An in-Depth Exploration of Consumer and Consumer Representative Views on Chronic Pain Management in Australia: A Key Informant Interview Study.

Chronic pain affects millions of Australians. Despite guidelines recommending non-pharmacological approaches as the first line treatment, opioid medications remain among the most common treatments. This study interviewed consumers and consumer representatives (i.e., representatives of peak pain advocacy organizations in Australia) to gain first-hand perspectives on chronic pain treatment in Australia. Individual semi-structured Key Informant Interviews (KIIs) with three consumers and three representatives were undertaken. Interviews were transcribed, and thematic analysis applied. Results showed that consumers and consumer representatives identified critical treatment access barriers. Another shared theme related to overarching principles of care, with sub-themes pertaining to the need for an interdisciplinary approach and pain education. A further shared theme focused on typical medical interventions, with one shared subtheme regarding the benefits and drawbacks of pain medications. Both groups highlighted the importance of a biopsychosocial approach with consideration of mental health, particularly related to perceived stigma and comorbidities. These findings highlight that chronic pain remains both undertreated and inadequately treated in Australia. There is a critical need to use novel approaches to overcome access barriers and stigma, and to advance precision medicine to match patients to the treatment most likely to be of benefit as early as possible in their journey.

An Interactive, Case-Based Workshop on the Patient Experience for Internal Medicine Residents.

Introduction: The technological revolution has narrowed the information gap between physician and patient. This has led to an evolution in medicine from paternalistic to patient-centric, with health care systems now prioritizing patient experience to achieve higher satisfaction scores. Therefore, it is imperative to start early in educating trainees on how to best address the holistic needs of the patient while also delivering high-quality care. Methods: We implemented a 1-hour workshop that was repeated weekly over 8 weeks to capture all internal medicine residents in our program. During the workshop, we reviewed the historical evolution of patient care from paternalistic to patient-centered, presented the Hospital Consumer Assessment of Healthcare Providers and Systems survey questions, and discussed evidence-based strategies for physicians to improve their patients' experience utilizing four case-based scenarios. Results: Over the 8-week period, a total of 195 residents participated in the workshop. One hundred thirty-nine residents (71%) completed the pre- and postsession survey. Results demonstrated significant knowledge improvement (p < .001) in all of the topics discussed. Additionally, the majority of residents felt the workshop would be useful in their clinical practice and found the clinical scenarios useful. Discussion: Given the evolution towards patient-centered care, it is important to take a proactive approach in providing residents with the tools to best address their patients' needs. Early understanding of patient satisfaction surveys and the impacts they have on hospital metrics can help trainees in their careers as practicing physicians.

Need for a More Objective, Inclusive, and Equitable Selection Process for Gastroenterology Fellowships.

Diseases related to the digestive system account for a significant proportion of the diseases burden in the United States and result in 36.8 million ambulatory visits, 3.8 million hospital admissions, and 22.2 million gastrointestinal endoscopies. To meet the challenge that this quantum of gastroenterological disorders poses, we are obligated to select and train competent gastroenterologists. Admission into a Gastroenterology (GI) fellowship program is highly selective. In 2023, only 62.7% of candidates who applied were successful in matching into a fellowship program, making it even more competitive than a cardiology fellowship (match rate of 68.4%). Therefore, it is imperative that we ensure that the selection process is fair and transparent. Additionally, we need to be socially more responsible by emphasizing diversity and inclusivity to produce gastroenterologists who reflect the changing society we live in. An analysis of current practices indicates that the process of selection is not standardized and is more subjective than objective. This review is an attempt to identify deficiencies that can be rectified by the introduction of a standardized system that includes structured interviews, Standard Letters of Recommendation (SLOR), and objective scoring protocols-all of which would make the process of selection more equitable, diverse, and inclusive. Newer methods like Casper exam, Psychometric testing, and Preference Signaling can also be explored to this end.

Thinking on the purposes, roles and activities of networks for research on maternal and perinatal health: opinions of coordinators and members.

