With more than three billion people in isolation, the status of digital spaces is switching from an amenity to a necessity, as they become not only the main way to access information and services, but also one of the only remaining vectors for economic, educational, and leisure activities as well as for social interactions to take place. However, not all are equals in terms of access to networks or connected devices, or when it comes to the skills required to navigate computerized spaces optimally. Digital inequalities were already existing, yet the COVID-19 crisis is exacerbating them dramatically. On the one hand, the crisis will worsen digital inequalities within the population. On the other hand, digital inequalities represent a major risk factor of vulnerability for exposure to the virus itself, and for the non-sanitary consequences of the crisis. Therefore, this paper aims at exploring the reciprocal impacts of the COVID-19 crisis and digital inequalities, and to propose operative solutions to help fight the nefarious consequences of the crisis. We first describe how digital inequalities are a determinant of health. We then investigate how COVID-19 can potentiate digital inequalities, and how digital inequalities potentiate vulnerability to COVID-19. Finally, in order to contribute to the mitigation of this crisis, we propose a set of multi-layered strategies focusing on actionability that can be implemented at multiple structural levels, ranging from governmental to corporate and community levels.

BackgroundPatient decision aids aim to present evidence relevant to a health decision in understandable ways to support patients through the process of making evidence-informed, values-congruent health decisions. It is recommended that, when developing these tools, teams involve people who may ultimately use them. However, there is little empirical evidence about how best to undertake this involvement, particularly for specific populations of users such as vulnerable populations.MethodsTo describe and compare the development practices of research teams that did and did not specifically involve members of vulnerable populations in the development of patient decision aids, we conducted a secondary analysis of data from a systematic review about the development processes of patient decision aids. Then, to further explain our quantitative results, we conducted semi-structured telephone interviews with 10 teams: 6 that had specifically involved members of vulnerable populations and 4 that had not. Two independent analysts thematically coded transcribed interviews.ResultsOut of a total of 187 decision aid development projects, 30 (16%) specifically involved members of vulnerable populations. The specific involvement of members of vulnerable populations in the development process was associated with conducting informal needs assessment activities (73% vs. 40%, OR 2.96, 95% CI 1.18–7.99, P = .02) and recruiting participants through community-based organizations (40% vs. 11%, OR 3.48, 95% CI 1.23–9.83, P = .02). In interviews, all developers highlighted the importance, value and challenges of involving potential users. Interviews with developers whose projects had involved members of vulnerable populations suggested that informal needs assessment activities served to center the decision aid around users’ needs, to better avoid stigma, and to ensure that the topic truly matters to the community. Partnering with community-based organizations may facilitate relationships of trust and may also provide a non-threatening and accessible location for research activities.ConclusionsThere are a small number of key differences in the development processes for patient decision aids in which members of vulnerable populations were or were not specifically involved. Some of these practices may require additional time or resources. To address health inequities, researchers, communities and funders may need to increase awareness of these approaches and plan accordingly.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0399-8) contains supplementary material, which is available to authorized users.

This article explores the matching process at micro-, meso-, and macro-levels in health services in order to arrive at culturally competent and gender-sensitive health care. We provide a brief overview of sex, gend~ ethnicity, and health, specifically in terms of sex and ethnic matching at micro-, meso-, and macro-levels. Throughout the article we raise some controversial elements surrounding matching by providing a discussion of studies conducted in this field. In conclusion we examine the challenges to sex and ethnic matching in order to provide recommendations and alternative strategies toward the achievement of culturally competent and gender-sensitive health care. Cet article examine le processus de jumelage aux niveaux micro-, mdso-, et macro-dans les services de santd afin d'en arriver ?z des services de santd qui soient culturellement compdtents et adaptds aux diff&ences entre les hommes et Ies femmes. Nous donnons un bref apercu du sexe, de l'origine ethnique et de l'dtat de sant~ surtout en ce qui concerne le jumelage du point de vue du sexe et de l'ethnie aux niveaux micro-, mdso-et macro-. Tout au long de l' article, nous soulevons certains dl~rnents controversds qui entourent Ie jumelage en discutant d'dtudes mendes dans ce domaine. En conclusion, nous examinons les difficultds que repr~sente le jumelage du point de vue du sexe et de l'ethnie afin de formuler des recommandations et des strategies de rechange pour en arriver dL des services de santd culturellement compdtents et adapt~s aux diffdrences entre les hommes et les femmes.

