Problems and Barriers Related to the Use of mHealth Apps From the Perspective of Patients: Focus Group and Interview Study.

BACKGROUND: Since fall 2020, mobile health (mHealth) apps have become an integral part of the German health care system. The belief that mHealth apps have the potential to make the health care system more efficient, close gaps in care, and improve the economic outcomes related to health is unwavering and already partially confirmed. Nevertheless, problems and barriers in the context of mHealth apps usually remain unconsidered. OBJECTIVE: The focus groups and interviews conducted in this study aim to shed light on problems and barriers in the context of mHealth apps from the perspective of patients. METHODS: Guided focus groups and individual interviews were conducted with patients with a disease for which an approved mHealth app was available at the time of the interviews. Participants were recruited via self-help groups. The interviews were recorded, transcribed, and subjected to a qualitative content analysis. The content analysis was based on 10 problem categories ("validity," "usability," "technology," "use and adherence," "data privacy and security," "patient-physician relationship," "knowledge and skills," "individuality," "implementation," and "costs") identified in a previously conducted scoping review. Participants were asked to fill out an additional questionnaire about their sociodemographic data and about their use of technology. RESULTS: A total of 38 patients were interviewed in 5 focus groups (3 onsite and 2 web-based) and 5 individual web-based interviews. The additional questionnaire was completed by 32 of the participants. Patients presented with a variety of different diseases, such as arthrosis, tinnitus, depression, or lung cancer. Overall, 16% (5/32) of the participants had already been prescribed an app. During the interviews, all 10 problem categories were discussed and considered important by patients. A myriad of problem manifestations could be identified for each category. This study shows that there are relevant problems and barriers in the context of mHealth apps from the perspective of patients, which warrant further attention. CONCLUSIONS: There are essentially 3 different areas of problems in the context of mHealth apps that could be addressed to improve care: quality of the respective mHealth app, its integration into health care, and the expandable digital literacy of patients.

Temporalities of peer support: the role of digital platforms in the 'living presents' of mental ill-health.

This paper considers matters of time in online mental health peer support. Significant evidence of the value of peer support exists, with new digital platforms emerging as part of the digitisation of mental health support. This paper draws from a project exploring the impact of digital platforms on peer support through interviews with users of a major UK-based online peer support platform. Drawing on Gilles Deleuze's concept of the 'living present', the paper highlights how notions of past, present and future operate as co-existing dimensions of the present. The analysis highlights how the immediacy of digital platforms elicits expectations of peer support being 'on tap', which creates challenges when support is not received synchronously. Unlike in-person support, digital platforms facilitate the archiving of support, which can (re)enter the present at any moment through asynchronous communication. Anticipations of the future feature as dimensions of the present in terms of feelings regarding when support may no longer be needed. The paper offers potential implications for social scientific understanding of digital peer support, which include valuable insight for mental health services designing and delivering digital peer support.

Exploration of clinical and ethical issues in an expanded newborn metabolic screening programme: a qualitative interview study of healthcare professionals in Hong Kong.

INTRODUCTION: The Newborn Screening Programme for Inborn Errors of Metabolism (NBSIEM) enables early intervention and prevents premature mortality. Residual dried bloodspots (rDBS) from the heel prick test are a valuable resource for research. However, there is minimal data regarding how stakeholders in Hong Kong view the retention and secondary use of rDBS. This study aimed to explore views of the NBSIEM and the factors associated with retention and secondary use of rDBS among healthcare professionals in Hong Kong. METHODS: Between August 2021 and January 2022, semi-structured interviews were conducted with 30 healthcare professionals in obstetrics, paediatrics, and chemical pathology. Key themes were identified through thematic analysis, including views towards the current NBSIEM and the retention and secondary use of rDBS. RESULTS: After implementation of the NBSIEM, participants observed fewer patients with acute decompensation due to undiagnosed inborn errors of metabolism. The most frequently cited clinical utilities were early detection and improved health outcomes. Barriers to rDBS storage and its secondary use included uncertain value and benefits, trust concerns, and consent issues. CONCLUSION: This study highlighted healthcare professionals' concerns about the NBSIEM and uncertainties regarding the handling or utilisation of rDBS. Policymakers should consider these concerns when establishing new guidelines.

Trans men and paternal pregnancy: experiences during the pregnancy-puerperal period. / Homem trans e gestação paterna: experiências durante o período gravídico-puerperal.

