Uncovering communication strategies used in language-discordant consultations with people who are migrants: Qualitative interviews with healthcare providers.

BACKGROUND: Global migration has led to a sharp increase in the number of language-discordant consultations (LDCs) in healthcare. Evidence on how healthcare providers (HCPs) meet migrant patients' needs while mitigating language barriers is lacking. DESIGN: Using purposive and snowball sampling, we recruited twenty-seven Dutch HCPs (Mage = 45.07, SD = 11.46) and conducted semi-structured interviews to collect qualitative, open-ended data for identifying the communication strategies used with migrant patients in LDCs. We analysed the transcripts using deductive and inductive approaches (e.g., constant comparative method from Grounded Theory). Final pattern codes (i.e., key themes) were discussed among the research team until mutual agreement had been achieved. RESULTS: Five key themes emerged from the analyses: HCPs often 'got-by' with (1) instrumental and (2) affective communication strategies used in language-concordant consultations to start medical consultations. When some instrumental communication strategies were deemed ineffective (e.g., lingua franca, gesturing, etc.) to bridge language barriers, HCPs turned to (3) incorporating digital tools (e.g., Google Translate). When HCPs were unable to communicate with migrant patients at all, (4) informal, ad-hoc and professional interpreters were involved. Finally, HCPs often (5) involved additional support to engage migrant patients to engage in treatment-related behaviours. DISCUSSION AND CONCLUSIONS: Our results highlight the importance of raising awareness among HCPs about using various combinations of different strategies. The development of a guideline indicating the optimal combination of communication strategies for different medical consultation goals may be useful in reshaping the current communication behaviour of HCPs in LDCs. PATIENT OR PUBLIC CONTRIBUTION: HCPs were the study population involved in this qualitative study. Refugee health advisors, general practitioners and linguistic specialists (i.e., members of the Right2Health consortium) with experience with the Dutch healthcare system were involved throughout the development of this research. This includes a review of the research question, participant information sheet and interview topic guide as well as providing interpretations of the data and feedback to this manuscript.

Evaluating patient participation in value-based healthcare: Current state and lessons learned.

INTRODUCTION: Value-based healthcare (VBHC) focusses on increasing value for patients. Hospitals aim to implement VBHC via value improvement (VI) teams for medical conditions. To determine the patient's perspective on value, collective patient participation is important in these teams. We therefore evaluated the current state of patient participation in VI teams and share lessons learned. METHODS: This mixed-methods study was conducted at seven collaborating hospitals in the Netherlands. A questionnaire (the public and patient engagement evaluation tool) was tailored to the study's context, completed by VI team members (n = 147 from 76 different VI teams) and analysed with descriptive statistics. In addition, 30 semistructured interviews were held with VI team members and analysed through thematic analysis. Data were collected between February 2022 and January 2023 and were triangulated by mapping the quantitative results to the interview themes. RESULTS: Thirty-eight of the 76 included VI teams reported using a form of patient participation. Many respondents (71%) indicated a lack of a clear strategy and goal for patient participation. Multiple VI team members believed that specific knowledge and skills are required for patients to participate in a VI team, but this led to concerns regarding the representativeness of participating patients. Furthermore, while patients indicated that they experienced some level of hierarchy, they also stated that they did not feel restricted hereby. Lastly, patients were satisfied with their participation and felt like equal VI team members (100%), but they did mention a lack of feedback from the VI team on their input. CONCLUSION: The results imply the lack of full implementation of patient participation within VI teams. Guidelines should be developed that provide information on how to include a representative group of patients, which methods to use, how to evaluate the impact of patient participation, and how to give feedback to participating patients. PATIENT AND PUBLIC CONTRIBUTION: Two patient advisors were part of the research team and attended the research team meetings. They were involved as research partners in all phases of the study, including drafting the protocol (e.g., drafting interview guides and selecting the measurement instrument), interpreting the results and writing this article.

Sources of knowledge empowerment amongst pregnant women with TB disease: A qualitative study in South Africa.