Focus groups have become increasingly popular in health research. However, their feasibility depends on the context of such research. Through discussion of focus groups they conducted in rural India, the authors argue that successful focus groups in rural contexts must be culturally sensitive, with a research team that goes beyond the mere technicalities of collecting data. A culturally competent focus group can result when the research team has geographic, political, economic, and sociocultural knowledge related to the research area and its population. With extensive local collaboration, foreign researchers are better able to conduct data collection respectfully. The authors provide recommendations for future studies toward increasing the cultural appropriateness of focus groups in areas such as rural India.

Dental education on specific knowledge and intervention approaches for working with people living on welfare is crucial to the therapeutic success of the relationships dental professionals establish with this clientele. Despite growing attention to the importance of cultural competence and communication skills training in dentistry, very few initiatives have been documented in relation to serving low-income populations. Following discussions at a 2006 Montreal-based colloquium on access to dental care, academics, dental association administrators, and public health agency and antipoverty coalition representatives began collaborating to develop innovative pedagogy designed to increase providers' competence in interacting with their underprivileged patients. The group's first round of workshops (November 2006-October 2007 resulted in the creation of an original video-based tool containing testimonies from six individuals living currently or formerly on welfare. The videotaped interview data represent their perceptions and experiences regarding their oral health, dental care service provision, and poverty in general. This article describes the participative methods, the content of the resulting DVD, and the implications of the "Listening to Each Other" program, a collaborative knowledge translation approach for improving interaction between underprivileged people and dental care providers.

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BackgroundA large proportion of patients encounter barriers to access and navigation in complex healthcare systems. They are unable to obtain information and services and to take appropriate action to improve their health. Low health literacy affects the ability of individuals to benefit from health services. Some social groups are disproportionately affected by low health literacy, including those with low educational attainment, Aboriginal people, and those on social assistance. These individuals face significant barriers in self-management of chronic diseases and in navigating the healthcare system. For these people, living in a context of deprivation contributes to maintaining disparities in access to healthcare and services. The objective of this study is to support knowledge co-construction and knowledge translation in primary care and services by involving underserved and Aboriginal people in research.MethodsThis study will integrate participatory health processes and action research to co-create, with patients, individuals, and community members impacted by health literacy, practical recommendations or solutions for facilitating navigation of the healthcare system by patients, individuals, and community members with less than optimal health literacy on how to best access health services. With this approach, academics and those for whom the research is intended will collaborate closely in all stages of the research to identify findings of immediate benefit to those impacted by health literacy and work together on knowledge translation. This study, carried out by researchers, community organizations and groups of people with low health literacy from three different regions of Quebec and Saskatchewan who can play an expert role in improving health services, will be conducted in three phases: 1) data collection; 2) data analysis and interpretation; and, 3) knowledge translation.DiscussionPersons with low health literacy experience major obstacles in navigating the health system. This project will therefore contribute to addressing the gap between healthcare challenges and the needs of underserved patients with multi-morbidity and/or low health literacy who have complex health-related needs. It will pave the way for co-creating successful solutions for and with these communities that will increase their access to health services.

At the end of the 1970s, the term "community health" was hugely popular in the field of health and welfare in many countries throughout the world. Mainly inspired by American and Latin American sources, the concept was based on a participatory and multidisciplinary approach to preventive and curative health services. What is the current state of community health? The objective of this study was to examine the socio-historical development of community health over the last 40 years. The paper begins by presenting a conceptual framework defining community health and public health as two distinct domains in the field of health and welfare. The study found that depending on the setting, the historical period and the ability of actors to promote their views, the space occupied by the two domains and the relationships between them tend to vary, as shown by a comparative analysis between France and Québec from the 1970s to the 2010s. Based on the results of this study, the expression ?doing community health' appears to refer to a precise set of?practices based on certain approaches and methods implemented by actors in specific areas of intervention. Depending on the time and place, the actions and practices of the?concerned actors will determine the extent to which they are incorporated into the institutional context of public interventions.