonization provides a rights-based intersectional framework that is distinct from alternative approaches, unique in its ambition to address power imbalance and see structural transformation. Misalignment between ideological positioning of decolonial theory and governments may limit the opportunity for implementation within publicly funded health systems. Research, implementation and evaluation of decolonization approaches is needed to expand knowledge, influence future public policy and see structural transformation of health systems to support Indigenous well-being and health equity.
This scoping review examines the health and well-being of older Canadian Veterans, a population facing distinct aging challenges shaped by military service. Guided by Arksey and O'Malley's five-stage framework, we searched peer-reviewed and grey literature across six databases and multiple Canadian government sources. Eligible sources included journal articles, reports, book chapters, and editorials addressing Canadian Veterans aged 55+ years and their physical, mental, or overall well-being. From 2,229 identified sources, 68 were included. Data extraction captured study characteristics, concepts, participant details, and main findings. Three themes were identified: 1) health and well-being across all Veteran ages, 2) interventions and programs, and 3) research specifically on older Veterans. Older Veterans experience higher rates of chronic physical conditions but often report greater social support and life satisfaction than younger Veterans. Mental health conditions, particularly PTSD, frequently co-occur with depression, anxiety, and chronic pain. Interventions exist but are rarely age-specific, limiting relevance for older adults. Research on older Veterans highlighted gaps in long-term care, dementia, caregiving, and experiences of equity-deserving sub-groups, including women, racialized, and LGBTQIA2S+ Veterans. Findings underscore the need for age-specific, intersectional research adopting a life course perspective to understand aging within military contexts. Future work should prioritize inclusion of older Veterans to guide tailored health services, caregiver supports, and long-term care strategies. Addressing these gaps is essential to promote equitable, evidence-informed support for Canada's growing population of older Veterans. Older Canadian Veterans face unique and increasingly complex health challenges shaped by both aging and their military service. As they grow older, their military experiences can significantly impact their physical and mental health, as well as their overall quality of life. This study reviews what is currently known about the health and well-being of older Veterans in Canada. Researchers examined over 2,200 sources, identifying 68 that specifically focused on Veterans aged 55 years and older. The findings were grouped into three key areas: 1) general health and well-being, 2) programs and services for Veterans, and 3) studies focused specifically on older Veterans. The review found that older Veterans often experience more physical health problems than younger Veterans but report higher levels of social support, financial security, and life satisfaction. Mental health challenges, including PTSD, anxiety, and chronic pain, remain common among this group. While some programs exist to support Veterans, very few are tailored specifically to the needs of older adults. Significant gaps were identified in research on long-term care, dementia, caregiver support, and the needs of women Veterans, racialized groups, and LGBTQIA2S+ Veterans. This review highlights the urgent need for more research and policies focused on older Veterans. By addressing these gaps, health care and social services can be better designed to meet the unique and evolving needs of Canada’s aging Veteran population. Cette analyse exploratoire aborde la santé et le bien-être des vétéran·e·s canadien·ne·s âgé·e·s, une population qui affronte des problèmes particuliers liés au vieillissement, façonnés par leur service militaire. Orientées par le cadre en cinq étapes d’Arksey et d’O’Malley, les autrices ont fouillé les publications révisées par un comité de lecture et la documentation parallèle dans six bases de données et de multiples sources gouvernementales canadiennes. Les sources admissibles incluaient des articles de revues, des chapitres de livres et des éditoriaux sur les vétéran·e·s canadien·ne·s de 55 ans et plus et leur bien-être physique, mental ou global. Des 2 229 sources extraites, 68 ont été retenues. L’extraction des données a tenu compte des caractéristiques des études, des concepts, des détails sur les participant·e·s et des principales observations. Trois thèmes ont émergé : 1) la santé et le bien-être chez les vétéran·e·s de tous âges, 2) les interventions et les programmes et 3) la recherche expressément sur les vétéran·e·s âgé·e·s. Les vétéran·e·s âgé·e·s présentent des taux plus élevés d’affections physiques chroniques, mais