Roles of Nurses in Reducing Health Disparities in Primary Healthcare in Namibia: A Scoping Review

Filippine Nekulu Nakakuwa; Hans Amukugo

doi:10.25159/2520-5293/21343

Authors

Filippine Nekulu Nakakuwa University of Namibia https://orcid.org/0000-0002-4617-5637
Hans Amukugo University of Namibia

DOI:

https://doi.org/10.25159/2520-5293/21343

Keywords:

nurse role, health care disparities, health care inequality, primary healthcare settings

Abstract

Health disparities are a major public health issue, especially in sub-Saharan Africa. Nurses are frontline healthcare professionals ensuring access to suitable healthcare, yet disparities in healthcare outcomes persist among various groups. This scoping review aimed to examine nurses’ roles in reducing health disparities in primary health care settings. The Joanna Briggs Institute Manual for Scoping Reviews was followed, and it complies with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Databases were searched for peer-reviewed empirical articles in English that were limited to less than ten years. The review scoped 30 articles. A qualitative thematic for analysis was employed. The review identified nursing roles in reducing health disparities across individual, system, community, and patient levels. Nurses play a crucial role in delivering quality care and reducing disparities. It emphasised key contributions to high-quality, patient-centred care and improved health outcomes, including cultural competency, stakeholder collaboration, effective communication, policy review, community health programmes, and understanding social determinants of health. The findings of this study point out the key role of the nursing workforce in advancing health equity. Furthermore, it highlights the need to strengthen support, training, and policy frameworks that enable nurses to address and reduce health disparities in health facilities.

References

Agyei, E., and E. Kumah. 2024. “Navigating the Complex Terrain of Healthcare Systems in Sub-Saharan Africa: Challenges and Opportunities for Progress.” Discover Health Systems 3 (1). https://doi.org/10.1007/s44250-024-00108-3

Allcock, S. H. 2019. “Population Health in Namibia: An Analytical Approach.” DoxcApollo - University of Cambridge Repository. https://doi.org/10.17863/CAM.40668

Arcaya, M. C., A. L. Arcaya, and S. V. Subramanian. 2015. “Inequalities in Health: Definitions, Concepts, and Theories.” Global Health Action 8 (1): 1–12. https://doi.org/10.3402/gha.v8.27106

Bates, M., L. Aurelien, and Phillips, J. 2015. “Nurses: Leading to Reduce Health Disparities in an Era of Healthcare Reform.” Journal of National Black Nurses’ Association: JNBNA 26 (2), 73–78. PMID: 27045160

Bailey, Z. D., N. Krieger, M. Agénor, J. Graves, N. Linos, and M. T. Bassett. 2017. “Structural Racism and Health Inequities in the USA: Evidence and Interventions.” The Lancet 389 (10077): 1453–1463. https://doi.org/10.1016/s0140-6736(17)30569-x

Bourne, M. J., S. C. Smeltzer, and M. M. Kelly. 2021. “Healthcare Inequities among Adults with Developmental Disability: An Integrative Review with Implications for Nursing Education.” Nurse Education in Practice 57: 103225. https://doi.org/10.1016/j.nepr.2021.103225

Centres for Disease Control and Prevention (CDC). 2022. Health Disparities. https://www.cdc.gov/healthy-youth/health-disparities/index.html

Chiwara, P., and A. Lombard. 2022. “Socio-Economic Inequalities in Namibia: A Qualitative Social Work Study.” Southern African Journal of Social Work and Social Development 34 (3). https://doi.org/10.25159/2708-9355/10869

Coombs, N. C., D. G. Campbell, and J. Caringi. 2022. “A Qualitative Study of Rural Healthcare Providers’ Views of Social, Cultural, and Programmatic Barriers to Healthcare Access.” BioMed Central Health Services Research 22 (1): 1–16. https://doi.org/10.1186/s12913-022-07829-2

Cunningham, R., R. C. Polomano, R. M. Wood, and J. Aysola. 2022. “Health Systems and Health Equity: Advancing the Agenda.” Nursing Outlook 70 (6, Supplement 1): S66–S76. https://doi.org/10.1016/j.outlook.2022.05.010

Dawson, A. J., A. M. Nkowane, and A. Whelan. 2015. “Approaches to Improving the Contribution of the Nursing and Midwifery Workforce to Increasing Universal Access to Primary Health Care for Vulnerable Populations: A Systematic Review.” Human Resources for Health 13 (1): 1–23. https://doi.org/10.1186/s12960-015-0096-1

