Publications by authors named "Alayne M Adams"

Background: Racism has been shown to impact the health of Black persons through its influence on health care, including its expression through implicit biases in provider training, attitudes, and behaviours. Less is known about the experiences of racism in contexts outside of the USA, and how race and racism interact with other social locations and systems of discrimination to shape Black patients' experiences of racism in health care encounters. To help address this gap, this study examined diverse Black individuals' perceived experiences of, and attitudes towards, anti-Black racism and racial discrimination in Canadian health care, specifically in Montreal, Quebec.

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South Asia is rapidly urbanising. The strains of rapid urbanisation have profound implications for the health and equity of urban populations. This Series paper examines primary health care (PHC) in south Asian cities.

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Background And Aim: Globally, harmful substance use is among the leading causes of premature deaths in the general population, and most of these behaviours are initiated during pre-adolescence to young adulthood. Preventing the onset or reducing the prevalence of substance use among young people is thus a global health priority. Diverse school-based interventions have been implemented in low-and-middle-income countries (LMICs); however, evidence regarding their theoretical underpinnings and core components is lacking.

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Background: Given that mental health problems in adolescence may have lifelong impacts, the role of primary care physicians (PCPs) in identifying and managing these issues is important. Artificial Intelligence (AI) may offer solutions to the current challenges involved in mental health care. We therefore explored PCPs' challenges in addressing adolescents' mental health, along with their attitudes towards using AI to assist them in their tasks.

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Objectives: A growing body of evidence points to persistent health inequities within racialized minority communities, and the effects of racial discrimination on health outcomes and health care experiences. While much work has considered how anti-Black racism operates at the interpersonal and institutional levels, limited attention has focused on internalized racism and its consequences for health care. This study explores patients' attitudes towards anti-Black racism in a Canadian health care system, with a particular focus on internalized racism in primary health care.

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Introduction: Urban health governance in Bangladesh is complex as multiple actors are involved and no comprehensive data are currently available on infrastructure, services, or performance either in public and private sectors of the healthcare system. The Urban Health Atlas (UHA)-a novel and interactive geo-referenced, web-based visualization tool was developed in Bangladesh to provide geospatial and service information to decision makers involved in urban health service planning and governance. Our objective was to study the opportunities for institutionalization of the UHA into government health systems responsible for urban healthcare delivery and document the facilitators and barriers to its uptake.

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Background: Social prescription programs represent a viable solution to linking primary care patients to nonmedical community resources for improving patient well-being. However, their success depends on the integration of patient needs with local resources. This integration could be accelerated by digital tools that use expressive ontology to organize knowledge resources, thus enabling the seamless navigation of diverse community interventions and services tailored to the needs of individual users.

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Introduction: Increasing food and nutritional inequities are apparent in urban settings across Low- and Middle-Income Countries (LMICs), along with nutrition transition towards ultra-processed diets high in fat, sugar, and salt. In urban informal settlements, characterized by insecurity and inadequate housing and infrastructure, food systems dynamics and their nutritional implications are poorly understood.

Objectives: This paper explores the food system determinants of food and nutrition security in urban informal settlements in LMICs with the goal of identifying effective approaches and entry points for policy and program.

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Background: Early in the COVID-19 pandemic, efforts to decrease risk of viral transmission triggered an abrupt shift from ambulatory health care delivery toward telemedicine. In this study, we explore the perceptions and experiences of telemedicine among socially vulnerable households and suggest strategies to increase equity in telemedicine access.

Methods: Conducted between August 2020 and February 2021, this exploratory qualitative study involved in-depth interviews with members of socially vulnerable households needing health care.

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Globally, vascular diseases are a leading cause of morbidity and mortality. Many of the most significant risk factors for vascular disease have a gendered dimension, and sex differences in vascular diseases incidence are apparent, worldwide. In this narrative review, we provide a contemporary picture of sex- and gender-related determinants of vascular disease.