BACKGROUND: Providing relevant knowledge to empower all pregnant women diagnosed and nondiagnosed with tuberculosis (TB) is essential worldwide. Proper dissemination of health information for pregnant women could assist in preventing TB complications amongst women and babies. The study aimed to describe the sources of knowledge that empower pregnant women diagnosed with TB and improve their quality of life in Limpopo Province, South Africa. METHODOLOGY: The study followed a qualitative, exploratory and descriptive research design. The study was conducted in 12 selected primary healthcare facilities in three crisis districts. Thirty-five pregnant women with TB disease were purposively selected, and face-to-face interviews were conducted to generate data, which were analysed using the thematic approach. Measures to ensure trustworthiness and ethical standards were adhered to. RESULTS: The findings of this study revealed that healthcare workers, community stakeholders, and TB ambassadors are the primary sources of knowledge dissemination for capacitating women diagnosed with TB. CONCLUSION: Most pregnant women lacked knowledge regarding TB ambassadors as sources of information for empowering women, community awareness campaigns, and Google searches as sources of information sharing. All stakeholders need to work together, considering the patients' charter for TB care that sets out the right for respect and information sharing. The emphasis of this study was on developing a comprehensive educational intervention that could assist in improving the quality of TB services offered to pregnant women.

Public participation in healthcare students' education: An umbrella review.

BACKGROUND: An often-hidden element in healthcare students' education is the pedagogy of public involvement, yet public participation can result in deep learning for students with positive impacts on the public who participate. OBJECTIVE: This article aimed to synthesize published literature reviews that described the impact of public participation in healthcare students' education. SEARCH STRATEGY: We searched MEDLINE, EMBASE, ERIC, PsychINFO, CINAHL, PubMed, JBI Database of Systematic Reviews and Implementation Reports, the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and the PROSPERO register for literature reviews on public participation in healthcare students' education. INCLUSION CRITERIA: Reviews published in the last 10 years were included if they described patient or public participation in healthcare students' education and reported the impacts on students, the public, curricula or healthcare systems. DATA EXTRACTION AND SYNTHESIS: Data were extracted using a predesigned data extraction form and narratively synthesized. MAIN RESULTS: Twenty reviews met our inclusion criteria reporting on outcomes related to students, the public, curriculum and future professional practice. DISCUSSION AND CONCLUSION: Our findings raise awareness of the benefits and challenges of public participation in healthcare students' education and may inform future research exploring how public participation can best be utilized in higher education. PATIENT OR PUBLIC CONTRIBUTION: This review was inspired by conversations with public healthcare consumers who saw value in public participation in healthcare students' education. Studies included involved public participants, providing a deeper understanding of the impacts of public participation in healthcare students' education.

Patient partner perspectives on compensation: Insights from the Canadian Patient Partner Survey.

INTRODUCTION: There is a growing role for patients, family members and caregivers as consultants, collaborators and partners in health system settings in Canada. However, compensation for this role is not systematized. When offered, it varies in both type (e.g., one-time honorarium, salary) and amount. Further, broad-based views of patient partners on compensation are still unknown. We aimed to describe the types and frequency of compensation patient partners have been offered and their attitudes towards compensation. METHODS: This study uses data from the Canadian Patient Partner Study (CPPS) survey. The survey gathered the experiences and perspectives of those who self-identified as patient partners working across the Canadian health system. Three questions were about compensation, asking what types of compensation participants had been offered, if they had ever refused compensation, and whether they felt adequately compensated. The latter two questions included open-text comments in addition to menu-based and scaled response options. Basic frequencies were performed for all questions and open-text comments were analyzed through inductive qualitative content analysis. RESULTS: A total of 603 individuals participated in the CPPS survey. Most respondents were never or rarely offered salary (81%), honorarium (64%), gift cards (80%) or material gifts (93%) while half were offered conference registration and expenses at least sometimes. A total of 129 (26%) of 499 respondents reported refusing compensation. Of 511 respondents, half felt adequately compensated always or often, and half only sometimes, rarely or never. Open-text comments revealed positive, ambivalent and negative attitudes towards compensation. Attitudes were framed by perceptions about their role, sentiments of giving back to the health system, feelings of acknowledgement, practical considerations, values of fairness and equity and accountability relationships. CONCLUSIONS: Our findings confirm that compensation is not standardized in Canada. Half of survey respondents routinely feel inadequately compensated. Patient partners have diverse views of what constitutes adequate compensation inclusive of personal considerations such as a preference for volunteering, and broader concerns such as promoting equity in patient partnership. Organizations should attempt to ensure that compensation practices are clear, transparent and attentive to patient partners' unique contexts. PATIENT CONTRIBUTION: Two patient partners are members of the CPPS research team and have been fully engaged in all study phases from project conception to knowledge translation. They are co-authors of this manuscript. The survey was co-designed and pilot tested with patient partners and survey participants were patient partners.

