"A part of my life". A qualitative study about perceptions of female genital mutilation and experiences of healthcare among affected women residing in Sweden.

BACKGROUND: Female genital mutilation (FGM) is defined as all procedures involving partial or total removal of the external female genitalia, or other injuries to them for non-medical reasons. Due to migration, healthcare providers in high-income countries need to better understand the consequences of FGM. The aim of this study was to elucidate women's experiences of FGM, with particular focus on perceived health consequences and experiences of healthcare received in Sweden. METHODS: A qualitative study was performed through face-to-face, semi-structured interviews with eight women who had experienced FGM in childhood, prior to immigration to Sweden. The transcribed narratives were analyzed using content analysis. RESULTS: Three main categories were identified : "Living with FGM", "Living with lifelong health consequences" and "Encounters with healthcare providers". The participants highlighted the motives behind FGM and their mothers' ambivalence in the decision process. Although the majority of participants had undergone FGM type 3, the most severe type of FGM, the lifelong health consequences were diverse. Poor knowledge about FGM, insulting attitude, and lack of sensitive care were experienced when seeking healthcare in Sweden. CONCLUSIONS: Our findings indicate that FGM is a complex matter causing a diversity in perceived health consequences in women affected. Increased knowledge and awareness about FGM among healthcare providers in Sweden is of utmost importance. Further, this subject needs to be addressed in the healthcare encounter in a professional way.

Patient's Perceptions and Attitudes Towards Medical Student's Involvement in Their Healthcare at a Teaching Hospital in Jordan: A Cross Sectional Study.

Background: Medical students' involvement in patients' care varies according to patient's willingness, as some might consider it a privacy invasion. Thus, exploring patients' perceptions and attitudes towards this interaction should be thoroughly investigated, to better understand it and to provide evidence-based data for improving the training of future doctors. Methods: A cross-sectional study was conducted at Jordan University Hospital. A questionnaire was answered by 420 patients from the out-patients' clinics. Results: Of the patients interviewed, 94% were aware that they were in a teaching hospital, 92% approved the presence of medical students during their consultation and 80% accepted to be observed and examined by medical students in the presence of a senior doctor. However, this decreased to 30.5% if there was no senior doctor. Almost 83% of the patients believed that their consent should be obtained first. However, only 58% of them indicated that the student asked for consent prior to interacting with them. Patients who were more likely to approve the existence of medical students during consultation and allow students to perform procedures on them, respectively, were those who were asked for consent by students (P = 0.001 and P = 0.021), considered seeing medical students' enjoyable (P < 0.001 and P < 0.001), thought that their privacy was not violated (P < 0.001 and P < 0.001), and were provided with useful information about their health problems (P < 0.001 and P < 0.001). Conclusion: Patients showed an overall positive stance towards the involvement of medical students in their healthcare. The majority were delighted to see medical students while some expressed concerns over their privacy due to the large number of students and because several students do not ask for their consent. It is essential to apply medical ethics practices together with patient-centered approach.

Workplace Violence against Health Care Providers in Emergency Departments of Public Hospitals in Jordan: A Cross-Sectional Study.

Workplace violence (WPV) against healthcare providers is a serious problem that carries health, safety, and legal consequences. Healthcare providers working in emergency departments (ED) are more susceptible to WPV compared to other healthcare settings. This study aimed to assess the prevalence of physical and verbal violence against ED physicians and nurses in public hospitals in Amman, Jordan, and to explore the relationship between WPV and the socio-demographic characteristics of the participants. A quantitative descriptive cross-sectional study design was used to assess physical and verbal violence against ED physicians and nurses. A self-administered questionnaire was completed by 67 physicians and 96 nurses from three public hospitals in Amman. In the past year, 33% and 53% of the participants experienced physical and verbal violence, respectively. Compared to their female counterparts, males were more frequently physically (43.7% vs. 2.3%, p-value < 0.001) and verbally (61.3% vs. 29.5%, p-value < 0.001) abused. The main perpetrators of physical and verbal violence were the patients' relatives. Out of 53 physical and 86 verbal abuse incidents, only 15 cases (10.8%) were followed up with legal persecution. In conclusion, there is a widespread occurrence of physical and verbal violence against ED physicians and nurses in the public sector hospitals in Jordan. A collaborative effort by all stakeholders should be instituted to ensure the safety of the physicians and nurses and to improve the quality of the healthcare provided.

