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See detailIs universal healthcare truly universal? Socioeconomic and migrant inequalities in healthcare
Paccoud, Ivana

Doctoral thesis (2022)

Through the principle of Universal Healthcare Coverage, many governments across Europe and beyond seek to ensure that all people have equal access to good quality healthcare services, without facing a financial burden. Despite this, studies have highlighted persistent migrant and socio-economic inequalities in the use of healthcare services, and personal health records. Therefore, understanding the complex mechanisms that produce and maintain social inequalities in the effective use of healthcare services is thus an important step towards advancing equity in healthcare. This thesis draws on Bourdieu's forms of capital (cultural, social, economic, and symbolic) to conceptualise and empirically test social inequalities related to healthcare. In doing so, it investigates the factors contributing to socioeconomic and migrant inequalities in the use, navigation and optimisation of healthcare services as well as personal health records. The three studies that make up this thesis empirically test these ideas through statistical modelling on population-based datasets as well as through the analysis of two cross-sectional surveys in Luxembourg and the Greater region. The first study draws on the fifth wave of the Survey of Health, Aging, and Retirement in Europe (SHARE). It used cluster analysis and regression models to explain how the unequal distribution of material and non-material capitals acquired in childhood shape health practices, leading to different levels of healthcare utilisation in later life. The results suggest that although related, both material and non-material capitals independently contribute to health practices associated with the use of healthcare services. The second study used data from a cross-sectional survey to investigate inequalities in the navigation and optimisation of healthcare services, taking into consideration the interplay between perceived racial discrimination and socioeconomic position. It revealed disparities between individuals born in Eastern Europe and the Global South and those born in Luxembourg which were explained by the experience of racial discrimination. It also found that the impact of discrimination on both health service navigation and optimisation was reduced after accounting for social capital. The last study used data from a cross-sectional survey developed as a part of a collaborative project (INTERREG-APPS) to examine the socioeconomic and behavioural determinants in the intention to use personal health record in the Greater region of Luxembourg (Baumann et al., 2020). This study found that people’s desire and actual access to personal health electronic records is determined by different socioeconomic factors, while educational inequalities in the intention to regularly use personal health records were explained by the role of behavioural factors. Taking together, the findings presented in this thesis thus show the value of mobilising Bourdieu’s theoretical framework to understand the mechanisms through which social inequalities in healthcare develop. In addition, it showed the importance of considering racial discrimination when examining migrant, and racial/ethnic differences in health.

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See detailIndividual factors and beliefs determining COVID-19 vaccination willingness
Pauly, Laure; Paccoud, Ivana; Satagopam, Venkata; Ghosh, Soumyabrata; Fritz, Joëlle; O'Sullivan, Marc; Rommes, Basile; Wilmes, Paul; Krüger, Rejko; Leist, Anja

Poster (2022, April)

Background: High vaccination coverage rates are necessary to reduce infections and transmissions of the SARS-CoV-2 virus causing COVID-19 and to allow successful mitigation of the current pandemic. To date, we are still lacking information to explain the hesitancy in Luxembourg towards uptake of the available COVID-19 vaccines. The present study explored motivations for and against vaccination in a population-representative sample of residents across Luxembourg to identify hesitant groups and develop strategies to increase population immunity against SARS-CoV-2. Methods: In the framework of the nationwide, representative longitudinal CON-VINCE study, a sample of 1589 respondents (49.6% women, 84.3% Luxembourg nationality) ranging from 18-84 years, participated in the survey in spring 2021. The protocol of the CON-VINCE study has been described in detail elsewhere (Snoeck et al. 2020). Results: 52% of the respondents had at least partial vaccination at time of assessment between April to June 2021. The most common reasons for vaccination of those willing to be vaccinated (81.2%) were altruistic motivations. Prevalent reasons against vaccination for those undecided (8.7%) or reluctant (10.2%) to be vaccinated were that the vaccine had not been tested sufficiently and the fear of long-term vaccine side effects. Only very few of the vaccination-hesitant or -reluctant respondents reported that they did not believe in vaccination in general. Conclusion: The present study identified motivations for and against COVID-19 vaccination and determined demographic and socio-economic factors associated with vaccination willingness. To increase vaccination rates, public health communication needs to target those unsure or unwilling to be vaccinated. We will continue to study the vaccination uptake in the Luxembourg population, as CON-VINCE is now part of the H2020-funded international ORCHESTRA project (https://orchestra-cohort.eu), research into comparing these results on a Pan-European level.