A Hybrid Type III Analysis of a Filmed Story-Telling Intervention's Impact on Provider Stigma.

Identity Development Evolution and Sharing (IDEAS) reduces provider stigma, but few have been trained to implement IDEAS, highlighting a need for implementation strategies that facilitate uptake. We evaluated whether external facilitation successfully supported IDEAS implementation and whether IDEAS reduced provider stigma within and across sites irrespective of implementation barriers and facilitators. Key informants from 10 sites completed interviews and surveys of appropriateness, acceptability, and feasibility. Interviews were analyzed using the Consolidated Framework for Implementation Research guidelines. Intervention effectiveness was measured via paired t tests of pre-/post-quantitative data on provider stigma completed by practitioners who attended the training. Ten sites successfully implemented IDEAS via external facilitation; 58 practitioners from nine sites completed pre- and post-surveys. Data showed significant decreases in stigma after the intervention. IDEAS, supported by external facilitation, is a feasible, acceptable, and appropriate means of reducing stigma among occupational therapy practitioners.

External Facilitation Supports the Successful Use of "Identity Development Evolution and Sharing" (IDEAS)­An Intervention That Effectively Reduces Harmful Biases Among Occupational TherapistsThis study is important for clinical managers and other change agents wishing to address provider biases in healthcare settings. The study expands an existing program for reducing healthcare provider bias called "Identity Development Evolution and Sharing" or "IDEAS." IDEAS is a program created by an occupational therapist who sought to improve healthcare experiences for those who have been harmed by implicit biases among healthcare providers. IDEAS involves watching filmed stories of people who have been harmed by stigma within healthcare and then having a reflective discussion about the film, creating a safe space in which providers can evaluate their biases and consider ways in which they might make positive changes. This study is important for managers and other change agents because it highlights characteristics of organizations that can both support and hinder the use of IDEAS in clinical settings. These factors can be taken into consideration prior to using an intervention such as IDEAS to support the degree to which an organization succeeds at implementing the program. This study also explains how the creator of IDEAS provides external support to facilitate staff in leading an IDEAS intervention. In addition, this study will be of interest to implementation scholars and/or people who would like to learn more about methods for measuring barriers and facilitators to integrating new programs in clinical settings.

Dr. Kadambini Ganguly (1861-1923): A Pioneer in Indian Medicine.

Dr. Kadambini Ganguly was a trailblazing Indian physician and social reformer. As one of the first female graduates and practitioners of Western medicine in India, she broke numerous barriers in a field dominated by men. Her contribution to medicine, particularly in women's healthcare, and her engagement in social reform through the Brahmo Samaj and the Indian National Congress, caused significant progress toward gender equality and social justice. This article looks back on her academic accomplishments, medical career, social activism, and lasting legacy, emphasizing her profound influence on medicine and society in India.

Approaches to improving mental healthcare for autistic people: systematic review.

BACKGROUND: Autistic people have a high likelihood of developing mental health difficulties but a low chance of receiving effective mental healthcare. Therefore, there is a need to identify and examine strategies to improve mental healthcare for autistic people. AIMS: To identify strategies that have been implemented to improve access, experiences of care and mental health outcomes for autistic adults, and to examine evidence on their acceptability, feasibility and effectiveness. METHOD: A co-produced systematic review was conducted. MEDLINE, PsycINFO, CINHAL, medRxiv and PsyArXiv were searched. We included all study designs reporting acceptability or feasibility outcomes and empirical quantitative study designs reporting effectiveness outcomes. Data were synthesised using a narrative approach. RESULTS: A total of 30 articles were identified. These included 16 studies of adapted mental health interventions, eight studies of service improvements and six studies of bespoke mental health interventions developed for autistic people. There was no conclusive evidence on effectiveness. However, most bespoke and adapted approaches appeared to be feasible and acceptable. Identified adaptations appeared to be acceptable and feasible, including increasing knowledge and detection of autism, providing environmental adjustments and communication accommodations, accommodating individual differences and modifying the structure and content of interventions. CONCLUSION: Many identified strategies are feasible and acceptable, and can be readily implemented in services with the potential to make mental healthcare more suitable for autistic people, but important research gaps remain. Future research should address these and investigate a co-produced package of service improvement measures.

