Hard-to-reach populations

难以到达的人群
  • 文章类型: Journal Article
    背景:受访者驱动的抽样(RDS)被广泛用于对没有抽样框架的HIV感染风险较高的人群进行抽样。然而,很少有研究来评估RDS在现实环境中的可靠性。
    方法:我们使用五轮国家HIV行为监测-在纽瓦克注射毒品的人调查,评估了未接触RDS样本的可靠性。新泽西州从2005年到2018年。具体来说,我们使用MonteCarlo双样本Kolmogorov-Smirnov检验,重复100,000次,比较了时间相邻RDS样本中时间不敏感的人口统计学特征的分布.还比较了时间敏感性人口统计学特征的分布作为敏感性分析。
    结果:研究表明,在更大的纽瓦克地区注射毒品的人群中,重复的RDS样本,新泽西州在大多数对时间不敏感的人口统计数据和招募同性恋统计数据中都是可靠的。时间敏感人口统计学的敏感性分析也显示了大多数时间相邻样本的一致性。
    结论:结论:RDS有可能提供可靠的样品,但是RDS样本的人口统计学特征很容易因同质性而产生偏差。未来使用RDS的研究可能需要更多地关注潜在的同质性偏倚,并考虑必要的诊断程序和样本调整。
    BACKGROUND: Respondent-driven sampling (RDS) is widely used to sample populations with higher risk of HIV infection for whom no sampling frames exist. However, few studies have been done to assess the reliability of RDS in real world settings.
    METHODS: We assessed the reliability of naïve RDS samples using five rounds of the National HIV Behavioral Surveillance - People Who Inject Drugs surveys in Newark, New Jersey from 2005 to 2018. Specifically, we compared the distributions of time-insensitive demographic characteristics in temporally adjacent RDS samples with Monte Carlo Two-Sample Kolmogorov-Smirnov Test with 100,000 replicates. The distributions of time-sensitive demographic characteristics were also compared as sensitivity analyses.
    RESULTS: The study showed that repeated RDS samples among people who inject drugs in the greater Newark area, New Jersey were reliable in most of time-insensitive demographics and recruitment homophily statistics. Sensitivity analyses of time-sensitive demographics also presented consistencies in most of temporally adjacent samples.
    CONCLUSIONS: In conclusion, RDS has the potential to provide reliable samples, but demographic characteristics of RDS samples may be easily biased by homophily. Future studies using RDS may need to pay more attention to potential homophily bias and consider necessary diagnostic procedures and sample adjustments.
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  • 文章类型: Review
    目标:解决后勤复杂性等障碍,社会耻辱,历史创伤的影响对于成功将代表性不足的群体纳入健康研究至关重要。
    方法:本文回顾了参与和采访技巧,这些技巧在道德上参与了最近在俄克拉荷马州定居的阿富汗难民和伊利诺伊州墨西哥出生的农村妇女的研究。本文最后对挑战和经验教训进行了反思讨论。
    结果:让难以接触到的人群参与研究的创造性策略包括在互动中考虑参与者的社会经济和文化背景,并发展社区伙伴关系以建立信任和获得可靠的数据。其他参与策略是用参与者的首选语言进行交流,为识字率低的人提供阅读和回答学习问题的帮助,从感兴趣的人群中雇用研究人员,并在感兴趣的人群居住的特定地点招募。
    结论:在研究的各个阶段,社区参与对于在难以接触的人群中建立信任至关重要,在健康研究中实现包容性,并确保干预措施具有文化敏感性和有效性。
    OBJECTIVE: Addressing obstacles such as logistical complexities, social stigma, and the impact of historical traumas is essential for the successful inclusion of underrepresented groups in health research.
    METHODS: This article reviews engagement and interview techniques used to ethically engage recently settled Afghan refugees in Oklahoma and rural Mexican-born women in Illinois in research. The paper concludes with a reflective discussion on the challenges and lessons learned.
    RESULTS: Creative strategies to engage hard-to-reach populations in research included considering the participants\' socioeconomic and cultural contexts in their interactions and developing community partnerships to establish trust and obtain reliable data. Other engagement strategies were communicating in the participants\' preferred language, providing assistance with reading and responding to study questions for those with low literacy, employing research staff from the population of interest, and recruiting in specific locations where the populations of interest live.
    CONCLUSIONS: Community engagement is essential at all stages of research for building trust in hard-to-reach populations, achieving inclusivity in health research, and ensuring that interventions are culturally sensitive and effective.