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See detailWhich demographic and socio-economic factors are associated with vaccination willingness and beliefs towards vaccination? Rapid report with first results
Leist, Anja; Klee, Matthias; Paccoud, Ivana; Pauly, Laure; Ghosh, Soumyabrata; Fritz, Joëlle; O Sullivan, Marc Paul; Rommes, Basile; Wilmes, Paul; Krüger, Rejko; CON-VINCE Consortium

Report (2021)

In the framework of the CoVaLux project on vaccination and long COVID in Luxembourg, the project “Socio-economic determinants of long COVID and vaccination, and economic consequences with focus on labour market and health care” aims to triangulate evidence from different data sources such as social security and general population data, the national cohort CON-VINCE as well as national health surveys. We seek to arrive at robust assessments of how socio-economic determinants shape vaccination willingness, occurrence, severity and persistence of long COVID, and economic consequences of long COVID in Luxembourg.

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See detailSocioeconomic and behavioural factors associated with access to and use of Personal Health Records
Paccoud, Ivana; Baumann, Michèle; Le Bihan, Etienne; Pétré, Benoît; Breinbauer, Mareike; Böhme, Philip; Chauvel, Louis; Leist, Anja

in BMC Medical Informatics and Decision Making (2021), 21

Background: Access to and use of digital technology are more common among people of higher socioeconomic status. These differences might be due to lack of interest, not having physical access or having lower intentions to use this technology. By integrating the digital divide approach and the User Acceptance of Information Technology (UTAUT) model, this study aims to further our understanding of socioeconomic factors and the mechanisms linked to different stages in the use of Personal Health Records (PHR): desire, intentions and physical access to PHR. Methods: A cross-sectional online and in-person survey was undertaken in the areas of Lorraine (France), Luxembourg, Rhineland-Palatinate and Saarland (Germany), and Wallonia (Belgium). Exploratory factor analysis was performed to group items derived from the UTAUT model. We applied linear and logistic regressions controlling for country-level heterogeneity, health and demographic factors. Results: A total of 829 individuals aged over 18 completed the questionnaire. Socioeconomic inequalities were present in the access to and use of PHR. Education and income played a significant role in individuals' desire to access their PHR. Being older than 65 years, and migrant, were negatively associated with desire to access PHR. An income gradient was found in having a physical access to PHR, while for the subgroup of respondents who expressed desire to have access, higher educational level was positively associated with intentions to regularly use PHR. In fully adjusted model testing the contribution of UTAUT-derived factors, individuals who perceived PHRs to be useful and had the necessary digital skills were more inclined to use their PHR regularly. Social influence, support and lack of anxiety in using technology were strong predictors of regular PHR use. Conclusion: The findings highlight the importance of considering all stages in PHR use: desire to access, physical access and intention to regularly use PHRs, while paying special attention to migrants and people with lower socioeconomic backgrounds who may feel financial constraints and are not able to exploit the potential of PHRs. As PHR use is expected to come with health benefits, facilitating access and regular use for those less inclined could reduce health inequalities and advance health equity.