Risk of obstetric anal sphincter tear among primiparous women with a history of female genital mutilation, giving birth in Sweden.

BACKGROUND: Female genital mutilation (FGM) includes a range of procedures involving partial or total removal of the external female genitalia. It is a harmful procedure that violates human rights of girls and women. FGM has been associated with obstetric anal sphincter injury (OASI), among other adverse obstetric complications. However, the obstetric outcomes in high-income countries are not clear. The aim of this study was to compare the risk of OASI among primiparous women, with and without a history of FGM, giving birth in Sweden. METHOD: A population-based cohort-study based on data from the Swedish Medical Birth Register during the period 2014-2018. The study included primiparous women with singleton term pregnancies. We compared the risk, using multivariable logistic regression, of our main outcome OASI between women with a diagnosis of FGM and women without a diagnosis of FGM. Secondary outcomes included episiotomy and instrumental vaginal delivery. RESULT: A total of 239,486 primiparous women with a term singleton pregnancy were identified. We included 1,444 women with a diagnosis of FGM and 186,294 women without a diagnosis of FGM in our analysis. The overall rate of OASI was 3% in our study population. By using multivariable logistic regression analysis, we found that women with a diagnosis of FGM had a significantly increased odds ratio (OR) of OASI (OR 2.69, 95%CI: 2.14-3.37) compared to women without a diagnosis of FGM. We also found an association between FGM and instrumental delivery as well as the use of episiotomy. CONCLUSION: Women with a history of FGM have an almost tripled risk of OASI in comparison with women without FGM, when giving birth in a Swedish setting. Increased knowledge and awareness regarding FGM, and its potential health implications is crucial in order to minimise the risk of OASI among women with FGM giving birth in high-income countries. A limitation in our study is the lack of information about the specific types of FGM.

Elucidating challenges and solutions in the maternal healthcare, identified by medical doctors in northern South Africa: a qualitative study.

INTRODUCTION: as South Africa's maternal mortality ratio increased between 1990 and 2015, the country failed to reach the United Nations millennium development goal 5a. The maternal mortality ratio of Limpopo province is higher than the national average and previous studies report shortages of manpower and medical equipment in Limpopo province. The overall study aim was to elucidate views and experiences of medical doctors regarding maternal healthcare by identifying the challenges they experience and solutions they suggest. METHODS: a qualitative interview-based study was performed with ten medical doctors as participants. Manifest content analysis was used to analyze the data. RESULTS: the main findings were categorized as lack of material and human resources, feelings of experienced isolation and solution-focused expressions. The challenges identified included logistical issues, staffing issues, demographic characteristics of the patient population, poor interinstitutional communication and lack of support from the administration. The solutions included revision of resource allocation and improvement of the interinstitutional cooperation. For example, participants suggested that exchange programs between hospitals could be arranged, that the emergency medical service personnel could triage patients and that private practitioners could be contracted to work at public institutions. CONCLUSION: most identified challenges were related to a lack of resources. Based on their inside experience, the participants suggested several solutions. These firsthand accounts of the local medical doctors highlight the need for intervention and should be taken into account when it comes to improving the provincial healthcare and working toward achieving the healthcare-related sustainable development goals by 2030.

Knowledge and Practices of Colorectal Cancer Early Detection Examinations in Jordan: A Cross Sectional Study

