Journal: International Journal for Equity in Health

Abbreviation

Int J Equity Health

Publisher

BioMed Central

Journal Volumes

ISSN

1475-9276

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2018 - 201912020 - 20251
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Publications 1 - 2 of 2
  • Equity by design principles for digital health interventions
    Item type: Journal Article
    Bitomsky , Laura; Nißen, Marcia; Kowatsch , Tobi (2025)
    International Journal for Equity in Health
    Background Despite significant progress in the past decade, health disparities persist. Digital health interventions (DHIs) offer a transformative opportunity to advance health equity but may also exacerbate the digital divide if equity considerations are not embedded from the onset. While there is broad consensus on the importance of equity-centered design, a critical gap re-mains in the form of actionable guidance for both research and practice. Thus, this study aims to develop equity by design principles for DHIs. Methods We first synthesized existing scientific knowledge by assessing 42 articles/guidelines and formulated an initial set of 26 actionable, evidence-based design principles for DHIs (July through October 2024). We then conducted three semi-structured expert interviews to refine these principles (November 2024 through January 2025). We finally facilitated end-user workshops with two DHI providers to assess and finalize the design principles with respect to practical relevance and applicability (January through March 2025). Results We identified 25 equity by design principles, 15 targeting DHIs, and 10 the organizational context in which DHIs are developed. The DHI-specific principles were categorized according to key process stages: needs assessment, design and development, implementation, and evaluation and dissemination. The organizational context principles were grouped into four domains: strategy, people, processes and structures, and partnerships and advocacy. We further challenged the principles real-world applicability, identifying three overarching challenges that hinder their successful implementation. Conclusions The study underscores the necessity of moving beyond DHI-specific design considerations to address health inequities in digital health. By adopting these design principles, digital health companies can embed equity as a core strategic priority, actively contribute to reducing health disparities, and foster a more inclusive healthcare ecosystem.
  • Vaccine hesitancy among mobile pastoralists in Chad: a qualitative study
    Item type: Journal Article
    Abakar, Mahamat Fayiz; Seli, Djimet; Lechthaler, Filippo; et al. (2018)
    International Journal for Equity in Health
    Background Demand side barriers to vaccination among rural and hard-to-reach populations in Chad are not yet well understood. Although innovative approaches such as linking human and animal vaccination increase vaccination uptake among mobile pastoralist communities, vaccination coverage in these communities is still lower than for rural settled populations. We hypothesize that mobile pastoralists’ communities in Chad face specific demand side barriers to access vaccination services. Understanding the factors that caregivers in these communities consider, explicitly or implicitly, in order to decide whether or not to vaccinate a child, in addition to understanding the provider’s perspectives, are essential elements to tailor vaccination programmes towards increasing vaccination acceptance and uptake. Methods We conducted a qualitative study in a rural health district in southern Chad in April 2016 with 12 key informant in-depth interviews and four focus group discussions (FGDs) including 35 male and female participants. Participants in the study included caregivers, traditional chiefs, local and religious leaders from mobile pastoralist communities, and health officials and staff. We conducted a content analysis using a pre-defined set of categories for vaccine hesitancy covering issues on harmful effects of vaccination, mistrust with vaccination programmes/services, issues with the health system and other issues. Results The groups of demand side barriers reported most frequently in focus group discussions were mistrust on the expanded programme on immunization (EPI) and polio vaccination outreach services (53%, n = 94), followed by health system issues (34%, n = 94), and concerns related to potential harm of vaccines (13%, n = 94). Concerns identified by caregivers, health professionals and community leaders followed a similar pattern with issues on programme mistrust being most frequently reported and issues with harm least frequently reported. None of the health professionals reported concerns about vaccinations being potentially harmful. Conclusion Mobile pastoralist communities face specific demand side barriers to vaccination. Understanding these barriers is essential to reduce vaccine hesitancy and increase vaccination uptake. Local health systems must plan for the periodic presence of pastoralist communities in their zones of responsibility and create more mutual trust.
Publications 1 - 2 of 2