This study aims to analyze the experiences of a transgender man during the gestational-puerperal period and the perspective of obstetric nurses in training based on the dynamics and organization of obstetric healthcare in a hospital setting. This qualitative study is based on a case study approach, employing interviews and direct observations to collect data. The analysis was based on the theoretical and normative framework of the Nursing Process, the Theory of Caring, and the theoretical/critical perspective of transfeminism. The results are organized into six categories: Transgender man in the context of pregnancy, childbirth, and postpartum; partnership and parental dimensions; dilemmas faced by the pregnant couple; impressions recorded by the nursing professional; understanding of the case through a theoretical and epistemological lens; implications for healthcare professionals. We underscore the need to promote spaces for continuing education among healthcare professionals and to reformulate legislation in a way that enables the development of public policies based on respect for diversity and equitable care, recognizing the transgender population's specificities in the contexts of pregnancy, childbirth, and postpartum.

Este estudo objetiva analisar as experiências de um homem trans durante o período gravídico-puerperal e a perspectiva de enfermeiras obstetras em formação, a partir das dinâmicas e da organização dos cuidados de saúde obstétricos em ambiente hospitalar. Trata-se de um estudo de abordagem qualitativa, baseado em estudo de caso, em que utilizou entrevistas e observações diretas para a coleta das informações. A análise foi feita a partir do marco teórico e normativo do Processo de Enfermagem, da Teoria dos Cuidados e da perspectiva teórico/crítica do transfeminismo. Os resultados estão organizados em seis categorias: Homem trans em contexto de gestação, parto e puerpério; parceria e dimensões parentais; dilemas enfrentados pelo casal grávido; impressões registradas pela profissional de enfermagem; compreensão do caso sob a lente teórica e epistemológica; implicações para os profissionais da saúde. Destaca-se a necessidade de promover espaços de educação permanente junto aos profissionais da saúde e reformular legislações de maneira a viabilizar a elaboração de políticas públicas baseada no respeito à diversidade e cuidado equânime, reconhecendo as especificidades da população trans nos contextos da gestação, parto e puerpério.

Between choices and decisions. Genetics in homoparental families through surrogacy in Argentina. / Entre elecciones y decisiones. La genética en familias homoparentales por gestación por sustitución en Argentina.

Comprehensive access to medically assisted reproduction procedures and techniques in Argentina has been assured by National Law No. 26,862 since 2013. This Law does not include surrogacy procedures, and the lack of specific regulation shifts practices to a paralegal setting. In this context, planned parenthood by male couples through surrogacy is performed through actions that convey demands for access rights and active State policies. For these couples, the argument is that surrogacy is the only option to have a child with a genetic bond with at least one of the two parents and recognize both filiatory bonds. This work results from field work in progress with parents from the Province of Buenos Aires running this practice in Argentina. Based on in-depth interviews, we attempted to rebuild personal experiences and analyze the meanings that the narratives construct regarding their parenting, the biological connections in establishing or defining family relationships, and the importance of genetics in constructing and maintaining affiliations.

En Argentina desde 2013 existe la Ley Nacional 26.862 de acceso integral a los procedimientos y técnicas de reproducción médicamente asistida (TRA). Esta no incluye los procedimientos de gestación por sustitución (GS) y la ausencia de regulación específica mueve las prácticas a un escenario de paralegalidad. En este contexto, las paternidades planificadas por parejas de varones a través de GS se llevan adelante mediante acciones que vehiculizan demandas de derechos de acceso y políticas activas del Estado. Para estas parejas el argumento es que la GS representa la única opción para tener un/a hijo/a con vínculo genético con al menos uno de los dos padres y poder reconocer ambos vínculos filiatorios. El presente trabajo es el resultado de un trabajo de campo en proceso con padres de Buenos Aires que están llevando adelante esta práctica en Argentina. A partir de entrevistas en profundidad intentamos reconstruir las experiencias personales y analizar los sentidos que construyen las narrativas respecto de sus parentalidades, las conexiones biológicas en la creación o definición de los lazos familiares y analizamos la importancia de la genética en la construcción y mantenimiento de vínculos filiatorios.

Intersectionality and challenges in support for chest-feeding transgender men. / Desafios para o suporte à amamentação em homens transgêneros sob à luz da interseccionalidade.

This article tried, from an intersectional standpoint, to grasp the challenges experienced by health professionals and service users of human milk banks in provision of care for transgender men chestfeeding. This exploratory, descriptive qualitative study drew on interviews of six human milk bank staff, who had previously assisted trans men in relation to chestfeeding and two bisexual trans men, who chestfed. The data was treated by thematic analysis, supported by Atlas.ti software, version 9.0. Lacunas in the educational, institutional and management spheres, associated with personal and social issues, reproduce a pre-conceived normative model and disregard the special demands of providing chestfeeding care for the trans population. Cisheteronormativity and "professional supremacy" operate in personal, social and institutional respects to segregate transgender men in lactation support services. Intersectional analysis of these challenges affords an overall view of segregative factors and enables public policies to be introduced to promote social justice.