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  • 文章类型: Journal Article
    背景:受访者驱动的抽样(RDS)是一种针对没有抽样框架或难以到达的人群的同伴链招募方法。虽然RDS通常是面对面的,在线版本(WebRDS)吸引了很多关注,因为它有许多潜在的好处,尽管如此,迄今为止,还没有明确的实施框架。本文旨在为希望通过WebRDS招募的研究人员提供指导。
    方法:开发阶段的描述:针对与形成性研究有关的方面提供指导,问卷的设计,使用免费软件和扩散计划实施优惠券系统,以2022年4月至6月在西班牙进行的基于网络的横断面研究为例,描述了依赖者的家庭护理工作者的工作条件和健康状况。
    结果:调查的应用:我们讨论了整个招聘过程中的监控策略和潜在问题以及提出的解决方案。
    结论:在一定条件下,可以在不需要金钱激励和使用免费访问软件的情况下获得与其他RDS相似的招聘绩效的样本,大大降低成本,并允许其使用扩展到其他研究小组。
    Respondent-driven sampling (RDS) is a peer chain-recruitment method for populations without a sampling frame or that are hard-to-reach. Although RDS is usually done face-to-face, the online version (WebRDS) has drawn a lot of attention as it has many potential benefits, despite this, to date there is no clear framework for its implementation. This article aims to provide guidance for researchers who want to recruit through a WebRDS.
    Description of the development phase: guidance is provided addressing aspects related to the formative research, the design of the questionnaire, the implementation of the coupon system using a free software and the diffusion plan, using as an example a web-based cross-sectional study conducted in Spain between April and June 2022 describing the working conditions and health status of homecare workers for dependent people.
    The application of the survey: we discuss about the monitoring strategies throughout the recruitment process and potential problems along with proposed solutions.
    Under certain conditions, it is possible to obtain a sample with recruitment performance similar to that of other RDS without the need for monetary incentives and using a free access software, considerably reducing costs and allowing its use to be extended to other research groups.
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  • 文章类型: Journal Article
    印度的医疗保健系统迫切需要一种新的医疗保健提供模式,以增加医疗保健的可及性并改善边缘化人群的健康状况。初级保健中心(PHCs)的难以接近和利用不足对生活在偏远地区的人们造成了不成比例的影响。因此,对于设计师来说,这是当务之急。工程师,卫生专业人员,和政策制定者以协作的心态共同制定创新的干预措施,以可持续地管理整个PHCs的可访问性,促进预防性健康,从而改善难以到达的社区的健康结果。本文研究了印度背景下关于初级医疗保健障碍的现有文献,PHCs失败的原因和前进的方向。本文进一步分析了有关现有移动医疗单位(MMU)作为常规PHC的替代解决方案的文献,并尝试提取与现有的常规静态PHC相比,提出移动初级健康中心(mPHC)的主要经验教训。目的是找出现有文献中的研究空白,并尝试为未来的研究人员解决相同的问题。设计师,工程师,卫生专业人员和政策制定者考虑提出移动初级保健中心(mPHC)的想法,作为向服务不足的社区提供基本医疗服务的主要交付模式。
    Indian healthcare system is in immediate need of a new healthcare delivery model to increase healthcare accessibility and improve the health outcomes of the marginalized. Inaccessibility and underutilization of Primary Health Centers (PHCs) disproportionately affect people living in remote areas. It is thus imperative for the designers, engineers, health professionals, and policymakers to come together with a collaborative mindset to develop innovative interventions that sustainably manage the accessibility of PHCs at large, promote preventive health, and thus improve the health outcomes of hard-to-reach communities. This article examines the available literature on barriers to primary healthcare in Indian context, the reason of failure of PHCs and the way forward. The article further analysis literature on existing Mobile Medical Units (MMUs) as an alternate solution to conventional PHCs and attempt to extract the major lessons to propose a mobile Primary Health Center (mPHC) in contrast to the existing conventional static PHCs. The intention is to find out the research gaps in the existing literature and try to address the same for future researchers, designers, engineers, health professionals and policy makers to think forward to make this idea of a mobile Primary Health Center (mPHC), as the main delivery model to cater basic healthcare services to the underserved communities.
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  • 文章类型: Published Erratum
    [这更正了文章DOI:10.3389/fpubh.2023.1175482。].
    [This corrects the article DOI: 10.3389/fpubh.2023.1175482.].