Dickerson, J. C., M. V. Ragavan, D. A. Parikh, and M. I. Patel. 2020. “Healthcare Delivery Interventions to Reduce Cancer Disparities Worldwide.” World Journal of Clinical Oncology 11 (9): 705–722. https://doi.org/10.5306/wjco.v11.i9.705

Flaubert, J. L., S. Le Menestrel, D. R. Williams, M. K. Wakefield, and National Academies of Sciences, Engineering, and Medicine. 2021. “The Role of Nurses in Improving Health Care Access and Quality.” In The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK573898/.

FitzGerald, C., and S. Hurst. 2017. “Implicit Bias in Healthcare Professionals: A Systematic Review.” BMC Medical Ethics 18 (1): 1–18. https://doi.org/10.1186/s12910-017-0179-8

Fowler, T., D. Garr, N. D. P. Mager, and J. Stanley. 2020. “Enhancing Primary Care and Preventive Services through Interprofessional Practice and Education.” Israel Journal of Health Policy Research 9 (12): 1–5. https://doi.org/10.1186/s13584-020-00371-8

Gizaw, Z., T. Astale, and G. M. Kassie. 2022. “What Improves Access to Primary Healthcare Services in Rural Communities? A Systematic Review.” Biomed Central Primary Care 23 (1): 1–16. https://doi.org/10.1186/s12875-022-01919-0

Goodman M., O. Onwumere, L. Milam, and J. F. Peipert. 2017. “Reducing Health Disparities by Removing Cost, Access, and Knowledge Barriers.” American Journal of Obstetrics and Gynecology 216 (4): 382.e1–5. https://doi.org/10.1016/j.ajog.2016.12.015

Handtke, O., B. Schilgen, and M. Mösko. 2019. “Culturally Competent Healthcare – a Scoping Review of Strategies Implemented in Healthcare Organizations and a Model of Culturally Competent Healthcare Provision.” PLOS ONE 14 (7): e0219971. https://doi.org/10.1371/journal.pone.0219971

Jindal, M., K. H. Chaiyachati, V. Fung, S. M. Manson, and K. Mortensen. 2023. “Eliminating Health Care Inequities through Strengthening Access to Care.” Health Services Research 58 (3): 300–310. https://doi.org/10.1111/1475-6773.14202

Kilbourne A. M., G. Switzer, K. Hyman, M. Crowley-Matoka and M. J. Fine. 2006. “Advancing Health Disparities Research within the Health Care System: A Conceptual Framework.” American Journal of Public Health 96 (12): 2113–2121. https://doi.org/10.2105/ajph.2005.077628

Komi, L. S., E. C. Chianumba, A. Y. Forkuo, D. Osamika, and A. Y. Mustapha. 2021. “Advances in Public Health Outreach through Mobile Clinics and Faith-Based Community Engagement in Africa.” ICONIC Research and Engineering Journals, 4 (8), 159–161. https://www.irejournals.com/paper-details/1708180

Kwame, A., and P. M. Petrucka. 2021. “Communication in Nurse-Patient Interaction in Healthcare Settings: A Scoping Review.” International Journal of Africa Nursing Sciences 12: 1–10. https://doi.org/10.1016/j.ijans.2020.100198

Li, J. L. 2017. “Cultural Barriers Lead to Inequitable Healthcare Access for Aboriginal Australians and Torres Strait Islanders.” Chinese Nursing Research 4 (4): 207–10. https://doi.org/10.1016/j.cnre.2017.10.009

Mabhala, M. A. 2015. “Public Health Nurse Educators’ Conceptualisation of Public Health as a Strategy to Reduce Health Inequalities: A Qualitative Study.” International Journal for Equity in Health 14 (1). https://doi.org/10.1186/s12939-015-0146-2

McGowan J., S. Straus, D. Moher, E. V. Langlois, K. K. O’Brien, T. Horsley, A. Aldcroft, W. Zarin, C. M. Garitty, S. Hempel, and E. Lillie. 2020. “Reporting Scoping Reviews – PRISMA ScR Extension.” Journal of Clinical Epidemiology 123 (177): e9. https://doi.org/10.1016/j.jclinepi.2020.03.016