confient souvent profiter d’un plus grand soutien social et ressentir une meilleure satisfaction envers la vie que les vétéran·e·s plus jeunes. Les troubles de santé mentale, notamment le trouble de stress post-traumatique, se présentent souvent conjointement avec de la dépression, de l’anxiété et des douleurs chroniques. Il existe des interventions, mais elles sont rarement adaptées à l’âge, ce qui en limite la pertinence auprès des adultes âgés. Cette recherche sur les vétéran·e·s âgé·e·s a fait ressortir les lacunes en matière de soins de longue durée, de démence, de proche aidance et d’expériences dans les sous-groupes dignes d’équité, y compris les femmes et les vétéran·e·s racisé·e·s et LGBTQIA2+. Les résultats soulignent la nécessité de mener des recherches intersectionnelles adaptées à l’âge selon la perspective du parcours de vie pour comprendre le vieillissement en contexte militaire. De futures recherches devraient prioriser l’inclusion de vétéran·e·s âgé·e·s pour favoriser des services de santé adaptés, le soutien de proches aidant·e·s et des stratégies de soins à long terme. Il est essentiel de corriger ces lacunes pour promouvoir le soutien équitable et fondé sur des données probantes de la population croissante de vétéran·e·s âgé·e·s au Canada. Les vétéran·e·s canadien·ne·s âgé·e·s affrontent des problèmes de santé uniques et de plus en plus complexes attribuables à la fois au vieillissement et au service militaire. À mesure qu’ils et elles vieillissent, leurs expériences militaires peuvent avoir des conséquences importantes sur leur santé physique et mentale, de même que sur leur qualité de vie globale. Cette étude examine les connaissances actuelles sur la santé et le bien-être des vétéran·e·s âgé·e·s du Canada. Les chercheuses ont examiné plus de 2 200 sources et en ont retenu 68 qui portaient expressément sur les vétéran·e·s de 55 ans et plus. Les résultats ont été groupés en trois grandes catégories : 1) la santé générale et le bien-être, 2) les programmes et les services aux vétéran·e·s et 3) les recherches portant expressément sur les vétéran·e·s âgé·e·s. L’analyse a révélé que les vétéran·e·s âgé·e·s souffrent souvent de plus de problèmes de santé physique que les plus jeunes vétéran·e·s, mais indiquent des taux plus élevés de soutien social, de sécurité financière et de satisfaction envers la vie. Les troubles de santé mentale, y compris le trouble de stress post-traumatique, l’anxiété et la douleur chronique, demeurent courants au sein de ce groupe. Même s’il existe certains programmes pour soutenir les vétéran·e·s, très peu sont adaptés expressément aux besoins des adultes âgés. Des lacunes importantes ont été observées en recherche en matière de soins de longue durée, de démence, de soutien des proches aidant·e·s et des besoins des vétéran·e·s, des groupes racisés et des vétéran·e·s LGBTQIA2S+. Cette analyse souligne l’urgence de réaliser de nouvelles recherches et d’adopter des politiques axées sur les vétéran·e·s âgé·e·s. Si ces lacunes sont corrigées, les services de santé et les services sociaux pourront être mieux conçus pour respecter les besoins uniques et évolutifs de la population vieillissante de vétéran·e·s au Canada.
Many digital tools are available to support healthy pregnancies. Far fewer focus on the postpartum period or have the explicit goal of reducing poor or inequitable maternal health outcomes. Yet, many pregnancy-related complications occur up to a year after labor and delivery. Here, we outline a healthequity-centered process, using multiple phases of data collection, which informed our design decisions when developing a comprehensive postpartum support app, Myana ("Mothers, you are not alone"). Drawing on a behavioral decision research approach and grounded in principles for developing equity-focused digital reproductive health tools, we iteratively designed and tested the Myana app. Our data collection included qualitative interviews, focus groups, and evaluations of an interactive experience prototype and app wireframes. To illustrate our process, we highlight two unique features of Myana intended to address health inequities: a symptom triaging feature ("The Healing Check-in") and a tailored educational hub ("The Learning Center"). Results from our iterative development process shaped how we asked about and responded to symptoms reported in the Healing Check-in, the topics and framing of curated content in the Learning Center, the cadence of expected interaction with features in the app, as well as the app's overall tone and visual design. We created a postpartum support app to help birthing parents make informed decisions about their health and well-being in the year postpartum, with the larger goal of improving health outcomes. The iterative design and development process integrated clinical and community perspectives while intentionally centering health disparities. This approach represents a new model for developing digital supports to supplement the formal healthcare system.
