Ulrika Enemark’s research while affiliated with Aarhus University and other places

Background Ensuring equitable access to Universal Health Coverage (UHC) is crucial, particularly in low-resource settings like Nepal, where high out-of-pocket expenditure (OOPE) poses a significant barrier to the utilization of healthcare services. This study examined the catastrophic and impoverishing impact of household-level healthcare expenditures, focusing on whether households with NCDs have a higher likelihood of incurring CHE and experiencing impoverishment. Methods We conducted this study in Pokhara Metropolitan City, Nepal, involving 1,276 households. Catastrophic Health Expenditure (CHE) was defined when OOPE was 10% or more of the household’s total expenditure, while impoverishment was measured using the poverty headcount ratio, poverty gap, and squared poverty gap. We used a poverty line of NPR 7,674 (approximately USD 230 in Purchasing Power Parity) per capita per month, as set by the National Statistics Office for the Gandaki urban area in 2024. Total monthly household consumption was the sum of food and non-food expenditures, including healthcare expenditures. Health expenditure was calculated based on self-reported data validated by pertinent documents. Household weight was used in the data analysis. Results Out of 1276 households, 853 (66.8%) reported illness in the past month, and 125 households suffered from CHE. This corresponds to 9.8% of all sampled and 14.6% of households that experienced illness. Out of those 125 households, 82 faced CHE due to NCDs, representing 6.4% of all sampled and 9.6% of households experiencing illness. Most health expenditures were primarily due to medication (60%) and curative care (17.3%) in NCD conditions. The poverty rate increased by 1.17%points, from 9.4% to 10.6%, over the past month due to healthcare costs, leading to a 12.3% increase in people living in poverty, with 1.02%points attributed to NCDs. The poverty gap rose from 1.5% to 1.9%, and the squared poverty gap increased from 0.003 to 0.005. Households with more than two members affected by NCDs had 3 times higher odds of experiencing CHE (AOR 3.02, 95% CI 2.59–3.51). Those with a household member/s suffering from heart disease had twice the odds of facing CHE (AOR 2.41, 95% CI 2.22–2.62). Households with diabetic members had 1.13 times higher odds of experiencing CHE (AOR = 1.13, 95% CI: 1.05–1.21). Households in the lowest quintile had twice the odds of incurring CHE than those in the highest quintile (AOR 1.93, 95% CI 1.75–2.15). Conclusion NCDs and their associated costs are significant contributors to CHE and impoverishment. As Nepal moves towards UHC, policymakers need to accord the highest priority to enhancing financial protection mechanisms by subsidizing healthcare costs, particularly for medicines and curative care related to NCDs. Furthermore, addressing economic inequalities through targeted support for low-income and marginalized households will mitigate CHE and prevent impoverishment.

There is a growing interest in understanding the conditions that facilitate and hinder well-functioning interprofessional collaborations in healthcare. However, important knowledge gaps persist regarding the significance of context conditions and how different professional groups contribute to mediating conditions. To address these gaps, we conducted a mixed-method single-case study using surveys, interviews, and observations. Specifically, we examined how personal workers (PWs) and therapists experienced and mediated conditions during a crucial period of their collaboration in rehabilitation pathways in Danish home care. The findings show that the professional groups experienced different context conditions as poor and, based on their experiences, used distinct strategies to mediate these conditions. The therapists used "Monitoring," "Educating," "Building Relationships," and "Retaining Tasks & Advocating." The PWs used "Gaming the System," "Cutting Corners," and "Keeping Old Habits." The findings further suggest that the professional groups' experience and mediation of the conditions contributed to how the collaboration functioned, maintaining and disrupting it. The study contributes to the literature and practice by offering valuable insights into the pivotal role of context conditions and professionals' agency in interprofessional collaborations. These insights can help inform researchers and practitioners in their efforts to improve the conditions for interprofessional collaborations in healthcare.

Background Unorganized caregivers increasingly face significant challenges that impact their participation in the labor market, particularly in low- and middle-income countries. This paper explores the effects of both care intensity and the subjective caregiving burden on the labor force participation and work hours of these unorganized caregivers. Method We used data from a sample of 1,806 unorganized caregivers in Ghana who provide care to older adults aged 60 and above. High-intensive caregivers were classified as those providing 20 hours of caregiving per week, while the caregiving burden was measured using the short version of the Zarit Burden Interview score. The results were based on the average marginal effect from a logistic regression model. Results The results showed that both high-intensity and high-burden caregiving have notable effects on labor force participation and the work hours of unorganized caregivers. High-intensive caregivers were associated with an approximately 12% increase in the probability of reducing work hours. Also, high-burden caregivers were found to be associated with a 7% increase in the probability of being self-employed. The combined effect of high-intensity and high-burden caregiving was found to amplify the labor market challenges, particularly in reducing work hours and limiting the ability to maintain stable employment. Conclusion These findings highlight the significant impact of unorganized caregiving on labor market outcomes, particularly for those providing intensive and high-burden care. Policymakers should consider these effects when designing support systems for caregivers to mitigate the negative impact on employment and income stability.

Up to 175 conditions influencing interprofessional practices have been identified. Still, little is known about to what extent these conditions interact, influence communication, and vary across professional groups and settings. We explored these knowledge gaps by examining communication among staff in home care and home nursing units in two Danish municipalities, Herning and Holstebro. Conditions were categorized into two types (programme and context) and two levels (professional and organizational). Structural Equation Modeling was used with a sample of 395 staff and 21 managers to analyze the condition categories’ interactions, influences on communication, and variations by unit type and municipality. Context conditions strongly influenced programme conditions on the professional and organizational levels. Organizational-level context conditions had no significant influence, organizational-level programme conditions had a weak influence, and professional-level programme and context conditions had moderate influences on communication. Lastly, professional-level programme conditions had the biggest influence on communication for staff in home care units and in Holstebro. In contrast, professional-level context conditions had the biggest influence on communication for staff in home nursing units and in Herning. These findings offer unique insights into conditions’ interactions, influences, and variances, contributing to our understanding of what makes communication work and for whom.

There is a growing interest in understanding when and why interprofessional collaborations are well functioning, especially within healthcare systems. However, more knowledge is needed about how professionals affect and contribute to these collaborations when they engage in them. To address this shortcoming, this study aims to contribute to professional and organizational studies of interprofessional collaboration by providing novel insights into how professionals engage in and contribute to interprofessional collaborations. It builds on a theoretical perspective of examining professionals’ everyday collaboration practices through the interplay between temporal-oriented agency and institutional work. It applies this perspective to a case study of interprofessional collaboration between personal workers (PWs), nurses, and therapists in the home care sector in Denmark. Overall, the findings show that the professionals engaged in and contributed to the interprofessional collaboration by ‘trying to patch a broken system’. All three professional groups did this primarily by ‘adopting new practices to deal with inept institutionalized practices’ to maintain collaboration. Additionally, some PWs ‘failed to enact institutionalized practices’ to disrupt the collaboration, and some nurses and therapists ‘invented and established mechanisms’ to create new arrangements for the collaboration. Based on the findings, the study demonstrates that certain dimensions of agency are associated with certain types of institutional work. Furthermore, the study suggests that the interplay between agency and institutional work varies between professional groups, influenced by their relative autonomy.