SAFE: an eHealth intervention for women experiencing intimate partner violence - study protocol for a randomized controlled trial, process evaluation and open feasibility study.

BACKGROUND: Intimate partner violence (IPV) affects almost one in three women worldwide. However, disclosing violence or seeking help is difficult for affected women. eHealth may represent an effective alternative to the standard support offers, which often require face-to-face interaction, because of easy accessibility and possibility of anonymous usage. In the Netherlands we are developing SAFE, an eHealth intervention for female victims of IPV, which will be evaluated in a randomized controlled trial and a process evaluation, followed by an open feasibility study to assess real-world user data. METHODS/DESIGN: The randomized controlled trial is a two-arm parallel design comparing an intervention arm and a control group. The groups both have access to eHealth but differ in the offer of interactive features compared to static information. Both groups complete questionnaires at three or four time points (baseline, three months, six months, 12 months) with self-efficacy at 6 months as the primary outcome, measured with the General Self-Efficacy (GSE) scale. The process evaluation consists of quantitative data (from the website and from web evaluation questionnaires) and qualitative data (from interviews) on how the website was used and the users' experiences. DISCUSSION: eHealth has the potential to reach a large number of women who experience IPV. The internet-based design can lower access barriers and encourage help-seeking behavior ultimately reducing the lag time between subjective awareness and protective action. TRIAL REGISTRATION: Trial registered on 15 August 2017 at the Netherlands Trial Register NL7108 (NTR7313).

Factors underlying diagnostic delay in tuberculosis patients in a rural area in Tanzania: a qualitative approach.

BACKGROUND: Diagnostic delay in patients with tuberculosis (TB) leads to ongoing TB transmission, higher mortality rates and increased patient and government health expenditure. Qualitative research focussed on patients' self-perceptions of disease and their care-seeking behaviour helps to guide health education programmes by providing us with the understanding of the knowledge, attitudes and practices that underlie diagnostic delay. PATIENTS AND METHODS: Semi-structured interviews with 28 recently diagnosed TB patients and four traditional healers were conducted. The interviews were audio-recorded and content analysis was performed. RESULTS: The median total delay was 188 days. The health provider delay (31 days) was longer than the patient delay (21 days) and the health system delay (26 days). The health system delay was longest in patients not being diagnosed at their first hospital visit and subsequently visiting other health care providers, mostly traditional healers. CONCLUSIONS: A poor knowledge of TB signs and symptoms and patients' beliefs about curses as the origin of diseases lead to delayed care-seeking at the hospital level in an area of North-Western Tanzania. Failure to identify TB cases by formal and non-formal health providers indicates that the education of both communities as well as health workers is essential in order to reduce diagnostic delays.

Bed death and other Lesbian sexual problems unraveled: a qualitative study of the sexual health of Lesbian women involved in a relationship.

OBJECTIVES: To shed light on lesbian "bed death" among lesbian women. To explore the wishes and expectations of lesbian women with respect to healthcare professionals. METHODS: Semi-structured interviews with 30 self-identified lesbian women. The interviews were audio recorded. Three researchers classified and analyzed the most important themes. RESULTS: The women indicated few sexual problems except for "bed death," a quasi-complete cessation of sexual activity. Twenty-three women experienced "bed death: during the current relationship or a previous one. The factors felt by the women to contribute to "bed death: were environmental influences, the existence of a symbiotic relationship, hormonal factors, and reduced sexual initiative. The women indicated that they would like family doctors to adopt a neutral attitude, be knowledgeable about homosexuality, and be able to recognize homosexuality in their patients. DISCUSSION: A careful examination of the potential causes of "bed death" suggests that the phenomenon is more closely linked to a patient's gender than to her sexual orientation. Lesbian women would also like general practitioners to possess at least some basic knowledge about homosexuality.