O objetivo deste artigo é apreender os desafios nas vivências dos usuários e profissionais de Banco de Leite Humano no atendimento a homens transgêneros no contexto da amamentação sob à luz da Interseccionalidade. Estudo qualitativo descritivo-exploratório a partir de entrevistas realizadas com seis profissionais do Banco de Leite Humano, que atenderam previamente homens trans no contexto de amamentação, e dois homens trans bissexuais, que amamentaram ao peito. Os dados foram tratados pela Análise Temática com auxílio do software Atlas.ti versão 9.0. Observam-se lacunas nas esferas educacionais, institucionais e na gestão, associadas a questões pessoais e sociais, que reproduzem um modelo pré-concebido normativo, desconsiderando as singularidades requeridas no atendimento à população trans no contexto da amamentação. A cisheteronormatividade e a supremacia do profissional operam em âmbitos pessoais, sociais e institucionais para a segregação de homens transgêneros nos serviços de suporte à amamentação. A análise interseccional destes desafios permite uma visão global dos fatores de segregação e a implementação de políticas públicas promotoras da justiça social.

Lesbian and bisexual couples experiencing dual motherhood: (dis)encounters in the provision of healthcare. / Casais de mulheres lésbicas e bissexuais que vivenciam a dupla maternidade: (des)encontros na produção do cuidado em saúde.

The bond with healthcare services is a crucial dimension in facilitating the maternal journey of lesbian and bisexual women couples. This study aimed to analyze the culturally constructed meanings regarding the bond with healthcare services and professionals by lesbian and bisexual women who experienced dual motherhood. It is a qualitative investigation grounded in interpretative anthropology. The research corpus was built based on in-depth interviews with 10 lesbian and bisexual women, aged 30 to 39 years. The results indicate that access to parenthood, until its realization, involved a journey permeated by satisfactions and sufferings triggered by failed attempts and gestational losses. Challenges experienced in healthcare provision were also reported due to prejudices, lack of empathy, and unpreparedness of professionals in dealing with prenatal care for lesbian and bisexual women couples. Manifestations of discrimination were more pronounced concerning non-gestational mothers. The findings offer insights into implementing policies that prioritize humanization and planning programs and healthcare services based on culturally sensitive care for lesbian and bisexual women couples as they transition into dual motherhood.

O vínculo com os serviços de saúde é uma dimensão crucial para viabilizar o projeto materno de casais de mulheres lésbicas e bissexuais. Este estudo teve como objetivo analisar os significados culturalmente construídos sobre o vínculo com os serviços e profissionais de saúde por mulheres lésbicas e bissexuais que vivenciaram a dupla maternidade. Investigação qualitativa fundamentada na antropologia interpretativa. O corpus de pesquisa foi construído com base em entrevista em profundidade com 10 mulheres de 30 a 39 anos. Os resultados mostram que o acesso à parentalidade implicou um itinerário permeado por satisfações e sofrimentos devido a tentativas frustradas e perdas gestacionais. Também foram relatados percalços vivenciados na produção do cuidado em saúde devido a preconceitos, falta de empatia e despreparo de profissionais para lidarem com acompanhamento de pré-natal aos casais de mulheres lésbicas/bissexuais. As manifestações de discriminação foram mais contundentes em relação às mães não gestantes. Os resultados oferecem subsídios para implementação de políticas de humanização e planejamento de programas e serviços de saúde baseados em cuidados culturalmente sensíveis à diversidade para casais de mulheres lésbicas/bissexuais que vivenciam a transição para a maternidade.

The overcoming of the monogamous family is through the community! Non-monogamous parenting of sex-gender-diverse people. / A superação à família monogâmica é pela coletividade! Parentalidades não-monogâmicas de pessoas sexo-gênero-diversas.

Sex-gender-diverse and non-monogamous strain cisnormativity and mononormativity. In scientific terms, the parenting arrangements of these people are uncertain. Thus, this ethnography aims to understand the perception of non-monogamous sex-gender-diverse people about parenting. The theoretical framework adopted is derived from non-monogamous studies, love and sexuality from the Social and Human Sciences in Public Health and the digital ethnography methodological framework. Fieldwork occurred from 2021 to 2022 through an online WhatsApp group. Participant observation was employed in the group, and semi-structured online interviews were held. Two categories emerged: a) The non-monogamous parenting nodes and b) Collective parenting. In the first, the importance of bonds in affective networks is explored, and the barriers to these family arrangements are exposed. The second describes the importance of living in a community, and Indigenous and Black ancestry is revived. The revived ancestry and ways of living in a community gain importance as we understand their relevance in the experience of parenting for sex-gender-diverse people who are non-monogamous.