The growing worldwide challenges of climate change, environmental degradation with biodiversity loss, and systemic inequities call for accessible, transformative, and impactful planetary health education that embraces a global perspective. However, traditional international learning experiences favor those with financial advantages, limiting equitable access to (planetary health) knowledge, intercultural collaboration competencies, and leadership opportunities. To address this challenge, the University Medical Center (UMC) Utrecht in the Netherlands and St. Luke's Medical Center College of Medicine's Planetary and Global Health Program (PGHP) in the Philippines developed a joint online course on Planetary Health and Climate-Resilient Health Systems, combining synchronous and asynchronous learning activities. This novel approach allowed for collaboration between Dutch and Filipino medical students, integrating international perspectives while providing an opportunity to solve local problems and offering equitable access to education. The course incorporated online modules, workshops, and mentorshipblending expertise from educators from the Netherlands and the Philippines. Through the course, participants engaged in intercultural teamwork, focusing on student-identified planetary health priority issues such as eco-anxiety, fast fashion, and healthcare waste management. This initiative illustrates the importance and feasibility of collaborative, glocal approaches to planetary health education, with learners gaining insights into localized solutions for global issues. It also showed how the values of decolonizing global health education and bidirectional knowledge exchange can turn intercultural learning into educational practice. Future iterations will expand the course to involve more countries, refine the use of interactive tools, address time-zone challenges, and incorporate education research to further study the learning process and outcomes. Institutional support is essential to scale this educational model, ensuring planetary health education remains accessible and impactful.
Maternal health in the United States is in crisis, and perinatal mental health conditions are emerging as a critical contributor to maternal morbidity and mortality. Perinatal mood and anxiety disorders (PMADs) encompass a range of mental health disorders experienced during pregnancy and 1 year after delivery. Expanding the perinatal mental health workforce to include paraprofessionals could help address a national shortage of mental health professionals. This scoping review aims to investigate the literature on perinatal mental health interventions delivered by community health workers (CHWs) or paraprofessionals in the United States. Studies on interventions addressing perinatal mental health were included if delivered by CHWs or paraprofessionals in the United States. Seven databases were searched via EBSCO through August 29, 2025. No publication year limits were applied. Results were exported to Zotero for deduplication, Catchii for screening, and Excel for data extraction and analysis. Risk of bias was not assessed. After removing 4148 duplicates from the 7524 records identified, 3376 records were screened, and 13 studies met the inclusion criteria. CHW-delivered interventions for PMADs in the United States varied in design, content, and implementation. Most were initiated during the antenatal period, extended postnatally, and targeted primary prevention of depression symptoms. Ten studies evaluated outcomes among predominantly low-income, Latina, or Black mothers in urban environments. Interventions enhanced social support, cognitive, emotional, behavioral, parenting, and practical skills. Intervention results varied. Most studies reported positive effects: all nonexperimental designs found statistically significant improvements in depressive symptoms, and many experimental designs demonstrated statistically significant improvements in depressive symptoms among women receiving adequate intervention dosage. This review expands knowledge of perinatal mental health interventions delivered by CHWs and health paraprofessionals in the United States, including information about populations served, CHWs, intervention characteristics, and outcomes. Gaps in evidence and recommendations for future research are presented.
Small-scale livestock farming remains central to food security and income-generation in several low and middle countries (LMIC), but it can also be an important source of zoonoses in areas where access to water and sanitation is poor. The role played by women in this sector is often overlooked. ELUZO is an international, intersectoral, and multidisciplinary One Health project that aims to reduce the impact of zoonotic diseases and empower women in rural communities in Senegal and Burkina Faso. The project adopts a women-centered approach, integrating development and research using a Theory of Change (ToC) framework to combine measurement tools that meet Global Affairs Canada's requirements with scientific rigour. As part of the study protocol, we co-designed tools to collect baseline data using mixed methods to generate a comprehensive picture of the human, animal and environmental health concerns in each participating community. The baseline findings were then used to guide selection and design of interventions. The decision-making process of the project is carried out collaboratively with community members, ensuring local realities and needs are reflected. The final stage of the project will be implementation and assessment of the effectiveness of the community interventions. Additionally, the team will provide training sessions on One Health and gender equity. This paper describes the study protocol developed to guide the ELUZO project. The protocol includes the governance structure, objectives and methods used to design a gender-sensitive, community-driven and multisectoral One Health intervention project to reduce the impacts of zoonotic disease in low-resource settings. Main findings: The paper describes a women-centered, community-driven framework to operationalize a One Health approach in rural Africa to fight against zoonoses.Added knowledge: The study demonstrates the importance of integrating gender equity, participatory methods and bridging research and development in community-level initiatives.Global health impact for policy and action: The paper provides a model for designing integrated One Health initiatives that engage communities, especially women, in zoonotic disease prevention.