Objective: To identify the opinion of coordinators and members about the essential characteristics and to understand the research networks characteristics, to facilitate their implementation, sustainability and effectiveness so it can be replicated in low and middle-income countries. Methods: A qualitative study using a semi-structured interview technique was conducted. We selected potential members, managers and participants of networks from publications identified in PubMed. After checking the FIGO congress program, we identified authors who were assigned as speakers at the event. An invitation was sent and interviews were scheduled. Results: In total, eleven interviews were performed. Coordinators and members of networks have the same goal when they decide to participate in a network. In general, they cited that these individuals had to be committed, responsible and enthusiastic people. The network should be composed also of postgraduate students. A network should allow multi-leadership, co-responsibility, autonomy and empowerment of its members. Effective communication was mentioned as an important pillar for network maintenance. Another motivation is being an author or coauthor in publications. One way to maintain a network running is social or governmental commitment, after resources expire, studies continue. Conclusion: Networks are different due to the social context where they are inserted, however, some characteristics are common to all of them, such as having engaged leaders. For an effective and sustainable network, commitment and motivation in a leader and members are more in need than financial resources. Ideally, to ensure the operation of the network, the institution where the leader is linked should support this network.

[Alzheimer's dementia in people with Down syndrome : Results of guideline-assisted expert interviews on healthcare deficits in the diagnostics and treatment as well as solution approaches]. / Alzheimer-Demenz bei Menschen mit einem Down-Syndrom : Ergebnisse leitfadengestützter Expert:inneninterviews zu Versorgungsdefiziten in Diagnostik und Therapie sowie Lösungsansätzen.

BACKGROUND: People with Down syndrome have a genetically increased risk of developing early onset Alzheimer's dementia. An interview study with healthcare providers, patient representatives and employees in residential and work facilities was conducted to identify deficits in the healthcare process and approaches to overcoming them. METHOD: In this study 14 semi-structured interviews were conducted and analyzed using qualitative content analysis. RESULTS: A lack of knowledge and experience on the part of medical service providers in dealing with and providing medical care for people with Down syndrome was identified as a key challenge. In addition, the diagnosis of dementia in people with Down syndrome is difficult for various reasons (including lack of appropriate diagnostic tools in standard care and lack of time or financial resources). Doubts were expressed about the efficacy of antidementia medications and the reasons for the increased use of sedatives were discussed. Attentive observation of behavior and involvement of caregivers, regular review and reduction of polypharmacy and the use of alternative behavior modification techniques were mentioned as possible solutions. CONCLUSION: The identified deficits in the medical care of the target population and the approaches to solving them will be incorporated into the development of health policy recommendations in order to optimize the care situation of those affected in the long term.

"Aging Amplifies Challenges": A Descriptive Phenomenological Exploration of the Lived Experiences and Needs of Elderly Individuals With Schizophrenia.

Older adults diagnosed with schizophrenia face unique public health challenges, with specific treatment needs, complex care demands, accelerated aging, and increased susceptibility to health issues. This phenomenological study explored the existential realities and needs of older adults diagnosed with schizophrenia. Fifteen participants, with a mean age of 69.47 (SD ± 9.47) years, ranging from 62 to 79 years old and hailing from rural regions, participated in the study. Four main themes and eight sub-themes emerge: compounding the burden (challenges in symptom management, comorbidities); the abyss of a life filled with emptiness (loss of mental pillars, living in agony); living on the margins of society (the vicious cycle of social and self-isolation, unattainable social welfare); and glimmer of light in the darkness (support systems, self-adjustment). The study calls for healthcare professionals to improve follow-up care efficiency, strengthen engagement, understand patients' living conditions and needs, enforce existing welfare policies for older mentally ill patients, and enhance their mental health and quality of life.

Corrigendum: Barriers and facilitators to implementing a new regulation restricting antimicrobial use in dairy production in Québec, Canada: a qualitative study.

[This corrects the article DOI: 10.3389/fvets.2023.1025781.].

Talk before they sleep: strategies for patient-centred communication in anaesthesiology.

Patient-physician communication is an integral part of daily anaesthetic practice. Although it is an undeniably powerful means of building a solid therapeutic alliance, several of its fundamental aspects are often overlooked, which can hinder successful communication in the preoperative period. We outline these underexploited elements by analysing the various phases of preoperative patient-physician interactions to provide the practising anaesthesiologist with a useful framework for achieving thoughtful and patient-centred communication.

Participants' Experiences of Being Treated for Peri-Implant Mucositis-A Qualitative Interview Study.