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See detailOrienter les soins vers le patient partenaire. Un livre blanc pour la Grande Région
Consortium Interreg APPS; Baumann, Michèle; Chauvel, Louis; Odero, Angela; Paccoud, Ivana; Le Bihan, Etienne; Baumann-Croisier, Pierre

Book published by INTERREG APPS (2020)

Les différents chapitres de ce livre proposent une approche holistique pour faire évoluer le système de santé vers le partenariat de soins. Résultat de trois années de recherche et de concertation, le Livre Blanc s’appuie sur des recherches documentaires (analyse de la littérature scientifique et de la législation spécifique de chaque pays), des entretiens et des enquêtes auprès de nombreux acteurs, le repérage et l’analyse d’initiatives en GR et la discussion orientée vers le consensus. Par ailleurs, les propositions de recommandations ont été élaborées et discutées lors d’un séminaire interrégional réalisé en décembre 2019. Le Livre Blanc est structuré en 5 parties qui s’adressent chacune à un public ciblé. La première partie situe le contexte dans lequel s’est réalisé le projet et décrit la méthodologie du programme. La seconde partie est consacrée aux aspects réglementaires de l’approche patient partenaire et à leurs conséquences sur les pratiques et les initiatives analysées sur le terrain. Elle est destinée de manière privilégiée aux mandataires politiques. La troisième partie propose une réflexion sur le développement de stratégies de partenariat au niveau des institutions de santé. Elle concerne les gestionnaires des établissements de santé. La quatrième partie vise à amener les professionnels à s’interroger sur ce que le partenariat de soins peut leur apporter dans leurs pratiques de soins. Elle s’adresse, en particulier, aux acteurs en contact direct avec les patients. La cinquième et dernière partie suggère différentes voies possibles de développement de l’APPS dans les domaines de l’enseignement et de la recherche. Toutes ces parties s’adressent bien évidemment au patient, qui est au coeur de l’APPS. Les prises de position proposées par ce Livre Blanc s’appuient sur les données collectées par le consortium de recherche de 2017 à 2020. Dès lors, ce document ne peut être exhaustif et est appelé à évoluer, basé davantage sur une fonction vectrice de normes que de règles. Pour davantage d’information et pour connaitre nos activités et nos publications, rendezvous sur le site web du projet APPS (https://www.patientpartner.org/).

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See detailThe patients’ perspective on access to and use of Personal Health Records
Paccoud, Ivana; Baumann, Michèle; Le Bihan, Etienne; Pétré, Benoit; Breinbauer, Mareike; Böhme, Philipp; Chauvel, Louis; Leist, Anja

Scientific Conference (2020)

We present the patients' perspective regarding the use of Personal Health Records, and give insights on patients' characteristics, such as socioeconomic and behavioural factors, that are associated with the access to and use of Personal Health Records. The findings come from the INTERREG APPS project that investigated preferences for and intention to use Personal Health Records in four cross-border regions, in Lorraine/France, Luxembourg, Rhineland-Palatinate and Saarland/Germany, and Wallonia/Belgium.

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See detailA Bourdieusian approach to class‐related inequalities: the role of capitals and capital structure in the utilisation of healthcare services in later life
Paccoud, Ivana; Nazroo, James; Leist, Anja

in Sociology of Health and Illness (2019)

This paper draws on Bourdieu's theory of economic, social and cultural capital to understand the relative effect of the volume and the composition of these capitals on healthcare service use in later life. Based on data from the fifth wave of the Survey of Health, Aging, and Retirement in Europe (n = 64,840), we first look at the contribution of each capital in the use of three healthcare services (general practitioner, dentist and hospital). Using cluster analysis, we then mobilise Bourdieu's concept of habitus to explain how the unequal distribution of material and non‐material capitals acquired in childhood lead to different levels of health and hospital care utilisation in later life. After controlling for demographic and health insurance variables, our results show that economic capital has the strongest individual association among the three capitals. However, the results of a cluster analysis used to distinguish between capital structures show that those with high non‐material capital and low material capital have higher levels of primary healthcare utilisation, and in turn lower levels of hospital use. Bourdieu's approach sheds light on the importance of capitals in all forms and structures to understand the class‐related mechanisms that contribute to different levels of healthcare use.