Defining and measuring health equity in research on task shifting in high-income countries: A systematic review

Abstract

Introduction Task shifting interventions have been implemented to improve health and address health inequities. Little is known about how inequity and vulnerability are defined and measured in research on task shifting. We conducted a systematic review to identify how inequity and vulnerability are identified, defined and measured in task shifting research from high-income countries. Methods and analysis We implemented a novel search process to identify programs of research concerning task shifting interventions in high-income countries. We searched MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and CENTRAL to identify articles published from 2004 to 2016. Each program of research incorporated a “parent” randomized trial and “child” publications or sub-studies arising from the same research group. Two investigators extracted (1) study details, (2) definitions and measures of health equity or population vulnerability, and (3) assessed the quality of the reporting and measurement of health equity and vulnerability using a five-point scale developed for this study. We summarized the findings using a narrative approach. Results Fifteen programs of research met inclusion criteria, involving 15 parent randomized trials and 62 child publications. Included programs of research were all undertaken in the United States, among Hispanic- (5/15), African- (2/15), and Korean-Americans (1/15), and low socioeconomic status (2/15), rural (2/15) and older adult populations (2/15). Task shifting interventions included community health workers, peers, and a variety of other non-professional and lay workers to address a range of non-communicable diseases. Some research provided robust analyses of the affected populations’ health inequities and demonstrated how a task shifting intervention redressed those concerns. Other studies provided no such definitions and measured only biomedical endpoints. Conclusion Included studies vary substantially in the definition and measurement of health inequity and vulnerability. A more precise theoretical and evaluative framework for task shifting is recommended to effectively achieve the goal of equitable health.

Conceptual framework for task shifting and task sharing: an international Delphi study

“…The generalized purpose statement indicates that TS/S is intended to reduce morbidity, mortality, and burden of disease among populations where the inaccessibility of professionalized cadres limits access to effective care. Although health care tasks might be redistributed to providers with less training to deliver cost savings or improve operational efficiencies, this purpose statement reinforces that TS/S occurs when health care redistribution and delegation is driven by efforts to enhance health equity by meeting the health needs of underserved populations [ 1 , 18 , 19 ]. The general purpose statement also asserts that TS/S achieves its goals without compromising the standards of care, including maintaining safety and quality [ 20 – 23 ].…”

Pediatric Rattlesnake Envenomation: A Simulation Scenario With Optional Health Equity, Virtual Facilitation, and Senior Learner Modifications

“…We recommend approaching this with a "pause and restart" approach, with an initial debrief of the resources available to the uninsured or underinsured patient population as well as strategies to approach the parent who would like to refuse treatment immediately following the simulated discussion. The debrief can be expanded if desired to include other aspects of health equity and obstacles such as poverty and discrimination, lack of access to good jobs with fair pay, quality education, housing, healthcare, and safe environments [8].…”

How can task shifting put patient safety at risk? A qualitative study of experiences among general practitioners in Norway

“…Substantial evidence exists about the impact of vertical task shifting on outcomes such as cost savings, efficiency improvements, quality of care, user satisfaction or health equity related to conditions such as infectious diseases [2,21], mental health problems [22] or childbirth [23]. Evidence is mostly developed from low-and middle-income countries, but it also refers to high-income settings [24]. However, our priority was to study patient safety consequences regarding horizontal shifting of tasks from specialist colleagues and other service partners to GPs, a strategy identified as a critical element of the GP crisis in Norway [25].…”