{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T10:36:16Z","timestamp":1771929376996,"version":"3.50.1"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004484","name":"Tehran University of Medical Sciences and Health Services","doi-asserted-by":"publisher","award":["96-03-62-36567"],"award-info":[{"award-number":["96-03-62-36567"]}],"id":[{"id":"10.13039\/501100004484","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Given the critical perspective of intersectionality and its potential to identify the causes of inequalities, it has been employed increasingly in studies related to health. Despite the rich theoretical evidence about intersectionality, there is a need to consider this approach empirically. This study aimed to apply the intersectionality in practice for health policy makers and researchers seeking to reduce health inequalities. In this regard, we described the development of an intersectionality-based and context-specific intervention focusing on HIV testing uptake among Afghan immigrants in Iran.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is an intervention development study. The intersectionality was used to design a peer-led intervention guided by the 2008 MRC framework. We undertook the following activities related to the three stages of the MRC framework: 1. Identifying the existing evidence (conducting a scoping review to investigate the application of intersectionality in designing and implementing health interventions; designing the checklist of applying the intersectionality in health interventions and programs); 2. Identifying and developing a program theory (conducting a realist review to identify why, how, and under what conditions peer interventions can improve HIV testing uptake among immigrants); and 3. Modeling process and outcomes (adapting the contextual factors identified by conducting a qualitative study and the realist review; extracting considerations regarding intersectionality principles using the checklist of applying the intersectionality in health interventions and programs; determining context specific, intersectionality-based and evidence-based intervention components for each of the intervention pathways).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>According to considerations regarding checklist of application of intersectionality principles, the intervention at the different individual, organizational, and policy levels with multiple strategies should be designed to respond to needs\/conditions affecting HIV testing uptake among immigrants. We determined the peer-led intervention features to improve the use of HIV testing services in Afghan immigrants following the intersectionality principles, target group needs, and contextual conditions aiming to modify power structures. Intervention strategies included HIV information provision, support, community-based services, and structural interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study provides a practical framework for health planners and researchers seeking to reduce inequalities by presenting how intersectionality can influence the design of a health intervention. Accordingly, it is necessary to revisit the social relationships and power structures, determine the intervention components based on evidence tailored to the target group\u2019s needs, and apply changes at different levels.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0335311","type":"journal-article","created":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T17:21:36Z","timestamp":1761585696000},"page":"e0335311","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["From theory to practice of designing for diversity: Applying intersectionality to improve HIV testing uptake"],"prefix":"10.1371","volume":"20","author":[{"given":"Elham","family":"Ghasemi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatemeh","family":"Rajabi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8429-5261","authenticated-orcid":true,"given":"Reza","family":"Majdzadeh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,10,27]]},"reference":[{"key":"pone.0335311.ref001","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.socscimed.2018.01.025","article-title":"Understanding the micro and macro politics of health: Inequalities, intersectionality & institutions - A research agenda","volume":"200","author":"A Gkiouleka","year":"2018","journal-title":"Soc Sci Med"},{"issue":"4","key":"pone.0335311.ref002","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1093\/heapro\/daz080","article-title":"Applying intersectionality theory in health promotion research and practice","volume":"35","author":"E Heard","year":"2020","journal-title":"Health Promot Int"},{"key":"pone.0335311.ref003","volume-title":"Intersectionality 101","author":"O Hankivsky","year":"2014"},{"key":"pone.0335311.ref004","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1163\/9789004506725_060","article-title":"Intersectionality.","volume-title":"Encyclopedia of Critical Whiteness Studies in Education","author":"A Duran","year":"2021"},{"issue":"3","key":"pone.0335311.ref005","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1057\/s41296-021-00490-0","article-title":"Intersectionality as Critical Social Theory","volume":"20","author":"PH Collins","year":"2021","journal-title":"Contemp Polit Theory"},{"key":"pone.0335311.ref006","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1007\/s11199-008-9400-z","article-title":"When Black + Lesbian + Woman \u2260 Black Lesbian Woman: The Methodological Challenges of Qualitative and Quantitative Intersectionality Research","volume":"59","author":"L Bowleg","year":"2008","journal-title":"Sex Roles"},{"key":"pone.0335311.ref007","first-page":"269","author":"Combahee River Collective","year":"1977"},{"issue":"1","key":"pone.0335311.ref008","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1186\/s12939-021-01509-z","article-title":"\u201cDoing\u201d