Mobula, L. M., M. T. Okoye, L. E. Boulware, K. A. Carson, J. A. Marsteller, and L. A. Cooper. 2014. “Cultural Competence and Perceptions of Community Health Workers’ Effectiveness for Reducing Health Care Disparities.” Journal of Primary Care and Community Health 6 (1): 10–15. https://doi.org/10.1177/2150131914540917

Ndugga, N., and S. Artiga. 2021. “Disparities in Health and Health Care: 5 Key Questions and Answers.” Kaiser Family Foundation, 11 (1), 4. https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-5-key-questions-and-answers/

Niohuru, I. 2023. “Healthcare and Disease Burden in Africa: The Impact of Socioeconomic Factors on Public Health.” Springer Nature. https://doi.org/10.1007/978-3-031-19719-2

Oruche, U. M., and T. C. B. Zapolski. 2020. “The Role of Nurses in Eliminating Health Disparities and Achieving Health Equity.” Journal of Psychosocial Nursing and Mental Health Services 58 (12): 2–4. https://doi.org/10.3928/02793695-20201112-01

Pérez-Stable, E. J., and S. El-Toukhy. 2018. “Communicating with Diverse Patients: How Patient and Clinician Factors Affect Disparities.” Patient Education and Counseling 101 (12): 2186–2194. https://doi.org/10.1016/j.pec.2018.08.021

Peters, M. D. J., C. M. Godfrey, H. Khalil, P. McInerney, D. Parker, and C. B. Soares. 2015. “Guidance for Conducting Systematic Scoping Reviews.” International Journal of Evidence-Based Healthcare 13 (3): 141–146. https://doi.org/10.1097/xeb.0000000000000050

Peters, M., C. Godfrey, P. McInerney, Z. Munn, A. Trico, and H. Khalil. 2020. “Chapter 11: Scoping Reviews.” JBI Manual for Evidence Synthesis. https://doi.org/10.46658/jbimes-20-12

Phillips, J., A. Richard, K. M. Mayer, M. Shilkaitis, L. F. Fogg, and H. Vondracek. 2020. “Integrating the Social Determinants of Health into Nursing Practice: Nurses’ Perspectives.” Journal of Nursing Scholarship 52 (5): 497–505. https://doi.org/10.1111/jnu.12584

Poghosyan, L., and J. M. B. Carthon. 2017. “The Untapped Potential of the Nurse Practitioner Workforce in Reducing Health Disparities.” Policy, Politics, and Nursing Practice 18 (2): 84–94. https://doi.org/10.1177/1527154417721189

Purtzer, M. A., and J. J. Thomas. 2019. “Intentionality in Reducing Health Disparities: Caring as Connection.” Public Health Nursing 36 (3): 276–83. https://doi.org/10.1111/phn.12594

Salmond, S. W., and M. Echevarria. 2017. “Healthcare Transformation and Changing Roles for Nursing.” Orthopaedic Nursing 36 (1): 12–25. https://doi.org/10.1097/NOR.0000000000000308

Sellers, S. L., M. E. Moss, K. Calzone, K. E. Abdallah, J. F. Jenkins, and V. L. Bonham. 2016. “Nurses’ Use of Race in Clinical Decision Making.” Journal of Nursing Scholarship 48 (6): 577–586. https://doi.org/10.1111/jnu.12251.

Smolowitz, J., E. Speakman, D. Wojnar, E. M. Whelan, S. Ulrich, C. Hayes, and L. Wood. 2015. “Role of the Registered Nurse in Primary Health Care: Meeting Health Care Needs in the 21st Century.” Nursing Outlook 63 (2): 130–36. https://doi.org/10.1016/j.outlook.2014.08.004

Strasser, R., and S. Strasser. 2020. “Reimagining Primary Health Care Workforce in Rural and Underserved Settings.” Washington, DC: The International Bank for Reconstruction and Development/The World Bank. https://hdl.handle.net/10289/14072.