Perinatal mental health disorders are among the most common complications of pregnancy and childbirth and represent a leading cause of maternal mortality in the United States. Black, Indigenous, and other People of Color (BIPOC) are disproportionately affected, reflecting the impact of structural racism, inequitable care, and broader social determinants of health. While medical and public health frameworks have advanced important strategies to address these inequities, psychological perspectives accounting for sociopolitical and cultural contexts remain underutilized, limiting responsive and effective mental health care for BIPOC individuals. We introduce the PERI Model of Radical Healing to reframe perinatal mental health equity as a liberatory and intergenerational process. This model emphasizes four interconnected domains: Practice, Emancipation, Resistance, and Intergenerational Hope. It positions perinatal mental health not only as the reduction of pathology but as a source of justice, dignity, and collective flourishing.
People living with rare diseases in Africa face substantial barriers to accessing healthcare services, including delayed diagnoses, limited treatment options and fragmented care systems. The main objective of the scoping review is to explore and map existing interventions designed to improve access to healthcare services for individuals living with rare diseases across the African continent. Design: The scoping review will be conducted using the Arksey and O'Malley framework, further refined by the enhancements proposed by Levac and colleagues. The process will follow six key stages: (1) identifying the research question, (2) identifying relevant studies, (3) selecting eligible studies, (4) charting the data, (5) collating, summarising and reporting the results, and (6) stakeholder consultation. A comprehensive search strategy will be implemented across several electronic databases, including PubMed, Scopus and Web of Science. Additionally, grey literature sources such as conference abstracts and institutional reports will be included. Studies will be eligible if they were conducted in Africa, published between 2004 and 2024 and focused on interventions aimed at improving access to healthcare for people living with rare diseases. Two independent reviewers will screen all titles, abstracts and full texts, with disagreements resolved through discussion or a third reviewer. Data will be extracted using a standardised extraction form. The protocol has obtained waiver from the ethics committee of Sefako Makgatho Health Sciences University (SMUREC/M/365/2025). The findings will provide valuable insights for physicians, laboratory scientists, researchers and policymakers, highlighting pragmatic and cost-effective strategies to enhance healthcare access for individuals with rare diseases in Africa. Results will be disseminated through peer-reviewed publications, policy briefs, conference presentations and stakeholder engagement activities.
Cardiovascular disease (CVD) is the leading cause of mortality globally and imposes a substantial disease burden. Addressing the social determinants of health (SDOH) presents a critical opportunity to reduce CVD-related mortality and disability. In Japan, CVD constitutes a major cause of death and necessitates long-term care, with current guidelines now incorporating SDOH related to CVD, indicative of a growing interest in these determinants. This review outlines the definition and conceptual frameworks of SDOH, along with its key domains: (1) Economic stability, (2) Education access and quality, (3) Social and community context, (4) Health care access and quality, and (5) Neighborhood and built environment. In addition to these established determinants, we discuss emerging SDOH such as climate change and digital health technologies, which may reshape cardiovascular risk and potentially widen existing disparities. We also summarize existing epidemiological findings and implications for intervention strategies, and outline future perspectives, including the implications of genetic testing and related ethical, legal, and social issues, as well as strategies aimed at reducing health disparities. Overall, advancing equitable cardiovascular health will require continued research, greater recognition of the role of SDOH, and efforts to address these determinants, including improving understanding of SDOH among health care professionals and the public and strengthening the evidence base for CVD and SDOH.
Despite growing concerns about mental health in Black adolescents, cultural factors influencing their help-seeking behaviors remain largely understudied. Pathways to formal mental health help-seeking and the influence of religion remain underexplored in Black adolescents. This study investigated the relationship between religious affiliation and formal mental health service utilization in Black adolescents using a mixed-methods sequential explanatory approach. Quantitative analysis (n=285) revealed that religious Black adolescents are more likely to seek mental health services from school-based professionals and less likely to use phone or text lines compared to their nonreligious counterparts. Using inductive thematic analysis, three themes were identified from qualitative interviews (n=6): Cultural and Community Emphasis on Religious Coping, Stigma and Dismissiveness, and Awareness of the Need for Additional Help. Findings underscore the need for culturally responsive mental health interventions and collaborations with community organizations to improve formal service access and utilization for Black teens. Implications for clinicians, educators, and community leaders focus on strategies to promote health equity and address systemic barriers to care in Black communities.