Synergistic Strategies of Biomolecular Transport Technologies in Transdermal Healthcare Systems.

Transdermal healthcare systems have gained significant attention for their painless and convenient drug administration, as well as their ability to detect biomarkers promptly. However, the skin barrier limits the candidates of biomolecules that can be transported, and reliance on simple diffusion poses a bottleneck for personalized diagnosis and treatment. Consequently, recent advancements in transdermal transport technologies have evolved toward active methods based on external energy sources. Multiple combinations of these technologies have also shown promise for increasing therapeutic effectiveness and diagnostic accuracy as delivery efficiency is maximized. Furthermore, wearable healthcare platforms are being developed in diverse aspects for patient convenience, safety, and on-demand treatment. Herein, a comprehensive overview of active transdermal delivery technologies is provided, highlighting the combination-based diagnostics, therapeutics, and theragnostics, along with the latest trends in platform advancements. This offers insights into the potential applications of next-generation wearable transdermal medical devices for personalized autonomous healthcare.

Operational challenges and collaborative solutions in radiology image interpretation: perspectives from imaging departments in a low-resource setting.

INTRODUCTION: Medical imaging's critical role in diagnosis requires prompt and precise image interpretation. Numerous radiology departments, especially in low-resourced settings, encounter challenges such as a shortage of radiologists in their operational setup. This study explored the perceptions of radiographers and radiologists from low-resourced departments in a single country regarding operational challenges and potential solutions in image interpretation. METHODS: A qualitative approach was utilised, involving heads of departments, senior radiographers, and radiologists with a minimum of 5 years of experience, from three major state referral hospitals. Face-to-face, semi-structured interviews were conducted in November 2022, using an interview guide that included questions on the challenges encountered during image interpretation and the proposed solutions. Data analysis was conducted using Atlas.ti version 9.0, following the four-step content analysis method. All participants willingly provided consent to participate in the study. RESULTS: Ten participants, comprising two radiologists and eight radiographers participated in the study. The research identified three main themes: image interpretation pathways, image interpretation operational challenges and proposed solutions for image interpretation. In addition, a total of 10 subthemes were generated from the three main themes. CONCLUSION: The study revealed critical challenges and the need to explore the formal inclusion of radiographers in image interpretation, as a way to improve efficiency. However, a comprehensive assessment of the image interpretation system, encompassing radiographers' knowledge and competence, is recommended for context-specific, empirical-based modifications to enhance service provision.

The impact of targeted local outreach clinics to improve COVID-19 vaccine uptake: controlled interrupted time series in South West England.

BACKGROUND: Outreach clinics were part of efforts to maximise uptake in COVID-19 vaccination. METHODS: We used controlled interrupted time series, matching on age, sex, deprivation and vaccination eligibility date, to determine the effect of outreach clinics on time to first COVID-19 vaccine, using a population-based electronic health record database of 914,478 people, from December 2020 to December 2021; people living within 1 mile of each outreach clinics were exposed. RESULTS: 50% of 288,473 exposed citizens were white British, and 71% were aged 0-49 years. There was no evidence for an overall statistically significant increase in cumulative percentage vaccinated due to the outreach clinic at 6 weeks, with an overall pooled effect estimate of -0.07% (95% CI: -1.15%, 1.02%). The pooled estimate for increased cumulative vaccine uptake varied slightly depending on how the analysis was stratified; by ethnic group it was - 0.12% (95% CI: -0.90%, 0.66%); by age group it was - 0.06% (95% CI: -0.41%, 0.28%); and by deprivation it was 0.03% (95% CI: -0.74%, 0.79%). CONCLUSIONS: Living within a mile of an outreach clinic was not associated with higher vaccine uptake. Evaluation of future outreach clinics should consider the relative importance of travel amongst other barriers to accessing vaccines.