or \u201cusing\u201d intersectionality? Opportunities and challenges in incorporating intersectionality into knowledge translation theory and practice","volume":"20","author":"C Kelly","year":"2021","journal-title":"Int J Equity Health"},{"issue":"7","key":"pone.0335311.ref009","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.2105\/AJPH.2012.300750","article-title":"The problem with the phrase women and minorities: intersectionality-an important theoretical framework for public health","volume":"102","author":"L Bowleg","year":"2012","journal-title":"Am J Public Health"},{"key":"pone.0335311.ref010","article-title":"Can intersectionality help with understanding and tackling health inequalities? Perspectives of professional stakeholders","author":"D Holman","year":"2020","journal-title":"medRxiv"},{"key":"pone.0335311.ref011","article-title":"The feminist perspective of intersectionality in the field of public health: a narrative review of the theoretical-methodological literature","volume":"15","author":"MT Couto","year":"2019","journal-title":"Salud Colectiva"},{"key":"pone.0335311.ref012","doi-asserted-by":"crossref","first-page":"113876","DOI":"10.1016\/j.socscimed.2021.113876","article-title":"Intersectionality in quantitative health disparities research: A systematic review of challenges and limitations in empirical studies","volume":"277","author":"L Harari","year":"2021","journal-title":"Soc Sci Med"},{"issue":"8","key":"pone.0335311.ref013","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1093\/heapol\/czw020","article-title":"10 Best resources on\u2026 intersectionality with an emphasis on low- and middle-income countries","volume":"31","author":"E Larson","year":"2016","journal-title":"Health Policy Plan"},{"key":"pone.0335311.ref014","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.socscimed.2017.02.029","article-title":"Can intersectionality theory enrich population health research?","volume":"178","author":"MA Green","year":"2017","journal-title":"Soc Sci Med"},{"issue":"1","key":"pone.0335311.ref015","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1186\/s12889-021-11449-6","article-title":"\u201cApplying Intersectionality in designing and implementing health interventions: a scoping review\u201d","volume":"21","author":"E Ghasemi","year":"2021","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0335311.ref016","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1186\/s12961-021-00742-w","article-title":"Can intersectionality help with understanding and tackling health inequalities? Perspectives of professional stakeholders","volume":"19","author":"D Holman","year":"2021","journal-title":"Health Res Policy Syst"},{"key":"pone.0335311.ref017","author":"UNAIDS","year":"2021"},{"issue":"12","key":"pone.0335311.ref018","doi-asserted-by":"crossref","first-page":"2039","DOI":"10.1097\/QAD.0000000000003027","article-title":"Multiple HIV testing strategies are necessary to end AIDS","volume":"35","author":"EJ Sanders","year":"2021","journal-title":"AIDS"},{"key":"pone.0335311.ref019","author":"UNAIDS","year":"2025"},{"issue":"6","key":"pone.0335311.ref020","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1093\/eurpub\/cks130","article-title":"HIV testing and counselling for migrant populations living in high-income countries: a systematic review","volume":"23","author":"D Alvarez-del Arco","year":"2013","journal-title":"Eur J Public Health"},{"issue":"11","key":"pone.0335311.ref021","doi-asserted-by":"crossref","first-page":"2012","DOI":"10.1007\/s10461-015-1095-x","article-title":"Barriers and Facilitators to HIV Testing in Migrants in High-Income Countries: A Systematic Review","volume":"19","author":"SJ Blondell","year":"2015","journal-title":"AIDS Behav"},{"key":"pone.0335311.ref022","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.healthpol.2013.10.007","article-title":"Sexual and reproductive health of migrants: does the EU care?","volume":"114","author":"I Keygnaert","year":"2014","journal-title":"Health Policy"},{"issue":"1","key":"pone.0335311.ref023","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1186\/s12889-019-8052-y","article-title":"Delayed linkage to HIV care among asylum seekers in Quebec, Canada","volume":"19","author":"N Kronfli","year":"2019","journal-title":"BMC Public Health"},{"issue":"8","key":"pone.0335311.ref024","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.3390\/ijerph15081700","article-title":"The Effectiveness and Cost-Effectiveness of Screening for HIV in Migrants in the EU\/EEA: A Systematic Review","volume":"15","author":"K Pottie","year":"2018","journal-title":"Int J Environ Res Public Health"},{"issue":"4","key":"pone.0335311.ref025","doi-asserted-by":"crossref","DOI":"10.2196\/publichealth.7741","article-title":"Factors Associated With Access to HIV Testing and Primary Care Among Migrants Living in Europe: Cross-Sectional Survey","volume":"3","author":"I Fakoya","year":"2017","journal-title":"JMIR Public Health Surveill"},{"key":"pone.0335311.ref026","first-page":"19","article-title":"HIV\/AIDS health care challenges for cross-country migrants in low- and middle-income countries: a scoping review","volume":"6","author":"R Suphanchaimat","year":"2014","journal-title":"HIV AIDS (Auckl)"},{"key":"pone.0335311.ref027","author":"International Organization for Migration","year":"2020"},{"issue":"10","key":"pone.0335311.ref028","first-page":"735","article-title":"Migrants\u2019 Health in Iran from the Perspective of Social Justice: a Systematic Literature Review","volume":"19","author":"E Shamsi Gooshki","year":"2016","journal-title":"Arch Iran Med"},{"key":"pone.0335311.ref029","article-title":"Afghan Refugees and Immigrants Health Status in Iran: A Systematic Review","author":"N Roozbeh","year":"2018","journal-title":"JCDR"},{"key":"pone.0335311.ref030","article-title":"The