Pessoas sexo-gênero-diversas e que são não-monogâmicas tensionam a cisnormatividade e a mononormatividade. Em termos científicos, há uma nebulosidade quanto aos arranjos parenterais dessas pessoas. Assim, esta etnografia objetiva compreender a percepção de pessoas sexo-gênero-diversas não-monogâmicas sobre parentalidades. O referencial teórico utilizado partiu dos estudos não-monogâmicos, amor e sexualidade das Ciências Sociais e Humanas em Saúde da Saúde Coletiva, e o metodológico da etnografia digital. O trabalho de campo ocorreu entre 2021 e 2022, em um grupo on-line do WhatsApp. A observação participante foi empregada no grupo e foram realizadas entrevistas on-line semiestruturadas. Emergiram duas categorias: a) Os nós das parentalidades não-monogâmicas e b) As parentalidades coletivas. Na primeira, se explora a importância do vínculo nas redes afetivas e expõe as barreiras desses arranjos familiares. Já na segunda, se descreve a importância do viver em comunidade, bem como o resgate à ancestralidade indígena e negra. O resgate à ancestralidade e às formas de se viver em comunidade ganham relevo à medida que se compreende a importância que estes possuem na vivência das parentalidades de pessoas sexo-gênero-diversas e que são não-monogâmicas.

"You only have one mother!": institutional violence in experiences of double motherhood in healthcare. / "Mãe é só uma!": violência institucional nas experiências de dupla maternidade na atenção à saúde.

The objective was to understand experiences of double motherhood during antenatal, childbirth and postpartum healthcare, using a qualitative method involving individual online interviews and asynchronous, online focus groups of cisgender women, mostly in same-sex relationships. The results revealed how these women's experiences of parenting were marginalised, highlighting institutional violence in Brazilian healthcare services, which are presented here in two thematic dimensions: 1) Cisheteronormativity and its impact on experiences of double motherhood; and 2) Institutional violence in healthcare services: from curiosity to LGBTQIA+phobia. It was concluded that cisheteronormativity hinders healthcare for these experiences, especially by rendering the non-gestational mother invisible. This underscores the urgent need to train healthcare personnel, rethink and challenge cisgender and heterosexual norms and promote inclusive policies to ensure equitable care and combat institutional violence.

Objetivou-se compreender as experiências de dupla maternidade na atenção à saúde durante o pré-natal, parto e puerpério a partir de um método qualitativo, utilizando entrevistas individuais on-line e grupo focal on-line assíncrono com mulheres cisgêneros, a maioria em relacionamentos homoafetivos. Os resultados revelaram a marginalização das vivências parentais dessas mulheres, destacando a violência institucional presente nos serviços de saúde brasileiros, sendo apresentados em dois eixos temáticos: 1) Cisheteronormatividade e seu impacto nas experiências de dupla maternidade e 2) Violência institucional nos serviços de saúde: da curiosidade à LGBTQIA+fobia. Conclui-se que a cisheteronormatividade prejudica a atenção à saúde para essas experiências, especialmente ao invisibilizar a mãe não gestante, destacando a urgência de capacitar profissionais de saúde, repensar e desafiar as normas cisgênero e heterossexuais e promover políticas inclusivas para garantir cuidados equitativos e combater a violência institucional.

Adherence to Covid-19 vaccination during the pandemic: the influence of fake news.

OBJECTIVES: to understand how fake news has influenced adherence to Covid-19 immunization, from the perspective of health professionals. METHODS: a qualitative, descriptive-exploratory study was conducted in Campo Grande - MS. Twenty nursing professionals working in vaccine rooms or managing immunobiologicals participated through semi-structured interviews. The interviews were audio-recorded, fully transcribed, and subjected to thematic content analysis. RESULTS: two categories emerged in which the professionals highlighted an increase in vaccine hesitancy among the population, influenced by fake news and denialist actions, which negatively interfered with the population's trust in vaccines and in the professionals administering them. FINAL CONSIDERATIONS: concerns about vaccine safety and denialist actions by authorities and media outlets can contribute to the phenomenon of non-vaccination. The valorization of science, the promotion of educational actions, and raising public awareness about immunization were presented as strategies to increase vaccine coverage.