Background: Globally, colorectal cancer (CRC) is ranked the third most common cancer among men and the second in women. The American Cancer Society recommends that starting from the age 50 years, both men and women should be screened for polyps and for early detection of CRC. In Jordan, CRC is the most common cancer among males and the second most common cancer among females. This study aims to assess the knowledge and practices of CRC early detection tests and the barriers and motivators of screening in Jordan. Methods: A semi-structured questionnaire and face-to-face interviews were conducted with 300 males and 300 females recruited using stratified clustered random sampling technique from four governorates in Jordan. The participants were aged 30 to 65 years, without a previous history of CRC. Descriptive and multivariate analyses were used to assess knowledge and practices of CRC early detection tests. Results: Overall, there were poor knowledge and practices of CRC early detection tests. Better knowledge and practices were significantly associated with previously consulting a doctor due to symptoms and worries from CRC, receiving a recommendation from a doctor to perform CRC testing, or having more knowledge about CRC signs and symptoms (p≤ 0.05). Conclusions: This study indicates that there is a need for raising awareness about CRC early detection tests in Jordan, especially among those aged 50 years and above, and those who have a family history of CRC. Additionally, it is important to educate and encourage physicians to recommend CRC screening to patients that are at higher risk of the disease.

'Happy that someone cared'-Non-native-speaking immigrant mothers' experiences of participating in screening for postpartum depression in the Swedish child health services.

Immigrant mothers who have immigrated during the last ten years and do not speak the language of the new country are found to be at particular risk of being affected by postpartum depression (PPD). Still they choose to participate to a lesser extent in screening for PPD and are not screened out as frequently as can be expected. In this study, non-native-speaking immigrant mothers' experiences of participating in screening for PPD in the Swedish Child Health Services were elucidated. Thirteen qualitative interviews were performed with the help of an interpreter and analysed using latent content analysis. The possibility to participate in screening was appreciated by the mothers even though the concept of PPD in general was unclear. Cultural beliefs about mental ill health, negative expectations connected to their perceived value as a woman, shame at not being grateful enough for their new life and negative experience of the interaction during the screening challenged them in speaking about their mood. To facilitate the screening procedure for this vulnerable group of mothers, it is important to be aware of possible challenges when speaking about their mood and to strive for a trusting clinical interview with the assistance of a female interpreter on-site.

Sociodemographic Characteristics and Health Profile of the Elderly Seeking Health Care in Kampala, Uganda.

Aging entails health challenges globally, but pertinent data from low-income countries like Uganda remains scarce. A cross-sectional study was carried out at Mulago National Referral Hospital in Kampala, among 134 patients (38% men and 62% women) aged ≥60 years. Data was collected on sociodemographic characteristics, medical disorders, cognitive function, hearing handicap, and functional status, that is, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL). The participants had high independency in BADL (89%) and IADL (75%). The most common medical conditions were bone/joint pain (35%), hypertension (24%), and visual problems (20%). More women (54%) than men (37%) reported bone and joint pain. The majority (80%) of the participants did not report any hearing handicap, and half (54%) did not have any cognitive impairment. Dependency in IADL was associated with advanced age, being female, and being financially dependent, and the risk of having a hearing handicap was higher among those above the median age (68 years). In adjusted models, the effects remained similar although statistical significance was only achieved for advanced age versus dependency in IADL (RR: 2.38, 95% CI: 1.12-5.08) and hearing handicap (RR: 2.67, 95% CI: 1.17-6.12). Thus, socioeconomic status and gender are relevant aspects when attempting to understand the health profile of the elderly in Kampala, Uganda.

Cervical cancer risk perceptions, sexual risk behaviors and sexually transmitted infections among Bivalent Human Papillomavirus vaccinated and non-vaccinated young women in Uganda - 5 year follow up study.

BACKGROUND: Previous studies were conflicting regarding the associations between HPV vaccination, cervical cancer risk perceptions, high-risk sexual behaviors and STIs. This study compared the HPV-vaccinated and non-vaccinated young women in Uganda regarding cervical cancer risk perceptions, high-risk sexual behaviors, syphilis and HIV infections 5 years after vaccine implementation. METHODS: This was a population-based comparative cross-sectional survey conducted in Uganda. The 438 participants were sexually active young women aged 15-24 years and mean age was 18.6 (SD 1.4). The majority (53.0%) were HPV-vaccinated in 2008 without assessment of sexual activity prior to HPV vaccination. Upon verbal assessment of sexual activity at the time of follow-up, data were collected using a questionnaire and laboratory testing of blood samples for syphilis and HIV infections. RESULTS: There were no significant differences between the HPV-vaccinated and non-vaccinated groups regarding the prevalence of high-risk sexual behaviors, syphilis and HIV infections. Cervical cancer risk perceptions and age at sexual debut were nonetheless significantly lower among the vaccinated group compared to their non-vaccinated counterparts. However, HPV vaccination was not significantly associated to cervical cancer risk perceptions and early age at sexual debut in multivariate logistic regression analysis. CONCLUSIONS: We found no associations between HPV vaccination, cervical cancer risk perceptions, high-risk sexual behaviors, syphilis and HIV infections among young women in Uganda 5 years after vaccine implementation. Young girls in the study population were found to be sexually active at a young age, affirming the importance of targeting girls of younger age for HPV vaccination.