Sumah, A. M., L. Baatiema, and S. Abimbola. 2016. “The Impacts of Decentralisation on Health-Related Equity: A Systematic Review of the Evidence.” Health Policy 120 (10): 1183–1192. https://doi.org/10.1016/j.healthpol.2016.09.003

Tangcharoensathien, V., S. Adulyanon, N. Supaka, R. Munkong, S. Viriyathorn, S. Sirithienthong, S. Kanhachon, and R. Marten. 2024. “The Thai Health Promotion Foundation: Two Decades of Joint Contributions to Addressing Noncommunicable Diseases and Creating Healthy Populations.” Global Health: Science and Practice, 12 (2). https://doi.org/10.9745/GHSP-D-23-00311

Tawfik G. M., K. A. Dila, M. Y. Mohamed, D. N. Tam, N. D. Kien, A. M. Ahmed, and N. T. Huy. 2019. “A Step by Step Guide for Conducting a Systematic Review and Meta-Analysis with Simulation Data.” Tropical Medicine and Health 47 (1): 1–9. https://doi.org/10.1186/s41182-019-0165-6

Teresa-Morales, C., M. Rodríguez-Pérez, M. Araujo-Hernández, and C. Feria-Ramírez. 2022. “Current Stereotypes Associated with Nursing and Nursing Professionals: An Integrative Review.” ProQuest 19 (13): 7640. https://doi.org/10.3390/ijerph19137640

Thimm‐Kaiser, M., A. Benzekri, and V. Guilamo‐Ramos. 2023. “Conceptualizing the Mechanisms of Social Determinants of Health: A Heuristic Framework to Inform Future Directions for Mitigation.” The Milbank Quarterly 101 (2): 486–526. https://doi.org/10.1111/1468-0009.12642

Thompson, T., A. McQueen, M. Croston, A. Luke, N. Caito, K. Quinn, J. Funaro, and M. W. Kreuter. 2019. “Social Needs and Health-Related Outcomes among Medicaid Beneficiaries.” Health Education and Behavior 46 (3): 436–444. https://doi.org/10.1177/1090198118822724

Thornton, R. L., C. M. Glover, C. W. Cené, D. C. Glik, J. A. Henderson, and D. R. Williams. 2016. “Evaluating Strategies for Reducing Health Disparities by Addressing the Social Determinants of Health.” Health Affairs 35 (8): 1416–1423. https://doi.org/10.1377/hlthaff.2015.1357

Tricco, A. C., E. Lillie, W. Zarin, K. K. O’Brien, H. Colquhoun, D. Levac, D. Moher, M. D. J. Peters, T. Horsley, L. Weeks, and S. Hempel. 2018. “PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation.” Annals of Internal Medicine 169 (7): 467–73. https://doi.org/10.7326/M18-0850

Trotter Jr, P. S. 2024. “Faith Leaders’ Perceptions and Experiences of Advancing Collaborative Health Care Partnerships Focused on Community Health.” Doctoral Dissertation, Walden University.

Vanderbilt, A. A., M. D. Dail, and P. Jaberi. 2015. “Reducing Health Disparities in Underserved Communities via Interprofessional Collaboration across Health Care Professions.” Journal of Multidisciplinary Healthcare 8: 205–208. https://doi.org/10.2147/jmdh.s74129

Vo, J. B., A. Gillman, K. Mitchell, and T. S. Nolan. 2021. “Health Disparities: Impact of Health Disparities and Treatment Decision-Making Biases on Cancer Adverse Effects among Black Cancer Survivors.” Clinical Journal of Oncology Nursing 25 (5): 17–24. https://doi.org/10.1188/21.cjon.s1.17-24

Walsh, C., and K. DiBello. 2023. “Achieving Health Equity through Bias Reduction.” AAACN Viewpoint 45 (3): 12 13.

Wilson, D., V. Heaslip, and D. Jackson. 2018. “Improving Equity and Cultural Responsiveness with Marginalised Communities: Understanding Competing Worldviews.” Journal of Clinical Nursing 27 (19-20): 3810–3819. https://doi.org/10.1111/jocn.14546

Williams D. R., and L. A. Cooper. 2019. “Reducing Racial Inequities in Health: Using What We Already Know to Take Action.” International Journal of Environmental Research and Public Health 16 (4): 606. https://doi.org/10.3390/ijerph16040606

Wong, E., F. Mavondo, L. Horvat, L. McKinlay, and J. Fisher. 2022. “Healthcare Professionals’ Perspective on Delivering Personalised and Holistic Care: Using the Theoretical Domains Framework.” BMC Health Services Research 22 (1): 281. https://doi.org/10.1186/s12913-022-07630-1

World Health Statistics. 2022. “Monitoring Health for the Sustainable Development Goals (SDGs).” World Health Statistics. http://apps.who.int/bookorders