[Hegemony in medical pluralism: articulations and relationships in care, a case study]. / Hegemonía en el pluralismo médico: articulaciones y relaciones en la atención, un estudio de caso.

This study aims to describe and analyze the medical pluralism and the type of hegemony-subordination relation between forms of care or knowledge in the treatment of a patient with glaucoma to show the articulatory and transactional process between several therapeutic resources and understand which structural elements shaped the treatment itinerary and option. This is a qualitative research that used a narrative case study. To reconstruct the narrative, a semi-structured interview was conducted based on a thematic script previously established by a set of a priori categories to later transcribe the data and perform hermeneutic triangulation. Results showed that the hegemony in medical pluralism was based on equivalence relations, so that the patient replaced the use of pharmacological drugs with alternative medicine treatments. However, the relational process of equivalence developed itself in a context of biomedical significance, in which the treatment or control of intraocular pressure configured the substitution premise. Thus, the processes that triggered the hegemonic relations were constituted by various social, cultural, and economic factors such as unemployment, social security, and gender, which played a fundamental role during the search for care.

Este estudio tiene como objetivo describir y analizar el pluralismo médico y el tipo de relaciones de hegemonía-subalternidad entre diversas formas o saberes de atención, que se desarrollaron en el itinerario terapéutico de una padeciente de glaucoma, para mostrar el proceso articulatorio y transaccional entre distintos recursos terapéuticos, así como comprender qué elementos estructurales configuraron el itinerario y la elección terapéutica. La investigación es cualitativa, un estudio de caso en el cual se utilizó el enfoque narrativo. Para la reconstrucción de la narrativa se realizó una entrevista semiestructurada, dirigida por una guía temática previamente determinada por un conjunto de categorías apriorísticas, para posteriormente transcribir la entrevista y realizar un proceso de triangulación hermenéutica. Los resultados mostraron, en este caso, que la hegemonía en el pluralismo médico se constituyó mediante relaciones de equivalencia, así, la padeciente sustituyó el uso de medicamentos farmacológicos por terapias de medicina alternativa, no obstante, el proceso relacional de equivalencia se desarrolló en un contexto de significación biomédica, en el cual tratar o controlar la presión intraocular fue la premisa del remplazo. Asimismo, los procesos que desencadenaron la presencia de relaciones hegemónicas se constituyeron por diversos factores sociales, culturales y económicos como el desempleo, la seguridad social y el género, que desempeñaron un papel fundamental durante la búsqueda de la atención y del cuidado.

Este estudo visa descrever e analisar o pluralismo médico e o tipo de relação de hegemonia-subalternidade entre diversas formas de atendimento ou conhecimentos, que ocorreram no tratamento de um paciente com glaucoma, com a finalidade de mostrar o processo articulatório e transacional entre diferentes recursos terapêuticos, bem como entender quais elementos estruturais moldaram o itinerário e a opção de tratamento. Trata-se de uma pesquisa qualitativa, que utilizou um estudo de caso com abordagem narrativa. Para a reconstrução da narrativa, foi realizada uma entrevista semiestruturada, com base em um roteiro temático previamente estabelecido por um conjunto de categorias a priori, para posteriormente transcrever os dados e realizar a triangulação hermenêutica. Os resultados mostraram que a hegemonia no pluralismo médico esteve baseada em relações de equivalência, de modo que o paciente substituiu o uso de medicamentos farmacológicos por tratamentos da medicina alternativa; no entanto, o processo relacional de equivalência desenvolveu-se em um contexto de significância biomédica, na qual o tratamento ou controle da pressão intraocular foi a premissa para a substituição. Desse modo, os processos que desencadearam a presença de relações hegemônicas foram constituídos por fatores sociais, culturais e econômicos diversos como desemprego, previdência social e gênero, os quais tiveram papel fundamental durante a busca por atendimento e cuidado.

Perspectives on Injectable HIV Pre-Exposure Prophylaxis: A Qualitative Study of Health Care Providers in the United States.

The introduction of injectable HIV pre-exposure prophylaxis (PrEP) has the potential to significantly change the biomedical HIV prevention landscape. However, effective implementation will require health care providers to adopt, prescribe, and administer injectable PrEP within clinical settings. This study qualitatively examined challenges and benefit of injectable PrEP implementation from the perspective of health care providers. From April to August 2022, we conducted 19 in-depth interviews with current PrEP-prescribing health care providers in New York State, including 3 physician assistants, 5 physicians, and 11 nurse practitioners. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed to report semantic-level themes regarding injectable PrEP implementation. More than half of participants (61%) were aware of injectable PrEP; only 21% had experience prescribing it. Qualitative findings highlighted five themes. Three themes represented implementation challenges, including speculative concerns about side effects, appointment compliance, and practical and logistical considerations. The remaining two themes described benefits of injectable PrEP relative to oral PrEP, which included greater convenience and enhanced privacy. Findings from this qualitative study make significant applied contributions to the sparse knowledge on health care provider perspectives of injectable PrEP post-US Food and Drug Administration approval and their concerns and considerations regarding implementation in real-world clinical settings.