'There's something in their eyes' - Child Health Services nurses' experiences of identifying signs of postpartum depression in non-Swedish-speaking immigrant mothers.

BACKGROUND: Due to the current world situation, Sweden has one of the highest asylum applications within the European Union. Immigrant mothers, specifically those who have immigrated during the last ten years and do not speak the language of the new country, are found to be at particular risk of being effected by postpartum depression. AIM: In this study, we elucidate Swedish Child Health Services nurses' experiences of identifying signs of postpartum depression in non-Swedish-speaking immigrant mothers. METHODS: Latent content analysis was used when analysing data material from 13 research interviews. RESULTS: Being able to interpret a non-Swedish-speaking immigrant mother's mood required establishing and constant deepening of a transcultural caring relationship, the use of cultural knowledge to perceive signs of postpartum depression from observations and interactions and to rely on intuition. CONCLUSION: There are both challenges and key factors for success in interpreting the mood of non-Swedish-speaking immigrant mothers. IMPLICATIONS: This study provides information to healthcare professionals about challenges with adapting the screening with the Edinburgh Postnatal Depression Scale to immigrant mothers not speaking the language of residence. Tacit knowledge and cultural competence among healthcare personnel are invaluable assets when interpreting mental health in this vulnerable group of mothers.

Significantly Reduced Genoprevalence of Vaccine-Type HPV-16/18 Infections among Vaccinated Compared to Non-Vaccinated Young Women 5.5 Years after a Bivalent HPV-16/18 Vaccine (Cervarix®) Pilot Project in Uganda.

The objective of this study was to determine the prevalence and some predictors for vaccine and non-vaccine types of HPV infections among bivalent HPV vaccinated and non-vaccinated young women in Uganda. This was a comparative cross sectional study 5.5 years after a bivalent HPV 16/18 vaccination (Cervarix®, GlaxoSmithKline, Belgium) pilot project in western Uganda. Cervical swabs were collected between July 2014-August 2014 and analyzed with a HPV genotyping test, CLART® HPV2 assay (Genomica, Madrid Spain) which is based on PCR followed by microarray for determination of genotype. Blood samples were also tested for HIV and syphilis infections as well as CD4 and CD8 lymphocyte levels. The age range of the participants was 15-24 years and mean age was 18.6(SD 1.4). Vaccine-type HPV-16/18 strains were significantly less prevalent among vaccinated women compared to non-vaccinated women (0.5% vs 5.6%, p 0.006, OR 95% CI 0.08(0.01-0.64). At type-specific level, significant difference was observed for HPV16 only. Other STIs (HIV/syphilis) were important risk factors for HPV infections including both vaccine types and non-vaccine types. In addition, for non-vaccine HPV types, living in an urban area, having a low BMI, low CD4 count and having had a high number of life time sexual partners were also significant risk factors. Our data concurs with the existing literature from other parts of the world regarding the effectiveness of bivalent HPV-16/18 vaccine in reducing the prevalence of HPV infections particularly vaccine HPV- 16/18 strains among vaccinated women. This study reinforces the recommendation to vaccinate young girls before sexual debut and integrate other STI particularly HIV and syphilis interventions into HPV vaccination packages.

Beliefs, perceptions and health-seeking behaviours in relation to cervical cancer: a qualitative study among women in Uganda following completion of an HPV vaccination campaign.