Perspectives from cystinosis: access to healthcare may be a confounding factor for variant classification.

Genetic variability persists across diverse populations, and it may impact the characterization of heritable diseases in different ancestral groups. Cystinosis is a metabolic disease caused by pathogenic variants in the CTNS gene causing the cellular accumulation of cystine. We attempted to assess the currently poorly characterized prevalence of cystinosis by employing a population genetics methodology. However, we encountered a significant challenge due to genetic variations across different populations, and the consideration of potential disparities in access to healthcare made our results inconclusive. Pathogenic CTNS variants were identified in a representative global population cohort using The Human Gene Mutation Database (HGMD) and the 1000 Genomes (1 KG) database. The c.124G>A (p.Val42Ile) variant was reported to be pathogenic based on an observation in the white population presenting with atypical phenotypes, but it would be reclassified as benign in the African ancestral group if applying the ACMG allele frequency guideline due to its high allele frequency specifically in this population. Inclusion or exclusion of this c.124G>A (p.Val42Ile) variant results in a significant change in estimated disease prevalence, which can impact the diagnosis and treatment of affected patients with a broad range of phenotypic presentations. This observation led us to postulate that pathogenic manifestations of the disease may be underdiagnosed due to variable expressivity and systemic inequities in access to care, specifically in the African subpopulation. We call for a more cautious and inclusive approach to achieve more equitable care across diverse populations.

Depression, Anxiety and Stress Symptoms among Afghan Healthcare Workers: A Cross-Sectional Analytical Study.

Background: Decades of conflict and cycles of disasters in Afghanistan have caused enormous impacts on health, the economy, and even national security. Objectives: We aimed to assess the levels of depression, anxiety, and stress symptoms and their determinants among Afghan healthcare workers. Methods: A cross-sectional study of 830 Afghan healthcare workers working in public and private hospitals was conducted between May and July 2021. We employed a non-probability sampling method to select our subjects. The questionnaire was composed of sections on sociodemographic information, working conditions, and Depression, Anxiety, and Stress Scale-21 (DASS-21). Multivariable linear regression models were fitted using SPSS 21 to identify determinants of mental health symptoms among Afghan healthcare workers at a 5% significance level. Results: Of all participants, 52.3% (435) had symptoms of depression, 48.8% (405) anxiety, and 46.9% (389) stress. The likelihood of mental health symptoms was higher among those who worked in an urban setting (P = 0.001), were physically inactive (P = <0.001), had a decrease in income or an unpaid salary in the past six months (P = <0.001), thinking of leaving Afghanistan (P = <0.001), had medical comorbidity (P = <0.001), and being single (P = 0.048)]. Conclusion: This study highlights the important findings about the psychological health of healthcare workers in Afghanistan. These findings suggest rapid, actionable, and locally relevant interventions to assure potential improvements in working and living conditions for the health staff.

Unleashing leadership potential in unprecedented times: Lessons learned from an evaluation of a virtual cohort-based adaptive leadership program for public health executives.

Objectives: This paper presents the evaluation results from the Adaptive Leadership Academy (ALA), a pilot program aimed at developing executive-level leaders in public and community health. Study design: Mixed methods study. Methods: The evaluation followed the Kirkpatrick Model to assess program participants' satisfaction with the training, knowledge and skill gain, and behavior change. Data were collected beginning in December 2021 through August 2022 from 20 program participants via online surveys and key informant interviews. Results: The findings indicated that ALA helped participants improve their leadership knowledge, skills, and capabilities. In particular, the study highlighted the effectiveness of cohort-based leadership development programs using adaptive leadership as the foundation for the curriculum. Participants found the cohort-based model and synchronous components particularly useful in creating a supportive environment in which to be vulnerable and grow. Conclusions: Overall, the evaluation provided evidence that the ALA pilot enhanced leadership knowledge, skills, and capabilities. The findings support the use of adaptive leadership as a framework for leadership development programs in the public health sector.

Perceptions and attitudes of health science students relating to artificial intelligence (AI): A scoping review.