OBJECTIVE: To describe participants' experiences of being treated for peri-implant mucositis. METHODS: A qualitative study with nine individual, semistructured interviews was performed. The interview guide was based on a focus group interview. The participants had recently been treated for peri-implant mucositis on one dental implant in a randomised controlled trial (RCT). The treatment included information, oral hygiene instructions, nonsurgical treatment with Er:YAG laser or ultrasonic scaler and professional cleaning in several sessions over 6 months. The interviews performed were analysed using qualitative manifest and latent content analysis. RESULTS: The manifest results showed that learning how to brush the teeth, and repeated feedback, was appreciated, and increased the motivation to improve oral hygiene habits. Most participants experienced no discomfort from the treatment. The participants had an understanding that a longer treatment time was required to ensure the quality of the treatment. Respect and attention were important elements of the personal treatment. The latent results suggest that treatment with a laser or an ultrasonic scaler was not perceived as the most important part of the treatment. Participants felt that receiving information about the treatment process was more important; moreover, a person-centred approach gave a feeling of good and safe care. CONCLUSIONS: The present study highlights factors of importance in treatment of peri-implant mucositis with laser and ultrasonic scaler. A person-centred approach with respect and attention is important for a good and safe experience and may be important factors in future treatments.

Exploring Nursing Professionalism: A Focused Ethnography of Community Nurses in Slovakia.

Background: Professionalism is a multidimensional and dynamic concept that is a fundamental requirement to providing safe, quality nursing care. In the Slovak sociocultural context, professionalism is given only limited attention, and research in this area is completely lacking in community nursing. Purpose: To explore how community nurses (CNs) working in home care agencies understand professionalism in the context of their practice in Slovakia. Methods: This focused ethnography involved 10 CNs working in home care in two Slovak regions. The study was conducted between January and July 2022 and employed semistructured interviews, field notes, and reflexive thematic analysis. Findings: In this specific group and setting, understanding of professionalism was reflected through four themes: professional socialization, community service provision, job satisfaction, and professionalism in danger. Conclusions: The findings showed the need to improve the conditions of the working environment of nurses in the community setting. Implications for practice: The findings have implications for local policy, home care agency management, and nursing education in terms of strengthening professionalism in this specific nursing setting and cultural context.

Prevalence and trends of autism spectrum disorder and other developmental disabilities among children and adolescents in the United States from 2019 to 2021.

Background: The National Health Interview Survey (NHIS) is a comprehensive health survey conducted by the National Center for Health Statistics (NCHS) in the U.S., providing valuable insights into the health status of the population. This study focuses on the NHIS child survey between 2019 and 2021, exploring developmental disabilities in U.S. children, including autism spectrum disorder (ASD), attention deficit/hyperactivity disorder or attention-deficit disorder (ADHD/ADD), intellectual disability (ID), other developmental delay (other DD), and learning disability (LD). Objective: Leveraging NHIS data, our primary objective is to investigate the latest trends and disparities in the prevalence of developmental disabilities among various racial-ethnic groups. Methods: Employing a repeated cross-sectional design, we analyzed NHIS data from 2019 to 2021, focusing on children aged 3-17. The survey employed a meticulous stratified multi-stage sampling design. We utilized SAS version 9.4 for data analysis, calculating race-ethnicity-specific prevalence rates and employing weighted linear regression and the Rao-Scott chi-square test for trend analysis. Results: Among 19,490 children, prevalence rates varied: ASD (3.11%), ADHD/ADD (9.50%), ID (1.85%), other DD (5.66%), and LD (7.49%). Non-Hispanic black children exhibited higher rates of ID and LD, while non-Hispanic white children had the highest ADHD/ADD prevalence. Disparities persisted across sociodemographic subgroups, with variations in prevalence rates. Conclusion: Our study reveals an increase in ASD prevalence and persistent disparities among racial-ethnic groups. Non-Hispanic black children face elevated risks of ID and LD, while non-Hispanic white children exhibit higher rates of ADHD/ADD.

Key informant perspectives on overcoming HPV vaccination barriers in low-immunization NY counties.