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  • 文章类型: Journal Article
    背景:受访者驱动抽样(RDS)既指链式推荐抽样方法,也指用于分析抽样数据的分析模型。基于网络的受访者驱动抽样(webRDS)使用基于互联网的招聘以及电子调查来进行RDS研究;目前还没有商业上可用的webRDS解决方案。我们设计并开发了一个webRDS解决方案,以支持一项旨在估计也门冲突归因死亡率的研究。我们的webRDS解决方案由现有的调查平台(即ODK)和定制的RDS系统组成。RDS系统旨在管理和管理RDS调查级联,包括:(1)应用程序编程接口,(2)研究参与者客户,和(3)管理员界面。我们在这里报告webRDS解决方案的设计及其实现。
    结果:在整个解决方案的开发过程中,我们咨询了也门侨民的成员。技术障碍主要是由于:WhatsApp关于批量消息传递和自动消息传递行为的政策,短信的固有约束,和SMS过滤行为。语言支持是直接但耗时的。调查吸收低于预期。可能影响摄取的因素包括:我们使用消耗品调查链接,侨民的兴趣低,缺乏物质激励,以及调查本身的长度和主题。SMS/WhatsApp消息集成相对复杂,并且限制了我们可以向潜在参与者发送的信息。
    结论:尽管调查结果低于预期,我们相信我们的webRDS解决方案提供了有效和灵活的方法来调查全球不同的人群。
    Respondent-driven sampling (RDS) refers both to a chain-referral sampling method and an analytical model for analysing sampled data. Web-based respondent-driven sampling (webRDS) uses internet-based recruitment coupled with an electronic survey to carry out RDS studies; there is currently no commercially available webRDS solution. We designed and developed a webRDS solution to support a research study aimed at estimating conflict-attributable mortality in Yemen. Our webRDS solution is composed of an existing survey platform (i.e. ODK) and a bespoke RDS system. The RDS system is designed to administer and manage an RDS survey cascade and includes: (1) an application programming interface, (2) a study participant client, and (3) an administrator interface. We report here on the design of the webRDS solution and its implementation.
    We consulted members of the Yemeni diaspora throughout the development of the solution. Technical obstacles were largely the result of: WhatsApp\'s policies on bulk messaging and automated messaging behaviour, the inherent constraints of SMS messaging, and SMS filtering behaviour. Language support was straight-forward yet time consuming. Survey uptake was lower than expected. Factors which may have impacted uptake include: our use of consumable survey links, low interest amongst the diaspora population, lack of material incentives, and the length and subject matter of the survey itself. The SMS/WhatsApp messaging integration was relatively complex and limited the information we could send potential participants.
    Despite lower-than expected survey uptake we believe our webRDS solution provides efficient and flexible means to survey a globally diverse population.
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  • 文章类型: Journal Article
    播散性结核病通常与诊断延迟和预后较差有关。
    描述COVID-19期间低结核病负担国家的传播结核病病例系列和诊断延迟。
    我们连续纳入了2019年至2021年在巴塞罗那都会区北冠参考医院报告的所有播散性结核病患者。我们收集了社会人口统计信息,临床,实验室和放射学发现。
    我们纳入了研究期间报告的所有30例患者,分别为2019年、2020年和2021年的5例、9例和16例,其中20例(66.7%)为男性,平均年龄为41岁。25(83.3%)是非欧盟血统。最常见的系统受累是中枢神经系统(N=8;26.7%),其次是内脏系统(N=7;23.3%),胃肠道(N=6,20.0%),肌肉骨骼(N=5;16.7%),和肺(N=4;13.3%)。低蛋白血症和贫血非常普遍(72%和77%)。诊断延迟的中位数为6.5个月(IQR1.8-30),女性中的比例更高(36.0vs.3.5个月;p=0.002)。中枢神经系统受累和肺部受累与女性的诊断延迟有关。我们记录了24名治愈的病人,两人死亡,三名患者治疗后后遗症,还有一个失踪者.我们观察到低收入社区患者的聚集效应(p<0.001)。
    在我们的研究区域中,播散性结核病的诊断有很大的延迟,这可能会影响预后,女性受到的影响更大。我们的结果表明,由于诊断延迟而引起的播散性结核病的发生率增加可能是COVID-19大流行的次要影响。
    Disseminated tuberculosis is frequently associated with delayed diagnosis and a poorer prognosis.
    To describe case series of disseminated TB and diagnosis delay in a low TB burden country during the COVID-19 period.
    We consecutively included all patients with of disseminated TB reported from 2019 to 2021 in the reference hospital of the Northern Crown of the Metropolitan Area of Barcelona. We collected socio-demographic information, clinical, laboratory and radiological findings.