BACKGROUND: Cervical cancer remains a leading cause of morbidity and mortality in Uganda. Despite earlier information campaigns to introduce human papilloma virus (HPV) vaccination, which also targeted cervical cancer, misinterpretation and misunderstanding of the subject remain high. Women in Uganda present with cervical cancer at an advanced stage due to poor health-seeking behaviours, with an associated high mortality rate. This project explored beliefs, attitudes, perceptions, and health-seeking behaviours in relation to cervical cancer among women in Uganda after an HPV vaccination project had been rolled out. DESIGN: A qualitative study design was used, with six focus group discussions (FGDs) that included 36 women, aged 25-49 years, with no previous history of cervical cancer symptoms or diagnosis. The women were interviewed in February and March 2013. The transcribed data was analysed using content analysis. RESULTS: Three themes emerged: feeling unprotected and unsafe, misbelief and wondering about cervical cancer, and fear of the testing procedure. Participating women had heard of cervical cancer but preferred to wait to access cervical cancer screening until symptom debut. CONCLUSIONS: There are still barriers to cervical cancer screening among women in Uganda, where there is a need for culture-specific, sensitive information and interventions to address the issues of improving the cervical cancer screening uptake among these women. Societal context needs to be taken into account when implementing community-based health education.

Knowledge and Attitudes Toward Mandatory Premarital Screening Among University Students in North Jordan.

A mandatory National Premarital Thalassemia Screening Program was implemented in Jordan in 2004. This cross-sectional study aimed to assess the knowledge and attitudes of university students in North Jordan toward this program. Data was collected from 542 students from four universities (two public and two private universities) located in North Jordan, using a structured questionnaire. Results of t-test and analysis of variance (ANOVA) showed that while respondents had adequate knowledge of and positive attitudes toward the premarital screening program, there was still a lack of knowledge about the disease itself. Nearly half the respondents were under the impression that ß-thalassemia (ß-thal) is a disease that can be treated simply. One-third of the respondents believed that if both partners were carriers of ß-thal they should proceed with marriage. Negative attitude was revealed when many respondents believed that diagnosing a family member as a carrier affects other family members' future marriage opportunities. Significant associations were detected between the knowledge scores and gender, urban/rural residence, and the university where the students were enrolled. Students in private universities showed significantly lower attitude scores. Consideration of prenatal diagnostic services as part of a ß-thal prevention program is necessary. It would also be helpful to include information about ß-thal as a preventable inherited illness with a severe debilitating impact on the family in the high school curriculum. There is also a need for social marketing of the program.

Perceived and Ideal Body Image in Young Women in South Western Saudi Arabia.

OBJECTIVES: The aim of this study was to investigate perceived and ideal body image (BI) and associated factors among female university students in Saudi Arabia. METHODS: This cross-sectional study included 663 university female students. Anthropometric measurements including weight, height, BMI, and BI perception (the 9-figure silhouette) were obtained. Descriptive and logistic regression analysis were conducted. RESULTS: An agreement between actual, perceived, and ideal BI was found in 23% of the participants. Behavioral (activity levels), social (presence of obese parents and fathers' level of education), and economic factors (households' monthly income, number of cars in the household, and kind of residence) were positively and significantly associated with the desire to be thinner. Similarly, socioeconomic associations (number of sisters and number of cars in the household) correlated positively and significantly with the desire to be heavier. CONCLUSIONS: The whole family should rather be considered in interventions related to appearance concerns and BI discrepancies. Furthermore, campaigns targeting improvement of adolescents' physical self-image should be a major priority of the public health sector.

Integration of HIV and cervical cancer screening perceptions and preferences of communities in Uganda.

BACKGROUND: Despite the fact that HIV-positive women carry an increased risk of developing cervical cancer (CC) in comparison with HIV-negative women, HIV and CC screening programs in many developing countries have remained unintegrated. The objective of this study is to explore perceptions and preferences of community members in Uganda, including women, men, and village health teams, regarding the integration of HIV and CC screening services in a single-visit approach. METHODS: This qualitative study was conducted in three districts in Uganda. Data were collected through focus group discussions with women and village health teams, and individual interviews with men. Respondents were purposely selected from among those linked to three CC clinics in the three districts. The content analysis method was used to analyze the data. RESULTS: Three themes emerged from the data, namely appreciating the benefits of integration, worrying about the challenges of integration, and preferences for integration. The women endorsed the benefits. However, there were worries that integration would prolong the waiting time at the health facility and induce tiredness in both the healthcare providers and the women. There were also fears of being found positive for both HIV and CC and the consequences such as stress, self-isolation, and social conflicts. Participants, particularly the women, considered the challenges of screening integration to be manageable by, for example, taking a day off work to visit the hospital, delegating house chores to other family members, or taking a packed lunch on visiting the hospital. CONCLUSIONS: The community members in Uganda perceive the benefits of HIV and CC screening integration to outweigh the challenges, and expect that the challenges can be minimized or managed by the women. Therefore, when considering HIV and CC screening integration, it is important to not only recognize the benefits but also take into consideration the perceived challenges and preferences of community members.

