Month: January 2025

Abstract

Background

Chronic respiratory diseases are important causes of disability and mortality globally. Their incidence may be higher in remote locations where healthcare is limited and risk factors, such as smoking and indoor air pollution, are more prevalent. E-health could overcome some healthcare access obstacles in remote locations, but its utilisation has been limited. An improved understanding of barriers and facilitators to the implementation of e-health in remote locations could aid enhanced application of these approaches.

Methods

We performed a qualitative evidence synthesis to explore factors affecting the successful implementation of e-health interventions in remote locations for patients with chronic respiratory diseases. We searched PubMed, CINAHL, Embase, Web of Science and PsycINFO databases for qualitative and mixed-methods studies. Studies were assessed by two researchers, and 41 studies were included in the synthesis. Quality was assessed via the CASP-tool. Findings were coded with Atlas.ti software and categorised based on an adapted Digital Health Equity Framework.

Results

Nineteen themes were identified across five levels (individual, interpersonal, community, society and technology), with associated facilitators and barriers for implementation. An important facilitator of e-health was its role as a tool to overcome obstacles of distance and to increase access to care and patients’ self-efficacy. Potential barriers included the reduction of in-person interactions and an increased burden of work for healthcare providers. Good quality, usability, adaptability and efficacy of e-health interventions were important for implementation to be successful, as were adaptation to the local setting — including culture and language —and involvement of relevant stakeholders throughout the process.

Conclusions

Several factors affecting the implementation of e-health in remote and rural locations for patients with chronic respiratory disease were identified. Intervention objectives, target population, geographical location, local culture, and available resources should be carefully considered when designing an e-health intervention. These findings can be used to inform the successful design and implementation of future e-health interventions.

Abstract

Nationalistic far-right discourse promises to restore and defend the nation against identified alterities, which they blame for a supposed lost “national authenticity.” An analysis of the paradoxical claims of the Italian and Spanish far-right parties in 2022 and 2023 examines how discourses of ontological insecurities are presented as threats posed by alterities to national majorities. The article claims that sometimes these discourses are mixed with securitization moves, but at times there is evident separation between the two processes. Among what the far-right identifies as alterities, political and cultural adversaries are blamed for national ontological insecurity: the US liberal system, religious minorities, the EU, and migration. The findings illustrate that the far-right uses a catch-all strategy on all these themes through the usage of paradoxical claims in their discourse. Through the analysis, it becomes evident that the scapegoating of alterities is crucial to identify when ontological insecurity is indeed connected to the spiraling of the securitization process and particularly to how it allows the far-right to prosper.

Abstract

Upon the international community’s exit from Afghanistan in August 2021, the West made Afghanistan into a crisis, covering up its decades of violence while dehumanizing Afghans. Afghanistan was constructed as a site of oppression and homophobia, allowing the West to situate itself once again as not only ‘civilized’ but ‘queerly civilized’. From the United States to Canada, France and Ireland, saving the ‘at risk’ Afghan queers, trans and women became an international humanitarian responsibility. How and why did queer and trans Afghans all a sudden become “at risk” and “in need of saving” individuals? How did the Western governments and humanitarian regimes politicize queer and trans Afghan lives and “savings”? Based on a de/colonial ethnography of the Afghan evacuations at the moment of humanitarian exit, this article introduces the concept of ‘homo-humanitarianism’ through which the West so-called saved queer and trans Afghans upon/post its abrupt withdrawal while constructing Afghanistan as a site of perpetual violence and Afghans as homophobic.