Background and Aims: The recent integration of artificial intelligence (AI) across education, research, and clinical healthcare has led to a growing interest in AI training for healthcare students. This scoping review seeks to delve into existing literature, aiming to evaluate the perceptions and attitudes, of health science students toward the implementation of AI in their field. Methods: This review followed the methodological guidance offered by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). A systematic search was conducted in the databases Medline, Emcare, and Scopus. Studies using both quantitative and qualitative methodologies were eligible if they explored the perceptions or attitudes of health science students in relation to AI. Relevant data from eligible articles was extracted and analyzed using narrative synthesis. Results: Ten studies were included. Articles reported on the primary outcomes of perceptions (i.e., thoughts, ideas, satisfaction, etc.) and attitudes (i.e., beliefs, tendencies, etc.). Disciplines included nursing, diagnostic radiography, pharmacy, midwifery, occupational therapy, physiotherapy, and speech pathology were featured. Overall, students felt positively about the potential benefits AI would have on their future work. Students' interest and willingness to learn about AI was also favorable. Studies evaluating attitudes found positive correlations between attitudes toward AI, AI utilization, and intention to use AI. Negative perceptions related to threats of job security, and a lack of realism associated with AI software. Conclusion: Overall, evidence from this review indicates that health science students' worldwide hold positive perceptions toward AI. Educators should focus on instilling positive attitudes toward AI, given correlations between AI exposure and intention to adopt AI.

Autism-Friendly Healthcare: A Narrative Review of the Literature.

Disparities in healthcare access, delivery, and outcomes exist between autistic and non-autistic individuals. Autism-friendly healthcare initiatives aim to facilitate and improve the healthcare experience of autistic individuals by addressing commonly encountered challenges. While there is no consensus regarding the definition of autism-friendly healthcare, in this narrative review, we examine previously published research to determine the most important components of autism-friendly healthcare. Patient-related factors, provider-related factors, and system-related factors should be addressed. Proactivity, flexibility, and collaboration should guide the process of transforming the healthcare system. Finally, multiple strategies can be utilized as appropriate to the setting and individuals.

Literacy and Attitude Toward Suicide Among Doctors and Nurses: A Cross-Sectional Comparative Study.

Introduction Globally, suicide remains a major public health problem and is the second most common cause of death in the 15-45 years age group. Awareness about suicide and the attitude of healthcare professionals regarding suicide are crucial factors determining the care for suicidal behaviors. The present study aimed to compare suicide literacy and attitude toward suicide between doctors and nurses and to explore the association between suicide literacy and attitude toward suicide. Methods A cross-sectional comparison study was conducted between doctors and nurses in a tertiary healthcare center in southern India. The demographic characteristics and work and suicide care experience were recorded using a semi-structured proforma. Literacy of Suicide Scale - Short Form (LOSS-SF) and Attitude Toward Suicide Questionnaire (ATTS) were used to assess the awareness about suicidal behaviors and attitudes toward suicide, respectively. Appropriate statistical tests were used to compare the outcome measures between doctors and nurses with the statistical significance set at p ≤ 0.05. Results A total of 600 healthcare professionals (doctors (n=300) and nurses (n=300)) were included. The doctors were older, had longer work experience, and demonstrated better suicide literacy, yet harbored more negative attitudes toward suicide than nurses. Among doctors, increasing levels of suicide literacy were negatively correlated with positive attitudes toward suicide. Among nurses, increasing age was negatively correlated with healthy attitudes toward suicide. Conclusion Doctors had better awareness of suicidal behaviors yet displayed negative attitudes toward people with suicidal behaviors. Despite having less suicide awareness, nurses exhibited positive attitudes toward suicide. Suicide literacy and attitudes toward suicide can have complex relationships mediated by multiple factors.

Conceptualising the experiences of continuing professional development of young private sector audiologists as an attribute of andragogy.