Knowledge and Perceptions about Colorectal Cancer in Jordan.

BACKGROUND: Colorectal cancer (CRC) is the third most common cancer globally. In Jordan, it is the number one cancer among men and the second most common cancer among women, accounting for 15% and 9.4% respectively of all male and female diagnosed cancers. This study aimed to evaluate the knowledge and perceptions about colorectal cancer risk factors, signs and symptoms in Jordan and to provide useful data about the best modes of disseminating preventive messages about the disease. MATERIALS AND METHODS: A stratified clustered random sampling technique was used to recruit 300 males and 300 females aged 30 to 65 years without a previous history of CRC from four governorates in Jordan. A semi-structured questionnaire and face to face interviews were employed. Descriptive and multivariate analysis was applied to assess knowledge and perceptions about CRC. RESULTS: Both males and females perceived their CRC risk to be low. They had low knowledge scores about CRC with no significant gender association (P= 0.47). From a maximum knowledge score of 18 points, the median scores of males and females were 4 points (SD = 2.346, range 0-13) and 4 points (SD= 2.329, range 0-11) respectively. Better knowledge scores were associated with governorate, higher educational level, older age, higher income, having a chronic disease, having a family history of CRC, previously knowing someone who had CRC and their doctor's knowledge about their family history of CRC. CONCLUSIONS: There is a low level of knowledge about CRC and underestimation of risk among the study participants. This underlines the need for public health interventions to create awareness about the illness. It also calls for further research to assess the knowledge and perceptions about CRC early detection examinations in Jordan.

Prevalence and association of female weight status and dietary habits with sociodemographic factors: a cross-sectional study in Saudi Arabia.

OBJECTIVE: Research about the prevalence of underweight and overweight/obesity in the Saudi Arabian female population is limited. The aim of the present study was to examine the dietary habits and the prevalence of underweight and overweight/obesity and associated factors among female university students. DESIGN: A cross-sectional study. SETTING: A university centre for female students in south-western Saudi Arabia. SUBJECTS: The study involved 663 randomly selected female university students who self-reported their physical activities, nutritional habits and socio-economic factors. Multiple linear and logistic regression analyses were used to identify factors associated with the students' BMI, dietary variables, underweight and overweight/obesity. RESULTS: The majority of the university females were normal weight (56.9%), but a high prevalence of underweight (19.2%) and overweight/obesity (23.8%) occurred. Social factors significantly associated with BMI were the presence of obese parents and siblings as well as physical activity levels, marital status, number of sisters, father's level of education and more frequent intake of French fries/potato chips (>3 times/week). Several variables were found to correlate with dietary habits, underweight and overweight/obesity. Of special interest is the association between the number of siblings and the participants' BMI and dietary intake in both negative and positive ways. CONCLUSIONS: The findings of this research have implications for health promotion and prevention of malnutrition among college-aged females. Health-care providers and policy makers need to involve the whole family when promoting females' physical activity. The study serves as an evidence-based background for planning and implementation of interventions targeting improvement of highly educated populations' nutritional habits.

Nurses' views and experiences of caring for malnourished patients in surgical settings in Saudi Arabia - a qualitative study.