Doxycycline as Postsexual Exposure Prophylaxis: Use, Acceptability, and Associated Sexual Health Behaviors Among a Multi-Site Sample of Clinical Trial Participants.

Doxycycline postexposure prophylaxis (doxy-PEP) reduces sexually transmitted infections (STIs) in men who have sex with men (MSM) and transgender women (TGW). In a clinical trial of doxy-PEP, we sought to assess acceptability, impact, and meaning of doxy-PEP use among MSM/TGW. We conducted semistructured, in-depth 1:1 interviews with MSM and TGW enrolled in the intervention arm of the Doxy-PEP study. We queried motivations for and meaning of use, attitudes, beliefs, adherence, effect on sexual behaviors, and partner, community, and structural factors related to use. We coded interview transcripts into content areas, followed by thematic analysis. We interviewed 44 participants (median age 38), 2% were TGW, 17% Black, 61% White, 30% Hispanic, and 45% persons with HIV. We identified three overarching themes. First, participants found doxy-PEP acceptable, and believed it was effective based on their history of STIs, easy to adhere to, and acceptable to sex partners. Second, doxy-PEP benefited their quality of life and mental health, offering "peace of mind" by reducing their anxiety about acquisition or unwitting transmission of STIs. Participants reported feeling more "in control" of preventing STIs, and positive about supporting their personal, partner, and community health. Third, impact on sexual behavior was variable, with most reporting no change or a brief initial change. Participants in a multi-site clinical trial of doxycycline for STI prevention perceived it to be efficacious, and that it provided quality-of-life benefits, including reduced anxiety and sense of control over sexual health. Doxy-PEP had limited impact on sexual behavior. Clinicaltrials.gov: NCT03980223.

Understanding Attitudes of Postpartum Cisgender Women Toward Integration of HIV Prevention Services into Routine Prenatal and Postpartum Sexual Health Discussions.

Oral pre-exposure prophylaxis (PrEP) is an effective, user-controlled method for HIV prevention. However, awareness, uptake, and adherence to PrEP remain low among cisgender women (CGW). The prenatal and postpartum periods present an opportunity for delivery of comprehensive sexual health services that include HIV prevention education and services. However, little is known about postpartum CGW's attitudes toward integration of HIV prevention education and services into obstetric care in the US. We conducted semistructured interviews with 20 postpartum CGW in the Bronx, NY from July to November 2022 to explore their experiences with prenatal and postpartum sexual health care, examine their attitudes toward integration of HIV prevention services into obstetric sexual health care, and identify components of future implementation strategies. Transcripts were analyzed thematically using a framework approach. Among CGW interviewed, fewer than half reported prior knowledge of PrEP. Ten participants preferred long-acting injectable PrEP relative to six who preferred daily oral PrEP. Most participants reported no discussion of sex with their provider during pregnancy, and when discussions occurred, they focused on permission or prohibition of sexual activity. Participants described a reliance on providers to lead prenatal sexual health discussions. Even when not perceived as personally relevant, most respondents valued education on HIV prevention and PrEP services. In the postpartum period, sexual health discussions were similarly limited despite participants describing complex experiential sexual health concerns. This study supports the potential for integration of HIV prevention education and services into routine prenatal and postpartum sexual health discussions in an area of high HIV prevalence in the US.

Validating the Effectiveness of the Patient-Centered Cancer Care Framework by Assessing the Impact of Work System Factors on Patient-Centered Care and Quality of Care: Interview Study With Newly Diagnosed Cancer Patients.