Background: Continuing professional development (CPD) is an ongoing learning process that builds on initial training and education to improve competency. Low compliance rates of audiologists adhering to CPD have been reported by the Health Professions Council of South Africa. However, there is an absence of research on the uptake of CPD from the perspective of young audiologists working in the private sector. Aim: This study aimed to explore the experiences and views of young audiologists working in the private sector on continuing professional development. Setting: The study was conducted in KwaZulu-Natal province, South Africa. Methods: The descriptive, qualitative approach entailed conducting 11 online, semi-structured interviews with audiologists working in the private sector. Semi-structured interviews consisted of open-ended questions, and the qualitative data were thematically analysed. The adult learning theory, andragogy, was used as both the conceptual and analytical framework. Results: Five andragogy concepts were used to analyse the data, with eight sub-themes emerging related to: self-concept, adult learning experiences, readiness to learn, orientation to learning and internal motivation. Conclusion: The experiences of audiologists in the private sector on CPD aligned with the concepts of andragogy. Audiologists' experiences need to be taken into consideration during the planning and implementation of CPD for it to be relevant, effective and purposeful. Contribution: This study highlighted the experiences of audiologists on CPD working in the private sector with continuing professional development.

Beyond the curriculum: A gay medical student's perceptions of health sciences education and healthcare access in KwaZulu-Natal.

Background: The prevailing social constructs of cis-heteronormativity and endosexism have structurally marginalised sexual and gender minorities, leading to their limited representation and inclusion in mainstream health systems and health sciences education. Aim: The study aimed to explore a gay medical student's perceptions of the health sciences curriculum and their experiences in accessing and utilising healthcare services offered both by the university and externally. Setting: At a university in KwaZulu-Natal, South Africa. Methods: This study originates from a larger qualitative study conducted in 2018, involving 12 Lesbian, Gay, Bisexual, Transgender (LGBT)-identifying participants who were selected using purposive and snowball sampling techniques. The larger study used a case study approach to explore how healthcare services meet the sexual health needs of LGBT youth. Among the 12 sampled participants, one participant self-identified as 'gay' and was pursuing a Bachelor of Medicine and Bachelor of Surgery. This participant was specifically selected for analysis in this study because of their knowledge of health sciences education and pursuit of a career in healthcare. Results: Three themes were identified in the participant's interview, including: (1) navigating healthcare services as a young gay man, (2) silenced voices: the impact of the limited Lesbian, Gay, Bisexual, Transgender, Intersex, Queer, Asexual and + (LGBTIQA+) health education, and (3) challenging the silenced voices. Conclusion: There is a need for a well-planned curriculum that includes LGBTIQA+ issues to equip healthcare professionals with the knowledge to provide high-quality care to all patients, regardless of their sex, gender, or sexuality. Contribution: The study provides solid proposals for developing an inclusive healthcare curriculum that considers identities beyond binary going forward.

Income inequality and healthcare utilization of the older adults-based on a study in three provinces and six cities in China.

Purpose: The objective of this study is to gain a more nuanced understanding of the specific impact of income inequality on the utilization of healthcare services for older adults. Additionally, the study aims to elucidate the moderating and mediating roles of public transfer income and psychological health in this context. Methods: A systematic examination of the impact of income inequality on healthcare utilization among older adults was conducted through field questionnaire surveys in six cities across three major geographical regions (West, Central, and East). The analysis employed baseline regression, as well as mediating and moderating effect tests. Results: First, there is a negative relationship between income inequality and the use of therapeutic healthcare services (ß1 = -0.484, P < 0.01) and preventive healthcare services (ß2 = -0.576, P < 0.01) by older adults. This relationship is more pronounced in the low- and medium-income groups as well as in the western region. The mediating effect of psychological state is significant (ß3 = -0.331, P < 0.05, ß4 = -0.331, P < 0.05). Public transfer income plays a significant role in regulation. The moderating effect of public transfer income on therapeutic services was more significant in low-income groups (ß5 = 0.821, P < 0.01). The moderating effect of public transfer income on preventive services was more significant in middle-income groups (ß6 = 0.833, P < 0.01). Conclusion: The study clearly demonstrates a significant negative correlation between income inequality and the utilization of healthcare services by older adults. Furthermore, the study reveals that this relationship is particularly pronounced among older adults in low- and medium-income and Western regions. This detailed analysis of regional and income level heterogeneity is of particular value in this field of research. Secondly, this study attempts to integrate the two pivotal dimensions of public transfer income and psychological state for the first time, elucidating their moderating and mediating roles in this relationship. The findings indicate that public transfer income serves as a moderating factor, exerting a notable "reordering effect" on income inequality and resulting in a "deprivation effect." Such factors may impede the utilization of medical services, potentially influencing the psychological state of older adults.