BACKGROUND: Although the occurrence of malnutrition in hospitals is a growing concern, little is known about how hospital staff understand the care that nurses provide to patients with malnutrition. The purpose of this study was to explore nurses' views and experiences of caring for malnourished patients in Saudi Arabia (KSA). METHODS: Using a qualitative explorative design, fifteen nurses were interviewed as part of a purposive sample hospital staff. The transcripts were analyzed using latent content analysis. RESULTS: The nurses spontaneously and consistently linked malnutrition with physical inactivity. The two main categories, which emerged, were: 'Potentials for nurses to provide good nutrition and physical activity', and 'Having the ability but not the power to promote proper nutrition and physical activity'. These arose from the subcategories: Good nursing implies providing appropriate health education; Acknowledging the Mourafiq (sitter) as a potential resource for the nursing, but also as a burden; Inadequate control and lack of influence; Cultural diversity and lack of dialog; and Views of women's weight gain in KSA society. CONCLUSIONS: The nurses felt they have the capacity and passion to further improve the nutrition and activity of their patients, but obstacles in the health care system are impeding these ambitions. The implications for nursing practice could be acknowledgement of the nurses' views in the clinical practice; culturally adjusted care, improved communication and enhanced language skills.

Integration of HIV and cervical cancer screening perceptions of healthcare providers and policy makers in Uganda.

BACKGROUND: HIV-positive women have an increased risk of developing cervical cancer (CC) compared to the HIV-negative women. Despite this, HIV and CC screening programs in many developing countries have remained disintegrated. Therefore, the objective of the study was to explore perceptions of healthcare providers (HCP) and policy makers (PM) about integration of HIV and CC screening services in Uganda. METHODS: This was a qualitative study conducted among 16 participants comprising of 12 healthcare providers and 4 policy makers in Uganda. Data were collected through individual interviews. Participants were purposively selected from different level of health facilities with clinics for HIV and CC screening services. Content analysis method was used to analyze the data. RESULTS: Three themes emerged from the data, namely appreciating benefits of integration, worrying about the limited health system capacity and potential consequences of integration and feeling optimistic about integration under improved health system conditions. The benefits embraced the women - particularly the HIV-positive women- but also men, healthcare providers and the health system or the government. There were worries that HIV stigma and shortage of healthcare workers would affect the effective delivery of the integrated program. CONCLUSION: Integration of HIV and CC screening can offer manifold benefits to all stakeholders in the health system, more so to the women. However, its feasibility in developing countries such as Uganda will most likely be hampered by weak and inefficient health systems. Therefore, when considering HIV and CC screening integration, it is important not to only recognize the benefits but also take into account resources requirements for addressing the existing weaknesses and inefficiencies in the health systems such as limited infrastructure, insufficient drugs and supplies, inadequate and poorly motivated healthcare workers.

Home visits to improve breast health knowledge and screening practices in a less privileged area in Jordan.

BACKGROUND: Breast cancer is the most common cancer afflicting women in Jordan. This study aimed to assess the effects of an educational intervention through home visits, including offering free mammography screening vouchers, on changing women's breast health knowledge and screening practices for early detection of breast cancer in a less privileged area in Jordan. METHODS: Two thousand four hundred breast health awareness home visits were conducted and 2363 women aged 20-79 years (median: 41) answered a pre-test interview-administrated questionnaire to assess their breast health knowledge and practices at the baseline. After a home-based educational session, 625 women aged 40 years or older were referred to free mammography screening. Five hundred and ninety six homes were revisited six months later and out of these 593 women participated in a post-test. The women's retained breast health knowledge, the changes in their reported breast health practices and their usage of the free mammography voucher, were assessed. RESULTS: The mean knowledge score increased significantly (p < 0.001) from 11.4 in the pre-test to 15.7 in the post-test (maximum score: 16). At the six month follow-up the post-test showed significant (p < 0.001) improvement in women's perceived breast self-examination (BSE) knowledge, reported BSE practice and mammography screening. Out of 625 women that received a voucher for free mammography screening 73% attended the mammography unit, while only two women without a voucher went for mammography screening at the assigned unit. Women who received a follow-up visit were more likely to use the free mammography voucher compared to those who were not followed-up (83% vs. 67%; p < 0.001). CONCLUSIONS: Home visits by local community outreach workers that incorporated education about breast cancer and breast health in addition to offering free mammography screening vouchers were effective in improving women's breast health knowledge and practices in a less privileged area in Jordan.