Enduring Health Challenges of Afghan Immigrants and Refugees in Iran: A Systematic Review","volume":"9","author":"NS Hosseini Divkolaye","year":"2017","journal-title":"PLoS Curr"},{"issue":"2","key":"pone.0335311.ref031","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1108\/IJHRH-06-2015-0020","article-title":"Afghan refugees\u2019 experience of Iran\u2019s health service delivery","volume":"9","author":"A Heydari","year":"2016","journal-title":"International Journal of Human Rights in Healthcare"},{"issue":"7","key":"pone.0335311.ref032","first-page":"478","article-title":"Assessing the prevalence of HIV among Afghan immigrants in Iran through rapid HIV testing in the field","volume":"49","author":"H Jabbari","year":"2011","journal-title":"Acta Med Iran"},{"key":"pone.0335311.ref033","article-title":"Developing and evaluating complex interventions: the new Medical Research Council guidance","volume":"337","author":"P Craig","year":"2008","journal-title":"BMJ"},{"issue":"1","key":"pone.0335311.ref034","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1080\/1364557032000119616","article-title":"Scoping studies: towards a methodological framework","volume":"8","author":"H Arksey","year":"2005","journal-title":"Int J Soc Res Methodol"},{"key":"pone.0335311.ref035","unstructured":"Hankivsky O. Intersectionality 101. The Institute for Intersectionality Research & Policy, SFU. 2014;36."},{"key":"pone.0335311.ref036","author":"G Wong","year":"2013"},{"key":"pone.0335311.ref037","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1258\/1355819054308530","article-title":"Realist review--a new method of systematic review designed for complex policy interventions","author":"R Pawson","year":"2005","journal-title":"J Health Serv Res Policy"},{"issue":"1","key":"pone.0335311.ref038","doi-asserted-by":"crossref","first-page":"19","DOI":"10.34172\/hpp.42639","article-title":"Peer interventions to improve HIV testing uptake among immigrants: A realist review","volume":"14","author":"E Ghasemi","year":"2024","journal-title":"Health Promot Perspect"},{"key":"pone.0335311.ref039","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.h1258","article-title":"Process evaluation of complex interventions: Medical Research Council guidance","volume":"350","author":"GF Moore","year":"2015","journal-title":"BMJ"},{"issue":"3","key":"pone.0335311.ref040","first-page":"172","article-title":"Aspects Influencing Access to HIV\/AIDS Services among Afghan Immigrants in Iran: A Qualitative Study","volume":"10","author":"E Ghasemi","year":"2022","journal-title":"Int J Community Based Nurs Midwifery"},{"issue":"5","key":"pone.0335311.ref041","doi-asserted-by":"crossref","DOI":"10.1111\/hsc.13622","article-title":"HIV, migration, gender, and drug addiction: A qualitative study of intersectional stigma towards Afghan immigrants in Iran","volume":"30","author":"E Ghasemi","year":"2022","journal-title":"Health Soc Care Community"},{"issue":"1","key":"pone.0335311.ref042","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12913-017-2808-9","article-title":"Using the Medical Research Council framework for development and evaluation of complex interventions in a low resource setting to develop a theory-based treatment support intervention delivered via SMS text message to improve blood pressure control","volume":"18","author":"K Bobrow","year":"2018","journal-title":"BMC Health Serv Res"},{"issue":"10","key":"pone.0335311.ref043","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0141122","article-title":"Peer Support Workers in Health: A Qualitative Metasynthesis of Their Experiences","volume":"10","author":"J MacLellan","year":"2015","journal-title":"PLoS One"},{"issue":"3","key":"pone.0335311.ref044","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1111\/j.1939-0025.2011.01103.x","article-title":"Peer interventions to promote health: conceptual considerations","volume":"81","author":"JM Simoni","year":"2011","journal-title":"Am J Orthopsychiatry"},{"issue":"2","key":"pone.0335311.ref045","doi-asserted-by":"crossref","DOI":"10.1097\/ANS.0b013e3181a3b3fc","article-title":"Integrating intersectionality and biomedicine in health disparities research","volume":"32","author":"UA Kelly","year":"2009","journal-title":"ANS Adv Nurs Sci"},{"issue":"1","key":"pone.0335311.ref046","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1017\/S1537592707070065","article-title":"When Multiplication Doesn\u2019t Equal Quick Addition: Examining Intersectionality as a Research Paradigm","volume":"5","author":"A-M Hancock","year":"2007","journal-title":"Persp on Pol"},{"issue":"5","key":"pone.0335311.ref047","first-page":"261","article-title":"Development of a complex intervention for secondary prevention of coronary heart disease in primary care using the UK Medical Research Council framework","volume":"12","author":"M Byrne","year":"2006","journal-title":"Am J Manag Care"},{"key":"pone.0335311.ref048","doi-asserted-by":"crossref","first-page":"646504","DOI":"10.1155\/2014\/646504","article-title":"Using the Medical Research Council framework for the development and evaluation of complex interventions in a theory-based infant feeding intervention to prevent childhood obesity: the baby milk intervention and trial","volume":"2014","author":"R Lakshman","year":"2014","journal-title":"J Obes"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0335311","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T17:21:43Z","timestamp":1761585703000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0335311"}},"subtitle":[],"editor":[{"given":"Magdalena","family":"Szaflarski","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,10,27]]},"references-count":48,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,27]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0335311","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,27]]}}}