Smoking in Nepal poses significant public health challenges linked to chronic cardiovascular and respiratory disease and socioeconomic consequences. This study aims to examine the prevalence and associated factors of smoking patterns among Nepali adults using national representative data. The secondary data from the Nepal Demographic and Health Survey 2022 were the source of data for analysis. A complex sample analysis was conducted to accommodate the stratified and cluster design used in the survey with sampling weights. Multivariable binary logistic regression analysis was carried out to identify significant predictors. The prevalence of smoking patterns was 3.8% among 14,845 women and 28.0% among 4,913 men. Among women from Karnali province (adjusted odds ratio [AOR] = 3.144; p = 0.007), Janajati (AOR = 4.080; p = 0.003), women with no education (AOR = 3.705; p = 0.000), the 35-49 age group (AOR = 18.258; p = 0.000), and alcohol users (AOR = 2.808; p = 0.000), similarly, among men from Koshi (AOR = 1.881; p = 0.000), Dalit (AOR = 1.402; p = 0.030), men with basic education (AOR = 1.704; p = 0.001), the 20-34 age group (AOR = 1.597; p = 0.002), those engaged in nonagriculture (AOR = 2.430; p = 0.000), and alcohol users (AOR = 3.236; p = 0.000) were found more likely to smoke compared to their corresponding reference categories. Smoking among adults in Nepal is shaped by structural and sociocultural factors, such as province, caste/ethnic groups, educational attainment, occupational status, age and alcohol consumption. The difference between women and men reveals the necessity of equity-oriented smoking control program and strategies that address the structural and sociocultural factors of smoking on the higher level and promote smoking cessation through combination with public health and social development programs.
Doula support is increasingly recognized as a promising strategy to address racial inequities in maternal health. The New York City Health Department launched the Citywide Doula Initiative (CDI) in March 2022 to expand access to free, community-based doula support in disinvested neighborhoods. To evaluate the program's first year of implementation, we conducted semi-structured interviews with 44 clients, doulas, doula-organization staff, and Health Department staff between November 2022 and April 2023. We coded interview notes using template analysis (a thematic analysis approach) and grouped barriers and facilitators according to the Practical Robust Implementation and Sustainability Model. Facilitators included high perceived value of the CDI, a shared commitment to community, open communication, and policymaker support for doula work. Barriers included insufficient time for planning, cumbersome bureaucratic processes, and cultural and capacity differences between the Health Department and community partners. Additional factors, such as-variation in hospital treatment of doulas, doula-organization capacity, doula skills and experiences, and client needs and circumstances-had mixed effects on program implementation. Findings indicate that community-based doula models, which have been shown to improve birth outcomes in disinvested communities, can be successfully scaled in an urban setting. Programs seeking to expand access to doula support should prioritize time for planning, allocate sufficient resources for administrative support, and work to establish efficient and responsive payment and contracting processes. Having mission-driven staff at all levels of the program and prioritizing relationships with community-based organizations and doulas are vital for success.
Advance care planning (ACP) is important for older adults experiencing cognitive decline, and social determinants of health (SDoH) may shape engagement. To evaluate cognitive and social-contextual differences in ACP among older adults. Using 2018 Health and Retirement Study data, we evaluated ACP completion, defined as a living will (LW), durable power of attorney for health care, or both, across cognitive status groups and tested SDoH moderation. Individuals with dementia or impaired cognition had lower ACP completion than those with normal cognition. Education and neighborhood support moderated cognition-ACP associations. Among less educated individuals, dementia was associated with lower odds of LW completion. Lower neighborhood support was associated with lower odds of LW completion, whereas higher support was associated with greater odds of reporting at least one ACP measure. SDoH shape ACP during cognitive decline. Nurses should prioritize early, equitable ACP discussions to improve end-of-life care quality.
The maternal health crisis in the United States, particularly affecting Black women, is due to disparities in health care access, socioeconomic inequalities, and systemic racism. The Black Mamas Matter Alliance, Inc. (BMMA) leads efforts to improve Black maternal health using frameworks like reproductive justice and Black Feminism. To integrate reproductive justice frameworks within research, BMMA's Research Working Group created six holistic care research principles for conducting research by, with, and for Black Mamas. This article describes the application of these principles across BMMA's research projects, which can ensure that research activities and findings are responsive to the needs of Black birthing people.