BACKGROUND: Patients with cancer who have recently been diagnosed have distinct requirements compared to cancer survivors. It is crucial to take into account their unique needs to ensure that they make informed decisions and are receptive to the care provided. OBJECTIVE: This study suggested a framework titled Effectiveness of Patient-Centered Cancer Care that considers the needs of newly diagnosed patients with cancer and related work system factors. This study investigated how work system factors influence the perceptions of patient-centered care, quality of care, and associated outcomes among newly diagnosed patients with cancer. Patient-centered care is defined in terms of workload and communication considerations, whereas the quality of care is assessed through indicators such as trust in physicians, satisfaction with care, and perceptions of technology. METHODS: This study used qualitative data collected through interviews with newly diagnosed patients with cancer (N=20) right after their first visits with their physicians. Thematic analysis was conducted to validate the 5 hypotheses of the framework, mapping the interactions among quality of care, patient-centered care, and work system factors. RESULTS: We found that workload and patient-centered communication impact the quality of care and that the work system elements impact the patient-centeredness (workload and communication) and the quality of care (trust in physicians, satisfaction with care, and perception of technology use). CONCLUSIONS: Qualitatively validating the proposed Effectiveness of Patient-Centered Cancer Care framework, this study demonstrated its efficacy in elucidating the interplay of various factors. The framework holds promise for informing interventions geared toward enhancing patients' experiences during their initial visits after diagnosis. There is a pressing need for heightened attention to the organizational design, patient processes, and collaborative efforts among diverse stakeholders and providers to optimize the overall patient experience.

Impact of COVID-19 on essential healthcare services at the primary healthcare level in Armenia: a qualitative study.

BACKGROUND: The COVID-19 pandemic has presented significant global healthcare challenges, particularly impacting the continuity of essential health services in low- and middle-income countries. This study investigates the impact of the COVID-19 pandemic on the utilization and provision of essential health services in Armenia. METHODS: We employed a conventional qualitative study design, conducting semi-structured in-depth interviews (n = 17) within public and private primary healthcare (PHC) facilities in Armenia in 2021. Our study participants encompassed physicians providing specialty services in PHC facilities (e.g. endocrinologists, gynecologists/obstetricians, and pediatricians), regular visitors to PHC facilities (e.g. adults with chronic diseases, parents of children), and policymakers. Thematic analysis was conducted, yielding five emergent categories: mobilization and organization of PHC services during COVID-19; PHC visits during COVID-19; worsening of chronic conditions due to the decline in PHC visits; problems with routine childhood vaccinations; and patient-provider communication challenges. RESULTS: The number of in-person visits to PHC facilities declined due to adaptations in service delivery, imposed lockdown measures, and the public's fear of visiting healthcare facilities. Maternal and child health services continued with no major disruptions. PHC providers deliberately limited the number of maternal and child visits to essential antenatal care, newborn screenings, and routine childhood immunizations. Still, children experienced some delays in vaccination administration. The pandemic resulted in a notable reduction in follow-up visits and monitoring of patients with chronic conditions, thereby exacerbating their chronic conditions. Phone calls were the primary method of patient-provider communication during the pandemic. CONCLUSIONS: The COVID-19 pandemic has had a profound impact on the delivery and utilization of essential healthcare services at PHC facilities, especially for those with chronic conditions who needed continuous care. Unified national-level guidance and technical capacity are needed to direct the provision of essential services at the PHC level, promote effective health communication, and implement digital platforms for the uninterrupted provision of essential care during public health emergencies.

Identifying mitigation strategies of comprehensive health centers against dust hazard: a qualitative study in Iran.

BACKGROUND: Exposure to dust can disrupt healthcare services and severely affect all activity domains of the health system. The aim of this study was to explore mitigation strategies for comprehensive health centers against dust hazard. METHOD: The present study was conducted using a qualitative design with a conventional content analysis approach in 2023. The participants in this study were managers and staff of comprehensive health centers and experts in health in disasters and emergencies in Kerman, Bam, Regan, and Ahvaz. Data were collected through interviews. Data collection continued until data saturation. The collected data were analyzed based on the steps proposed by Graneheim and Lundman. Participants' statements, after recording and transcribing, were categorized into semantic units. Data were analyzed by using MAXQDA software version 2020. RESULTS: The analysis of the data with 23 participants revealed 106 Codes, 13 sub- categories and 5 main categories including: (A) reducing the impact of dust hazards, (B) management functions, (C) empowerment and performance improvement, (D) maintaining and promoting safety, and (E) Inter-sectoral coordination to implement mitigation strategies. CONCLUSION: The findings showed that the mitigation strategies and solutions can be used by health policymakers and planners to reduce the impact of dust hazard, empower and motivate healthcare staff, develop training protocols to enhance risk perception of the staff and members of the community, create the necessary infrastructure for adoption of effective mitigation strategies in healthcare centers to create resilience and continue service delivery.

Exploring information needs among family caregivers of children with intellectual disability in a rural area of South Africa: a qualitative study.