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Background: "Contracting Out" is a popular strategy to expand coverage and utilization of health services. Bangladesh began contracting out primary healthcare services to NGOs in urban areas through the Urban Primary Health Care Project (UPHCP) in 1998. Over the three phases of this project, retention of trained and skilled human resources, especially doctors, proved to be an intractable challenge.

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Introduction: Disparities in health outcomes and access to maternal neonatal and child health (MNCH) are apparent among urban poor compared with national, rural or urban averages. A fundamental first step in addressing inequities in MNCH services is knowing what services exist in urban areas, where these are located, who provides them and who uses them. This study aims to institutionalise the Urban Health Atlas (UHA)-a novel information and communications technology (ICT) tool-to strengthen health service delivery and oversight and generate critical evidence to inform health policy and planning in urban Bangladesh.

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Background: An effective referral system is critical to ensuring access to appropriate and timely healthcare services. In pluralistic healthcare systems such as Bangladesh, referral inefficiencies due to distance, diversion to inappropriate facilities and unsuitable hours of service are common, particularly for the urban poor. This study explores the reported referral networks of urban facilities and models alternative scenarios that increase referral efficiency in terms of distance and service hours.

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Introduction: Accompanying rapid urbanization in Bangladesh are inequities in health and healthcare which are most visibly manifested in slums or low-income settlements. This study examines socioeconomic, demographic and geographic patterns of self-reported chronic illness and healthcare seeking among adult slum dwellers in Bangladesh. Understanding these patterns is critical in designing more equitable urban health systems and in enabling the country's goal of Universal Health Coverage by 2030.

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Background: The dynamic intersection of a pluralistic health system, large informal sector, and poor regulatory environment have provided conditions favourable for 'corruption' in the LMICs of south and south-east Asia region. 'Corruption' works to undermine the UHC goals of achieving equity, quality, and responsiveness including financial protection, especially while delivering frontline health care services. This scoping review examines current situation regarding health sector corruption at frontlines of service delivery in this region, related policy perspectives, and alternative strategies currently being tested to address this pervasive phenomenon.

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Ensuring access to healthcare in emergency health situations is a persistent concern for health system planners. Emergency services, including critical care units for severe burns and coronary events, are amongst those for which travel time is the most crucial, potentially making a difference between life and death. Although it is generally assumed that access to healthcare is not an issue in densely populated urban areas due to short distances, we prove otherwise by applying improved methods of assessing accessibility to emergency services by the urban poor that take traffic variability into account.

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Objectives: This paper explores the underlying motivations and strategies of formal small and medium-sized formal private for-profit sector hospitals and clinics in urban Bangladesh and their implications for quality and access.

Methods: This exploratory qualitative study was conducted in Dhaka, Sylhet and Khulna City Corporations. Data collection methods included key informant interviews (20) with government and private sector leaders, in-depth interviews (30) with clinic owners, managers and providers and exit interviews (30) with healthcare clients.

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Since 1950, the global urban population grew from 746 million to almost 4 billion and is expected to reach 6.4 billion by mid-century. Almost 90% of this increase will take place in Asia and Africa and disproportionately in urban slums.

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Background: Contracting-out (CO) to non-state providers is used widely to increase access to health care, but it entails many implementation challenges. Using Bangladesh's two decades of experience with contracting out Urban Primary Health Care (UPHC), this paper identifies contextual, contractual, and actor-related factors that require consideration when implementing CO in Low- and Middle- Income Countries.

Methods: This qualitative case-study is based on 42 in-depth interviews with past and present stakeholders working with the government and the UPHC project, as well as a desk review of key project documents.

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Introduction: Maternal delivery is the costliest event during pregnancy, especially if a complicated delivery occurs that requires emergency hospital services. A health financing scheme or program that covers comprehensive maternal services, including specialized hospital services in the benefits health package, enhances maternal survival and improves financial risk protection.

Objectives: The objective of this study is to identify factors that enable the inclusion of comprehensive maternal services in the benefits package of emerging health financing schemes in low and middle-income countries across selected world regions.

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