Modifying and orienting interventions and services to reduce health disparities for marginalized and priority populations

Posted May 19, 2017

People working in fall prevention have a role to play in reducing health disparities. When planning or evaluating fall prevention programs & services it’s important to think about the unique needs of marginalized and priority populations. This post explores the idea of Modifying and Orienting interventions and services to reduce health disparities for marginalized and priority populations. This role is about critically examining a program or service to understand its effect on health disparities, then changing the way it is designed or delivered. There are some tools at the end to help you address this in your work!

How does the initiative affect health disparities?

The way a program or service is designed or provided may unintentionally privilege or disadvantage different groups. Here are some questions to ask when assessing an initiative’s effect on health disparities:

• Will some people have trouble accessing the service?


• Will the program have a differential impact on some people or communities?


• Who does the message exclude? What is the reason for this exclusion?


• Is the policy likely to have negative effects that contribute to, maintain, or widen health disparities?

Reflexive practice

It’s important to engage in reflexive practice when attempting to answer these questions. Reflexive practice, or reflexivity, is a form of critical reflection where you become aware of and examine your underlying values, assumptions and beliefs, and how they may affect your work.¹ Reflexive practice requires you to think about the broader social and political contexts that influence you.¹ This differs from reflective practice, which focuses on thinking about experiences to learn from them and improve practice. Reflexive practice helps you to recognize when you need to seek more information when assessing your initiative’s effect on health disparities.

A tool to help with reflexive practice

A useful tool is the Power Flower. This exercise asks you to identify who you are and who you aren’t in relation to those who hold the most power in our society.² It invites you to become aware of how your experiences are influenced by multiple factors such as age, ability, and Indigenous ancestry, and how you may experience privilege or marginalization related to these factors.

Tools to help modify your initiative

Examples of tools that can help you modify your program or service to reduce health disparities include:

• Health Equity Impact Assessment – identify unintended impacts of your initiative on marginalized populations, and make equity-based improvements to the initiative. 


• Equity and Inclusion Lens Handbook – remove barriers to your program or service by considering inclusion in all aspects of your work, including communications, training, monitoring and evaluation, and working with people. See pages 21 to 45 for practical tips.

Some examples to consider

For the following examples, think about how you might modify or orient programs or initiatives to reduce health disparities:

1. Marie is an older adult with a low, fixed income. Her eyeglass prescription recently changed but she cannot afford new glasses. She continues to wear her old eyeglasses and trips over clutter on the floor. She couldn’t see well. As a result, Marie breaks her hip.

2. Simon is a transgender man who is overweight. Simon’s doctor has recommended exercise classes at a local community centre, but he doesn’t feel comfortable using the change rooms there. Simon decides to do home workouts instead. After a couple weeks, he loses motivation and becomes sedentary again.

3. Frank lost touch with his social circle after his wife died. Their friend group was mainly couples. Recently, Frank has been dealing with an illness that prevents him from driving. Without friends or family to help, he’s finding it difficult to get to his medical appointments and the grocery store. He misses appointments and eats poorly. His health declines further.

DID YOU KNOW?

The Fall Prevention Community of Practice encourages all presenters and newsletter post contributors to consider health disparities and the social determinants of health when preparing their materials for you. We provide invited presenters and contributors with a brief document that highlights the importance of addressing health disparities and provides questions to consider as they prepare.

References

1. Health Nexus. Tip sheet: health equity impact assessment: engaging in reflexive practice when conducting HEIAs [Internet]. Toronto (ON): Health Nexus; 2015 Feb [cited 2017 Apr 10]. Available from: http://en.healthnexus.ca/sites/en.healthnexus.ca/files/resources/heia_tip1.pdf.


2. Arnold R, Burke B, James C, Martin D, Thomas B. Educating for a change. Toronto (ON): Between the Lines, Doris Marshall Institute for Education and Action; 1991.

This Loop post was adapted with permission from Social Determinants of Health Nurses at KFL&A Public Health.