    We included all 30 patients reported during the study period-5, 9, and 16 in 2019, 2020, and 2021 respectively-20 (66.7%) of whom were male and whose mean age was 41 years. Twenty-five (83.3%) were of non-EU origin. The most frequent system involvement was central nervous system (N = 8; 26.7%) followed by visceral (N = 7; 23.3%), gastro-intestinal (N = 6, 20.0%), musculoskeletal (N = 5; 16.7%), and pulmonary (N = 4; 13.3%). Hypoalbuminemia and anemia were highly prevalent (72 and 77%). The median of diagnostic delay was 6.5 months (IQR 1.8-30), which was higher among women (36.0 vs. 3.5 months; p = 0.002). Central nervous system involvement and pulmonary involvement were associated with diagnostic delay among women. We recorded 24 cured patients, two deaths, three patients with post-treatment sequelae, and one lost-to-follow up. We observed a clustering effect of patients in low-income neighborhoods (p < 0.001).
    There was a substantial delay in the diagnosis of disseminated TB in our study region, which might impacted the prognosis with women affected more negatively. Our results suggest that an increase in the occurrence of disseminated TB set in motion by diagnosis delay may have been a secondary effect of the COVID-19 pandemic.
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  • 文章类型: Journal Article
    疫苗每年预防4-5百万人死亡,但在关键的弱势亚人群中,疫苗覆盖率的不平等仍然存在.免疫不足的亚群(例如,移民,贫民窟居民)可能会被常规方法所忽略,以估计免疫覆盖率和评估疫苗接种障碍。自适应采样,例如受访者驱动的抽样,可能提供有用的策略来识别和收集这些通常“隐藏”或难以到达的亚群的数据。然而,这些适应性取样方法在全球免疫领域的使用尚未有系统记录.我们搜索了PubMed,Scopus,和Embase数据库,以确定截至2020年11月发表的合格研究,这些研究使用自适应抽样方法收集免疫相关数据。从符合条件的研究中,我们提取了他们目标的相关数据,设定和目标人口,和抽样方法。我们对抽样方法进行了分类,并评估了它们的频率。在筛选合格的3069篇文章中,有23项研究符合纳入标准。同行驱动抽样是最常用的自适应抽样方法(57%),其次是地理空间采样(30%),基于地点的抽样(17%),人种学制图(9%),和紧凑的分段抽样(9%)。61%的研究是在中高收入或高收入国家进行的。在65%的研究中收集了免疫接种数据,57%的研究收集了关于免疫接种的知识和态度的数据。我们发现适应性采样方法在测量免疫覆盖率和了解疫苗接种吸收的决定因素方面的应用有限。当前对适应性采样方法的利用不足,在免疫计划如何校准其策略以达到“隐藏”亚群方面留下了很大的改进空间。
    Vaccines prevent 4-5 million deaths every year, but inequities in vaccine coverage persist among key disadvantaged subpopulations. Under-immunized subpopulations (e.g., migrants, slum residents) may be consistently missed with conventional methods for estimating immunization coverage and assessing vaccination barriers. Adaptive sampling, such as respondent-driven sampling, may offer useful strategies for identifying and collecting data from these subpopulations that are often \"hidden\" or hard-to-reach. However, use of these adaptive sampling approaches in the field of global immunization has not been systematically documented. We searched PubMed, Scopus, and Embase databases to identify eligible studies published through November 2020 that used an adaptive sampling method to collect immunization-related data. From the eligible studies, we extracted relevant data on their objectives, setting and target population, and sampling methods. We categorized sampling methods and assessed their frequencies. Twenty-three studies met the inclusion criteria out of the 3069 articles screened for eligibility. Peer-driven sampling was the most frequently used adaptive sampling method (57%), followed by geospatial sampling (30%), venue-based sampling (17%), ethnographic mapping (9%), and compact segment sampling (9%). Sixty-one percent of studies were conducted in upper-middle-income or high-income countries. Data on immunization uptake were collected in 65% of studies, and data on knowledge and attitudes about immunizations were collected in 57% of studies. We found limited use of adaptive sampling methods in measuring immunization coverage and understanding determinants of vaccination uptake. The current under-utilization of adaptive sampling approaches leaves much room for improvement in how immunization programs calibrate their strategies to reach \"hidden\" subpopulations.