Perinatal morbidity and mortality are substantially higher for Aboriginal and Torres Strait Islander (hereafter called First Nations) mothers and babies compared with non-First Nations peoples. Women birth in systems designed and informed by Western values, and many report negative interactions with health professionals and a lack of cultural safety in the mainstream maternity system. To redress unacceptable health outcomes and system challenges, we implemented a culturally tailored caseload midwifery care programme called Baggarrook Yurrongi, at three tertiary maternity services in Melbourne, Australia. The model included continuity throughout pregnancy, labour, birth and the early postnatal period, recognition of culture as central to identity, and respecting and acknowledging the cultural background, beliefs and values of First Nations peoples. This paper describes maternal and infant health outcomes. This prospective non-randomised translational study used routinely collected clinical outcome data to explore whether, for women expecting a First Nations baby, receiving the new model was associated with improved clinical outcomes compared with usual care prior to and since implementation (adjusted for age, Body Mass Index, marital status, parity, diabetes and hypertensive disorders). Specifically, would the model decrease the proportion of First Nations babies born low birthweight (<2500 g) and increase the proportion born 'healthy' (alive, at term, of normal weight and size, and not admitted to neonatal special or intensive care (NICU)). All births were included except multiple pregnancies, where babies had major congenital anomalies, and births occurring within the first six months of model implementation. Baseline data were from 2012 to model commencement (2017) (99,952 non-First Nations and 1159 First Nations births). 'After' data were collected to 2022 (62,499 non-First Nations and 1038 First Nations births), and 669/1038 eligible women (64.5%) received the Baggarrook Yurrongi model. Fewer First Nations babies whose mothers received the model compared with those who received usual care 'Before' were low birthweight (AOR 0.67, 95% CI 0.47, 0.93) and more were born 'healthy' (AOR 1.45, 95% CI 1.14, 1.84). Culturally tailored caseload midwifery care significantly improved perinatal outcomes for women and their First Nations babies. Given poor perinatal outcomes are major risk factors affecting short- and long-term health, we recommend widespread model implementation, adapted to the needs of local First Nations communities, and supported by policymakers. Future research should include monitoring implementation and outcomes of the programme, along with robust cost-effectiveness analysis data to inform scale-up. Australian National Health and Medical Research Council.
Perinatal mood and anxiety disorders (PMADs) are among the most common complications of pregnancy. Yet, identification, access, and intervention lag behind need, particularly for those from historically marginalized backgrounds. Although couples-based, cognitive behavioral approaches show promise, few interventions integrate community-engaged, partner-inclusive, and in-home approaches that bolster accessibility. This article presents the development and protocol for the New Family Wellness Project (NFWP). The six-session NFWP focuses on shared family values and communication supplemented with between-session provider check-ins, support groups, homework, and tailored case management. Twenty-two participants (8 couples; 6 mothers alone) provided quantitative and qualitative feedback on the NFWP feasibility and acceptability. Participants reported very high engagement (M = 96/100) and identified the in-home and partner-inclusive format as vital. Qualitative feedback highlighted that the NFWP improved communication and enhanced reflection on family values and actionable steps to support effective co-parenting. Nearly half of the participants said they would not have participated without the in-home and couples-based format. Preliminary findings support the feasibility and acceptability of this community-engaged, cognitive behavioral therapy, couples-based intervention for PMADs. Future directions explore scalability on a larger scale to enhance equitable, perinatal mental health interventions for family systems.
This study aimed to examine geographic variation, temporal trajectories, and equity dimensions of quality in Australian residential aged care using the Star Ratings system introduced in late 2022. A repeated cross-sectional and longitudinal panel analysis of publicly available administrative data was performed. All 3002 rated residential aged care facilities were observed across 11 quarterly Star Ratings extracts (May 2023 to October 2025), yielding 28,708 facility-quarter records. Spatial clustering was assessed using Global and Local Moran's I. Overall-rating trajectories by provider type were modelled using linear mixed-effects models with facility random intercepts and slopes. Residential aged care quality deserts were defined as regions beyond 50 km from a rated mainstream residential facility. The results are reported as per STROBE guidelines. The mean overall rating improved from 3.38 to 3.87 stars, with improvement decelerating over time (P < 0.001). For-profit facilities rated 0.10 stars lower than not-for-profit (P < 0.001) and were 2.75 times more likely to be persistently low-performing (odds ratio 2.75; 95% CI 1.13-6.70). Overall ratings clustered spatially (Moran's I = 0.24, P < 0.001), with 17 low-rating clusters predominantly in Western Australia and South Australia. Eleven residential aged care quality deserts affected 14,056 people aged 65 and older; desert status is driven by remoteness, with disadvantage showing no independent association after adjustment (P = 0.60). Star Ratings, best interpreted as a regulatory and consumer signal rather than a validated measure of care quality, have improved substantially over the period observed; a persistent for-profit gap in overall ratings and geographic clustering present opportunities for targeted regulatory scrutiny.