BACKGROUND: Globally, families experience challenges caring for and raising children with intellectual disability (ID). Family caregivers in rural states are mostly known for lacking support resources, including information on understanding the care of ID. Lack of adequate information on understanding of ID compromises the provision of life-long care and support of the children with ID's physical, emotional, psychological and social developmental well-being. The study aimed to explore the information needs of family caregivers regarding the care of children with ID in rural areas of Limpopo Province, South Africa. METHODS: This qualitative explorative research conducted 16 in-depth individual interviews and one focus group discussion with ten family members. The participants shared their experiences of raising children with ID in rural communities. Inductive thematic analysis using Atlas Ti software categorised emerging themes and subthemes of this study from merged data sets on information needs regarding the care of children with ID among family caregivers. RESULTS: The findings highlighted the need for information regarding ID care among family caregivers raising children with ID in the home environment. The information challenges experienced by family caregivers include caring for the challenging behaviour of children with ID and available support resources and services for the children and their families. These challenges impact the care and support required to meet the developmental needs of children with ID. Furthermore, inadequate information on ID among family caregivers in rural communities with a lack of resources restricts the children from accessing required support services. CONCLUSIONS: Given the information challenges these families face on ID, the stakeholders must develop continuous training programmes that will equip, empower, and further monitor ID care and management among family caregivers to enhance care and the raising of children with dignity.

Access to family planning services and associated factors among young people in Lira city northern Uganda.

BACKGROUND: Access to family planning services among young people is crucial for reproductive health. This study explores the access and associated factors among young people in Lira City, Northern Uganda. METHODS AND MATERIALS: A mixed-methods study was conducted in March to April 2022. Quantitative data were collected using a structured questionnaire from 553 participants aged 15-24 years. Qualitative data were obtained through in-depth interviews and focus group discussions. Data analysis included univariate, bivariate, and multivariate analyses for quantitative data, while interpretative phenomenological analysis was used for qualitative data. RESULTS: Overall, 31.7% of the respondents had a good perceived access to family planning services, with 64.6% reporting perceived availability of FP methods. Challenges included lack of privacy (57.7%), fear of mistreatment (77.2%), and decision-making difficulties (66.2%). Among females, good perceived access to FP services was less likely among urban residents (AOR: 0.22, 95% CI: 0.09-0.53), Christian respondents (AOR: 0.51, 95% CI: 0.01-0.36), Muslim respondents (AOR: 0.07, 95% CI: 0.01-0.55) and respondents with poor attitude to FP services (AOR: 0.39, 95% CI: 0.24-0.64), but more likely among respondents with a sexual a partner (AOR: 4.48, 95% CI: 2.60-7.75). Among males, good perceived access to FP services was less likely among respondents living with parents (AOR: 0.19, 95% CI: 0.05-0.67) but more likely among respondents with good knowledge of FP services (AOR: 2.28, 95% CI: 1.02-5.32). Qualitative findings showed that three themes emerged; knowledge of family planning methods, beliefs about youth contraception and, friendliness of family planning services. CONCLUSION: The study revealed a substantial gap in perceived access to family planning services among young people in Lira City. Barriers include privacy concerns, fear of mistreatment, and decision-making difficulties. Tailored interventions addressing urban access, religious beliefs for females, and knowledge enhancement for males are essential. Positive aspects like diverse FP methods and physical accessibility provide a foundation for targeted interventions. Youth-friendly services, comprehensive sexual education, and further research are emphasized for a nuanced understanding and effective interventions in Northern Uganda.

A qualitative study of informal caregiver perceptions of the benefits of an early dementia diagnosis.

BACKGROUND: Current and former dementia policies in the United Kingdom (UK) recommend diagnosing dementia early, or as close to the onset of symptoms as possible. Informal caregivers play an important role in initiating the diagnostic process and providing support to people living with dementia. Therefore, this study aimed to explore caregiver perceptions of the benefits of an early diagnosis. METHODS: We conducted semi-structured interviews with 12 current and former informal caregivers to people with dementia in the UK in 2020. We analysed the interviews using thematic analysis. RESULTS: Benefits of an early diagnosis included: (1) protecting the person with dementia from financial or physical harm, (2) timely decision-making, and (3) access to services and treatments following a diagnosis. We identified three conditions necessary for the benefits of an early diagnosis to be felt: (1) adequate prognostic information, (2) someone to advocate on behalf of the person with dementia, and (3) a willingness to seek and accept the diagnosis. CONCLUSIONS: In this study, we identified how diagnosing dementia close to the onset of symptoms could be beneficial and the conditions necessary for these benefits to be felt. The findings highlight the importance of an early diagnosis for enabling people with dementia and caregivers to make practical arrangements and to access services. Further research is needed to build on the findings of this study by exploring the perspectives of people with dementia and by including a larger, more diverse sample of caregivers.