Human papillomavirus (HPV) infection is an important public health concern, with nearly 2,900 cases of HPV-related cancers reported in New York State (NYS) each year. Despite concerted efforts to enhance vaccine uptake in NYS, HPV vaccination rates among 13-15-year-olds failed to meet the 2020 healthy People target, and continue to lag behind the 2030 goal, of 80%. In counties with low immunization levels, understanding factors influencing decision-making among unvaccinated adolescents is crucial. This study aimed to identify barriers, facilitators, and potential interventions to improve HPV vaccine uptake. Qualitative semi-structured interviews were conducted with key informants in 15 NYS counties within the lowest quartile of HPV vaccine coverage among 13-year-old adolescents. Public health representatives, including Immunization Quality Improvement for Providers (IQIP) consultants, vaccine coordinators, medical directors, and primary care providers, were identified through purposive and snowball sampling. Interviews explored vaccination coverage knowledge, barriers and facilitating factors, and recommended strategies for improvement. All conversations were audio-recorded, transcribed, and analyzed using ATLAS.ti. Forty-four interviews were conducted, revealing barriers to HPV vaccination such as limited vaccine knowledge, vaccine misinformation, and accessibility. Key informants asserted barriers could be primarily addressed through education efforts, such increased public awareness, improved parent-doctor conversations, additional provider education on vaccine benefits, and supplementary education in patient spaces. Targeted education efforts and improved provider communication strategies have the potential to bolster HPV vaccination rates in NYS. These findings offer valuable insights for guiding future initiatives in communities facing significant barriers to vaccination.

Persistent low HPV vaccination rates emphasize the critical need for tailored interventions aimed at optimizing public health outcomes. This report identifies barriers to HPV vaccination in New York State (NYS), particularly within counties with low coverage rates, underscoring the importance of focused education efforts, enhanced accessibility, and improved communication between providers and patients. The study highlights ongoing challenges in boosting HPV vaccination rates across 15 NYS counties, advocating for innovative strategies to overcome existing barriers. Key recommendations include tailored education initiatives, improved provider communication, increased community engagement, potential policy changes, and proactive follow-up measures, to ensure vaccine completion.

Cross-cultural adaptation and validation of the 2021 Louisiana Needs Assessment Questionnaire for Arabic-speaking people living with HIV.

BACKGROUND: Despite the global decline in HIV infections and mortality worldwide, the HIV epidemic is still growing in the MENA region. In the region, People Living with HIV (PLWH) are facing many challenges related to cultural values, norms, and provided services which create significant obstacles to HIV prevention and control efforts. This study aimed to translate, culturally adapt, and validate the "2021 Louisiana Needs Assessment Questionnaire" for use among Egyptians and Arabic-speaking population. METHODS: Arabic translation and cultural adaptation of the questionnaire passed through five stages. The questionnaire was translated forward and backward then an expert committee reviewed the translated version. Another expert committee reviewed the developed version after modification to assess the content validity using the Content Validity Index (CVI). The last step included a cognitive interview of a convenient sample of 50 adult PLWH in five consecutive rounds to assess subjects' understanding of questions and response items and their meanings. RESULTS: Modifications were carried out all through the translation and adaptation process of the questionnaire including used words, nomenclature of services, adding or omitting response items, and ordering of questions and response items. The synthesized Arabic-adapted questionnaire has adequate content validity and all questions are clearly understood by the studied subjects. The calculated Content Validity Index of all questionnaire items ranged from 0.82 to 1. CONCLUSION: The developed culturally adapted questionnaire has adequate content validity/semantic appropriateness. It can be used to assess the needs of PLWH in the MENA region with minor adaptations to fit each country. It can also be used to follow the outcome and impact of implemented programs and services. Further research is recommended to assess its psychometric properties.

I am just a sister: a field study on sister as mother role from Guangdong, China.

This study aimed to explore sister-as-mother (jieximuzhi) roles in families after the implementation of China's universal two-child (quanmianerhai) and three-child policies (saihaizhengce). By conducting in-depth interviews with 10 sisters from Guangdong Province who fit the sister-motherhood profile, this study investigated their motivations for taking on maternal duties, the characteristics of sister-motherhood roles, and the impact of these roles on the sisters. The results revealed that in families with two or more children, sisters passively assume mother-like responsibilities primarily due to biological age differences and parental neglect, as well as their personal initiative to a certain extent. Additionally, the impact of sister-motherhood roles on sisters includes aspects such as time pressure, financial strain, and increased family intimacy. This study elucidated the phenomenon of sister-motherhood roles that emerge with changes in family structure in China while recognizing the diversity of women's roles within the family, appreciating the challenges faced by sisters in sister-motherhood roles, and providing insights into family labor division and education models.

Co-Designing a Conversational Agent With Older Adults With Chronic Obstructive Pulmonary Disease Who Age in Place: Qualitative Study.