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  • 文章类型: Journal Article
    新冠肺炎疫情进一步加深了全球社会经济和卫生不平等,特别是在经历社会脆弱性的人群中,比如国际移民。持续的封锁和社会距离增加了对难以接触的人群进行公共卫生研究的挑战。这项研究旨在探索在智利大流行期间招募“难以到达”国际移民进行定性公共卫生研究的策略,根据作者的经验。对侧重于智利国际移民的三个定性研究项目的征聘过程进行了回顾性定性评估。所有项目都在COVID-19大流行期间实施,要求补充和灵活的策略:(i)社交媒体;(ii)滚雪球抽样;(iii)社会工作者以及支持移民和移民主导的组织的推荐;(iv)疫苗接种中心和医疗中心;(v)基于社区的招聘。围绕七个新兴的定性类别对这些策略进行了定性评估:(i)封锁期间的可行性;(ii)招聘速度;(iii)地理覆盖范围;(iv)样本多样性;(v)成功面试的比例;(vi)道德考虑;(vii)成本。在大流行期间,让难以接触的国际移民参与公共卫生研究需要不断调整招聘策略。此外,依靠不仅基于互联网的战略,促进了互联网接入有限和数字识字率低的人群的参与。
    The COVID-19 pandemic has further deepened socioeconomic and health inequities worldwide, especially among populations experiencing social vulnerability, such as international migrants. Sustained lockdowns and social distancing have raised challenges to conducting public health research with hard-to-reach populations. This study aims at exploring strategies to recruit \"hard-to-reach\" international migrants for qualitative public health research during the pandemic in Chile, based on the authors\' experience. A retrospective qualitative evaluation process was carried out on the recruitment processes of three qualitative research projects focused on international migrants in Chile. All projects were implemented during the COVID-19 pandemic, demanding complementary and flexible strategies: (i) social media; (ii) snowball sampling; (iii) referrals from social workers and pro-migrant and migrant-led organizations; (iv) vaccination centers and healthcare centers; and (v) community-based recruitment. The strategies are qualitatively evaluated around seven emerging qualitative categories: (i) feasibility during lockdown periods; (ii) speed of recruitment; (iii) geographical coverage; (iv) sample diversity; (v) proportion of successful interviews; (vi) ethical considerations; and (vii) cost. Engaging hard-to-reach international migrants in public health research during the pandemic required constantly adapting recruitment strategies. Furthermore, relying on strategies that were not only Internet-based promoted the participation of populations with limited access to the Internet and low-digital literacy.
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  • 文章类型: Journal Article
    人口贩运对被贩运者的福祉具有长期影响,家庭,和受影响的社区。预防和干预努力,然而,由于缺乏关于问题规模和范围的信息而受阻。因为被贩运者大多隐藏在视线之外,建立流行率的传统方法在招聘中可能过于昂贵,参与,并保留调查参与者。此外,被贩运者不是随机分布在普通人群中。因此,研究人员已开始将以前在公共卫生研究和其他领域中使用的方法应用于难以接触的人群,以衡量人口贩运的患病率。在这篇专题评论中,我们研究了这些用于难以接触人群的流行率方法如何用于衡量人口贩运的流行率。这些方法包括基于网络的方法,如受访者驱动的抽样和网络放大方法,和基于地点的方法。受访者驱动的抽样很有用,例如,当有关被贩运人口的信息很少,并且没有足够的抽样框架时。网络放大方法的独特之处在于它不直接针对隐藏人群。我们在国际上的工作影响包括需要以一种比现有努力更有力的方式记录和验证美国的各种流行率估计方法。在提供估计人口贩运流行率的路线图时,我们的总体目标是促进不成比例地经历人口贩运的社会弱势群体的平等待遇和整体福祉。
    Human trafficking has long-lasting implications for the well-being of trafficked people, families, and affected communities. Prevention and intervention efforts, however, have been stymied by a lack of information on the scale and scope of the problem. Because trafficked people are mostly hidden from view, traditional methods of establishing prevalence can be prohibitively expensive in the recruitment, participation, and retention of survey participants. Also, trafficked people are not randomly distributed in the general population. Researchers have therefore begun to apply methods previously used in public health research and other fields on hard-to-reach populations to measure the prevalence of human trafficking. In this topical review, we examine how these prevalence methods used for hard-to-reach populations can be used to measure the prevalence of human trafficking. These methods include network-based approaches, such as respondent-driven sampling and the network scale-up method, and venue-based methods. Respondent-driven sampling is useful, for example, when little information about the trafficked population has been produced and when an adequate sampling frame does not exist. The network scale-up method is unique in that it does not target the hidden population directly. The implications of our work internationally include the need for documenting and validating the various prevalence estimation methods in the United States in a more robust way than was done in existing efforts. In providing this roadmap for estimating the prevalence of human trafficking, our overarching goal is to promote the equitable treatment and overall well-being of the socially disadvantaged populations who disproportionately experience human trafficking.
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