How do hospitals address health inequalities experienced by children and young people: a grey literature scoping review protocol

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ObjectivesThis study aimed to understand how staff in children’s hospitals view their responsibility to reduce health inequalities for the children and young people who access their services.DesignWe conducted an exploratory qualitative study.SettingThe study took place at nine children’s hospitals in England.Participants217 members of staff contributed via interviews and focus groups conducted January–June 2023. Staff were represented at all levels of the organisations, and all staff who volunteered to contribute were included in the study.AnalysisData were analysed using Rapid Research Evaluation and Appraisal (RREAL) methodology for rapid assessment procedures (RAP).ResultsAll of the children’s hospitals were taking some action to reduce health inequalities. Two key themes were identified. First, it was clear that reducing health inequalities was seen as something that was of vital import and should be part of staff’s day-to-day activity, framed as ‘everyone’s business.’ Many staff felt that there was an obligation to intervene to ensure that children and young people receiving hospital treatment were not further disadvantaged by, for example, food poverty. Second, however, the deeply entrenched and intersectional nature of health inequalities sometimes meant that these inequalities were complex to tackle, with no clear impetus to specific actions, and could be framed as ‘no-one’s responsibility’. Within a complex health and social care system, there were many potential actors who could take responsibility for reducing health inequalities, and staff often questioned whether it was the role of a children’s hospital toleadthese initiatives.ConclusionsBroadly speaking, senior leaders were clear about their organisational role in reducing health inequalities where they impacted on access and quality of care, but there was some uncertainty about the perceived boundaries of responsibility. This led to fragility in the sustainability of activity, and a lack of joined-up intervention. Most hospitals were forging ahead with activity, considering that it was more important to work to overcome health inequalities rather than debate whose job it was.

Section: Discussionmentioning

confidence: 99%

Understanding responsibility for health inequalities in children’s hospitals in England: a qualitative study with hospital staff

Brewster,

Brennan,

Hindocha

et al. 2024

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“…We will explore suitable unpublished grey literature that may have been produced by healthcare-related agencies and organisations, an example protocol of which has been developed by Brennan et al , 30 using similar search terms where possible.…”

Section: Methods and Analysismentioning

confidence: 99%

“…We will explore suitable unpublished grey literature that may have been produced by healthcare-related agencies and organisations, an example protocol of which has been developed by Brennan et al, 30 Care, responsible for improving public health policy), NHS England and other nations' Public Health Associations (eg, Australia and Canada). 4.…”

Section: Search Strategymentioning

confidence: 99%

Assessing the health needs of children and young people accessing paediatric hospital services: a scoping review protocol

Hindocha,

Brennan,

Brewster

et al. 2024

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IntroductionHealth needs are issues that face a population or specific groups, which can benefit from healthcare and wider social and environmental changes. They are inextricably linked to health inequalities, which are largely determined by non-health-related factors such as socioeconomic deprivation or belonging to ethnic minority groups. The hospital-accessing paediatric population, with higher rates of morbidity and mortality, are likely to have higher levels of met and unmet health needs related to social determinants, compared with their peers. As the gap in health inequalities widens globally, paediatric health services may now have an increasingly important role to play in identifying and acting on inequalities affecting their patient population. This scoping review aims to collate information on how children’s hospitals assess the health and wider health-related social needs of patients using a health inequalities lens. On a broader level, the review may also reveal themes about healthcare and other health needs of children accessing hospitals globally.Methods and analysisThis scoping review will follow Joanna Briggs Institute guidance. A search strategy will be described to identify published articles from healthcare databases worldwide as well as healthcare-related grey literature. Literature will be examined to identify methods that aim to assess the health and related social needs of hospital-accessing paediatric patients and will exclude literature published before 2010. Two or more reviewers will independently review the results of the searches using the inclusion and exclusion criteria. Study findings will be presented in tabular form detailing the assessments identified.Ethics and disseminationThe review will synthesise information on hospital approaches to understand and assess the health and health-related social needs of children and young people worldwide. The findings will be used to inform guidelines for children’s hospitals in the UK and will be disseminated through national and international professional bodies, conferences and research papers.

“…As presented in the published protocol, 30 this scoping review focused solely on grey literature due to the appropriateness of that approach for complex, multistakeholder interventions that lack robust data and predictability. 31 Grey literature is also more appropriate for topics that are under current review and moving at a fast pace, as is the case with interventions to address health inequalities.…”

Section: Methodsmentioning

confidence: 99%

How do children’s hospitals address health inequalities: a grey literature scoping review

Brennan,

Stres,

Egboko

et al. 2024

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ObjectivesHealth inequalities are systematic differences in health between people, which are avoidable and unfair. Globally, more political strategies are required to address health inequalities, which have increased since the global SARS-CoV-2/COVID-19 pandemic, with a disproportionate impact on children. This scoping review aimed to identify and collate information on how hospitals around the world that deliver care to children have addressed health inequalities.DesignScoping review focused solely on grey literature.Eligibility criteria for selecting studiesFollowing Joanna Briggs Institute guidelines, a four-step approach to identifying literature was adopted.Data sourcesOverton, OpenGrey, OpenMD, Trip Database, DuckDuckGo, Google, targeted websites and children’s hospital websites were searched on March 2023 for items published since 2010.Data extraction and synthesisRetrieved items were screened against clear inclusion and exclusion criteria before data were extracted by two independent reviewers using a data extraction tool. Studies were tabulated by a hospital. A meta-analysis was not conducted due to the varied nature of studies and approaches.ResultsOur study identified 26 approaches to reduction of health inequalities, from 17 children’s hospitals. Approaches were categorised based on their size and scope. Seven approaches were defined as macro, including hospital-wide inequality strategies. Ten approaches were classed as meso, including the establishment of new departments and research centres. Micro approaches (n=9) included one-off projects or interventions offered to specific groups/services. Almost half of the reported approaches did not discuss the evaluation of impact.ConclusionsChildren’s hospitals provide a suitable location to conduct public health interventions. This scoping review provides examples of approaches on three scales delivered at hospitals across high-income countries. Hospitals with the most comprehensive and extensive range of approaches employ dedicated staff within the hospital and community. This review indicates the value of recruitment of both public health-trained staff and culturally similar staff to deliver community-based interventions.