BACKGROUND: As a reaction to the global demographic increase in older adults (aged 60+ years), policy makers call for initiatives to enable healthy aging. This includes a focus on person-centered care and access to long-term care for older adults, such as developing different services and digital health technologies. This can enable patients to engage in their health and reduce the burden on the health care systems and health care professionals. The European Union project Smart Inclusive Living Environments (SMILE) focuses on well-being and aging in place using new digital health technologies. The novelty of the SMILE project is the use of a cocreational approach focused on the needs and preferences of older adults with chronic obstructive pulmonary disease (COPD) in technology development, to enhance access, adaptation, and usability and to reduce stigma. OBJECTIVE: The study aimed to describe the perspective, needs, and preferences of older adults living with COPD in the context of the design and development of a conversational agent. METHODS: This study carried out a data-driven thematic analysis of interview data from 11 cocreation workshops with 33 older adults living with COPD. RESULTS: The three particular features that the workshop participants wanted to implement in a new technology were (1) a "my health" function, to use technology to manage and learn more about their condition; (2) a "daily activities" function, including an overview and information about social and physical activities in their local area; and (3) a "sleep" function, to manage circadian rhythm and enhance sleep quality, for example, through online video guides. In total, 2 overarching themes were identified for the 3 functions: measurements, which were actively discussed and received mixed interest among the participants, and health literacy, due to an overall interest in learning more about their condition in relation to everyday life. CONCLUSIONS: The future design of digital health technology must embrace the complexities of the everyday life of an older adult living with COPD and cater to their needs and preferences. Measurements should be optional and personalized, and digital solutions should be used as a supplement to health care professionals, not as substitute.

Advocating a rational use of self-confrontation micro-phenomenological interviews to improve performance in elite athletes.

Self-Confrontation Micro-Phenomenological Interviews (SCMPIs) aim to capture the fine-grained details of an athlete's experience, focusing on pre-reflective consciousness without resorting to post-hoc rationalizations. This specific type of self-confrontation interview was developed in the domain of work analysis in cognitive ergonomics. Despite its integration into numerous research studies in sport performance and training practices, the direct effects of the SCMPI on athletes remain underexplored. In this perspective article, we provide a brief overview of the theoretical foundations of SCMPI as well as a description of the paradox of the SCMPI situation. Throughout this paper, we highlight the unsolved questions around use of SCMPIs to improve athletes' performance by enhancing reflective thinking as well as pre-reflective awareness. Furthermore, we discuss the epistemological and practical considerations regarding the selection and use of activity traces in SCMPIs. The paper calls for further research to evaluate the SCMPI's impact on performance in elite athletes, emphasizing the need for a rational application of this method in both research and practical interventions.

Communication and information about complementary medicine in a Dutch oncology setting: Interviewing patients and providers on their experiences and needs.

BACKGROUND: Complementary medicine such as yoga, massage and art therapy has become increasingly popular among patients with cancer. However, the topic remains under-discussed during oncology consultations: patients seem hesitant to disclose complementary medicine use, and healthcare providers lack resources to discuss complementary medicine. This study aims to gain an understanding of how to improve communication and information provision in oncological settings about complementary medicine by assessing the experiences and needs of patients and healthcare providers. MATERIALS AND METHODS: Semi-structured interviews were conducted with 17 patients with cancer and 13 oncology healthcare providers recruited from two general hospitals and one breast cancer center in the Netherlands. Nine (former) patients with breast cancer collaborated with the research team as 'co-researchers'. Reflexive thematic analysis was used. RESULTS: The main themes identified were barriers to patient-provider communication about complementary medicine (e.g. lack of time and knowledge among healthcare providers, negative attitudes toward complementary medicine), facilitators of communication (e.g. openness of healthcare providers, complementary medicine as a routine topic) and information provision needs (e.g. easy access to information, the hospital being involved in providing information). CONCLUSION: Patients with cancer and healthcare providers report issues with the current approach to discussing complementary medicine and are of the opinion that complementary medicine should be a routine topic in oncology consultations. Future studies should focus on effective methods for standardizing complementary medicine discussions into oncology care and making reliable information available for patients and healthcare providers.

Hospital antimicrobial stewardship team perceptions and usability of a computerized clinical decision support system.

