Abstract：
The COVID-19 pandemic highlighted the impact of social inequalities in health (SIH). Various studies have shown significant inequalities in mortality and morbidity associated with COVID-19 and the influence of social determinants of health. The objective of this qualitative case study was to analyze the consideration of SIH in the design of two key COVID-19 prevention and control interventions in France: testing and contact tracing. Interviews were conducted with 36 key informants involved in the design of the intervention and/or the government response to the pandemic as well as relevant documents (n = 15) were reviewed. We applied data triangulation and a hybrid deductive and inductive analysis to analyze the data. Findings revealed the divergent understandings and perspectives about SIH, as well as the challenges associated with consideration for these at the beginning stages of the pandemic. Despite a shared concern for SIH between the participants, an epidemiological frame of reference dominated the design of the intervention. It resulted in a model in which consideration for SIH appeared as a complement, with a clinical goal of the intervention: breaking the chain of COVID-19 transmission. Although the COVID-19 health crisis highlighted the importance of SIH, it did not appear to be an opportunity to further their consideration in response efforts. This article provides original insights into consideration for SIH in the design of testing and contact-tracing interventions based upon a qualitative investigation.
The COVID-19 pandemic has highlighted the importance of social inequalities in health (SIH) and the disproportionate burden of the pandemic and its consequences related to socioeconomic status, ethnicity and race, among other determinants of health. Public health interventions are likely to increase SIH when they are not considered in the design phase. Through a qualitative case study, we analyzed the design of one of the first local initiative providing testing and contact tracing offer to the general population in the Île-de-France region (Paris region, France) in response to the COVID-19 pandemic. This article discusses the uncertainty and challenges associated with consideration for SIH in the intervention design. It explores the diverse understandings of SIH among the actors and the complexities of cross-sectoral partnerships addressing SIH in times of health crisis. Despite a consensual concern for this issue among the respondents, an epidemiological frame of reference dominated the intervention design. It resulted in a model in which consideration for SIH appeared as a complement, with a clinical goal of the intervention: breaking the chain of COVID-19 transmission.
The COVID-19 pandemic has highlighted the importance of social inequalities in health (SIH) and the disproportionate burden of the pandemic and its consequences related to socioeconomic status, ethnicity and race, among other determinants of health. Public health interventions are likely to increase SIH when they are not considered in the design phase. Through a qualitative case study, we analyzed the design of one of the first local initiative providing testing and contact tracing offer to the general population in the Île-de-France region (Paris region, France) in response to the COVID-19 pandemic. This article discusses the uncertainty and challenges associated with consideration for SIH in the intervention design. It explores the diverse understandings of SIH among the actors and the complexities of cross-sectoral partnerships addressing SIH in times of health crisis. Despite a consensual concern for this issue among the respondents, an epidemiological frame of reference dominated the intervention design. It resulted in a model in which consideration for SIH appeared as a complement, with a clinical goal of the intervention: breaking the chain of COVID-19 transmission.
摘要：
COVID-19大流行强调了社会不平等对健康(SIH)的影响。各种研究表明，与COVID-19相关的死亡率和发病率以及健康的社会决定因素的影响显著不平等。这项定性案例研究的目的是分析在法国两个关键的COVID-19预防和控制干预措施的设计中对SIH的考虑：测试和接触者追踪。对参与干预措施设计和/或政府应对大流行的36名关键线人进行了访谈，并审查了相关文件（n=15）。我们应用数据三角剖分和混合演绎和归纳分析来分析数据。调查结果揭示了对SIH的不同理解和观点，以及在大流行的开始阶段与考虑这些挑战相关的挑战。尽管参与者之间对SIH有共同的关注，流行病学参考框架主导了干预措施的设计。它产生了一个模型，其中对SIH的考虑作为一个补充，干预的临床目标是：打破COVID-19传播链。尽管COVID-19健康危机凸显了SIH的重要性，这似乎不是一个在应对努力中进一步考虑它们的机会。本文基于定性调查，为SIH在设计测试和接触者追踪干预措施方面提供了原始见解。
COVID-19大流行强调了社会健康不平等（SIH）的重要性以及大流行的不成比例的负担及其与社会经济地位有关的后果，种族和种族,在其他健康决定因素中。如果在设计阶段不考虑公共卫生干预措施，则可能会增加SIH。通过定性案例研究，我们分析了第一个为法兰西岛地区普通民众提供测试和接触者追踪服务的本地计划之一的设计(巴黎地区，法国）以应对COVID-19大流行。本文讨论了在干预设计中考虑SIH的不确定性和挑战。它探讨了参与者对SIH的不同理解，以及在健康危机时期解决SIH的跨部门伙伴关系的复杂性。尽管受访者对这个问题有共识，流行病学参考框架主导了干预设计。它产生了一个模型，其中对SIH的考虑作为一个补充，干预的临床目标是：打破COVID-19传播链。
COVID-19大流行强调了社会健康不平等（SIH）的重要性以及大流行的不成比例的负担及其与社会经济地位有关的后果，种族和种族,在其他健康决定因素中。如果在设计阶段不考虑公共卫生干预措施，则可能会增加SIH。通过定性案例研究，我们分析了第一个为法兰西岛地区普通民众提供测试和接触者追踪服务的本地计划之一的设计(巴黎地区，法国）以应对COVID-19大流行。本文讨论了在干预设计中考虑SIH的不确定性和挑战。它探讨了参与者对SIH的不同理解，以及在健康危机时期解决SIH的跨部门伙伴关系的复杂性。尽管受访者对这个问题有共识，流行病学参考框架主导了干预设计。它产生了一个模型，其中对SIH的考虑作为一个补充，干预的临床目标是：打破COVID-19传播链。