BACKGROUND: Antimicrobial stewardship (AMS) programs aim to optimize antibiotic use through a panel of interventions. The implementation of computerized clinical decision support systems (CDSSs) offers new opportunities for semiautomated antimicrobial review by AMS teams. This study aimed to evaluate the perceived facilitators, barriers and benefits of end-users related to a commercial CDSS recently implemented in a hospital and to assess its usability. METHODS: A mixed-method approach was used among AMS team members nine months after the implementation of the CDSS in a university hospital in northeastern France. A qualitative analysis based on individual semistructured interviews was conducted to collect end-users' perceptions. A quantitative analysis was performed using the System Usability Scale (SUS). RESULTS: Eleven AMS team members agreed to participate. The qualitative analysis revealed technical, organizational and human barriers and facilitators of CDSS implementation. Effective collaboration with information technology teams was crucial for ensuring the installation and configuration of the software. CDSS adoption by the AMS team required time, human resources, training, adaptation and a clinical leader. Moreover, the CDSS had to be well designed, user-friendly and provide benefits to AMS activities. The quantitative analysis indicated that the CDSS was a "good" system in terms of perceived ease of use (median SUS score: 77.5/100). CONCLUSIONS: This study shows the value of the studied CDSS to support AMS activities. It reveals barriers, facilitators and benefits to the implementation and adoption of the CDSS. These barriers and facilitators could be considered to facilitate the implementation of the software in other hospitals.

International Swiss Primary Hypersomnolence and Narcolepsy Cohort Study (iSPHYNCS): the impact of psychiatric comorbidities on daily life in central disorders of hypersomnolence-a vicious circle.

Presence of psychiatric comorbidities is well documented in narcolepsy type-1 (NT1) but there are limited data on patients with 'other central disorders of hypersomnolence' (OCH). This study aimed to investigate frequency of psychiatric comorbidities in patients with NT1 and OCH, and to evaluate their impact on quality of life and sleep as an additive factor in combination with hypersomnolence-related symptoms. This study was conducted within the scope of the international Swiss Primary Hypersomnolence and Narcolepsy Cohort Study (iSPHYNCS), which aims to find new biomarkers in central disorders of hypersomnolence (CDH). Study participants underwent Mini International Neuropsychiatric Interview and completed questionnaires related to quality of life and sleep. Comparative analysis was conducted to investigate group differences, and multivariable regression models were used to reveal the impact of psychiatric comorbidities. Among a total of 90 patients, 26 were diagnosed with NT1 and 64 with OCH. In all, 38 patients showed at least one psychiatric disorder, 27% of NT1 and 48% of OCH, with female dominance (50% in females versus 23% in males, p < 0.02). Major depressive episodes (n = 29) were most common, followed by suicidality (n = 13). Patients with a psychiatric diagnosis were more fatigued (ß = 0.70, p < 0.05), apathic (ß = -5.41, p < 0.002), had more disturbed sleep (ß = 0.55, p < 0.02), worse sleep (ß = 1.89, p < 0.001) and general health (ß = -12.55, p < 0.02) quality. Comorbid psychiatric disorders are frequent in patients with CDH and worsen the impact of hypersomnolence-related symptoms on daily activities regardless of the type of CDH. Psychiatric comorbidities may create a vicious circle with fatigue and avoidance of physical activities, which aggravates hypersomnolence-related symptoms.

Community voices in health literacy: a qualitative exploration into perceptions of a health literacy mediator.

Health literacy is a vital asset needed to empower individuals to take control of their health. An individual's health literacy is the ability to find, use and apply health information and services to manage their health. They interact with the health services and members of their community who can offer additional support. Creating the role of a health literacy mediator (HLM) may help to improve health literacy outcomes for all. For this role to be accepted by individuals within a community, the community itself should be involved in the development of the roles and associated responsibilities. The aim of this study was to engage with community members to acquire their perspectives on the potential of this role. Qualitative semi-structured online interviews were used to engage in discussions with local community members. This study implemented a constructivist epistemology with qualitative research design. Data were thematically analysed to identify evolving themes that were important to the HLM role. The analysis identified three main themes that need to be considered when adopting an HLM role: (i) health empowerment of individuals, organizations and communities, (ii) meeting the needs of the community and (iii) addressing the existing barriers in navigating and accessing the healthcare system. Those working in the health promotion space must adopt novel and innovative ways to improve HL on both a local and an international scale. This study concluded that for the role of a HLM to be accepted, it would need to encompass these attributes.