Sleep and Happiness in Urban-Dwelling Older Adults in Ghana: A Serial Multiple Mediation Model of Generalized Anxiety and Depressive Symptoms.

OBJECTIVE: Sleep problems (SP) are highly prevalent and seriously affect health and well-being in old age. The aim of this study was to examine the association between SP and happiness in an urban-dwelling older sample. The authors further explore the effects of generalized anxiety and depressive symptoms in the SP-happiness link using serial mediating modeling. METHODS: Data came from the 2016 to 2018 Aging, Health, Psychological Well-being, and Health-seeking Behavior Study in Ghana (n = 661). The authors measured happiness with the cross-culturally validated item on a five-point scale. The GAD-7 and the CESD-8, respectively, assessed generalized anxiety and depressive symptoms. Participants reported nighttime and daytime SP in the last 30 days. The SPSS-based Hayes' PROCESS macro program (Model 6) was constructed to quantify the hypothesized mediation effect. RESULTS: The analysis included 661 adults aged greater than or equal to 50 years (mean age = 65.53 [SD] = 11.89 years; 65.20% women). After full adjustment, path models showed that SP was negatively associated with happiness (ß = -0.1277, 95%CI = -0.15950 to -0.096). Bootstrapping estimates revealed that the SP-happiness link was serially mediated via generalized anxiety representing 8.77%, depressive symptoms yielding 18.95%, and anxiety symptoms→depressive symptoms accounting for 26.70% of the total effect. CONCLUSION: Generalized anxiety and depressive symptoms may explain the negative association between SP and happiness in urban-dwelling older adults in the sub-Saharan African (SSA) context. Interventions, social and clinical, to improve happiness through sleep quality should include ways to improve mental health. Longitudinal and cross-cultural data are warranted to assess the bi-directionality of this relationship.

Mobility limitations and emotional dysfunction in old age: The moderating effects of physical activity and social ties.

BACKGROUND: This study aims to examine the association between mobility limitations and emotional dysfunction among older Ghanaians and evaluate the buffering effect of physical activity (PA) and social ties in this association. METHODS: The analysis included 1201 adults aged ≥50 from the 2016-17 Aging, Health, Psychological Well-being, and Health-seeking Behavior study. The Medical Outcomes Study Short Form-36 (MOS SF-36) assessed mobility limitations and emotional dysfunction. We measured PA using the International Physical Activity Questionnaire Short Form (IPAQ-SF). Hierarchical OLS regressions were performed to evaluate the hypothesized direct and interactive relationships. RESULTS: The mean age of the sample was 66.2 (SD = 11.9), and 63.3% were women. After full adjustment for potential confounders, OLS regressions found that mobility limitations increased the risk of emotional dysfunction (ß = 0.113, p = 0.004). Moreover, social ties (ß = -0.157, p < 0.001) and PA (ß = -0.096, p < 0.001) were independently and negatively associated with emotional dysfunction. We finally found a significant effect modification of the association of mobility limitations with emotional dysfunction by PA (ß = -0.040, p < 0.002) and social ties (ß = -0.013, p = 0.013). CONCLUSIONS: Mobility-enhancing strategies such as engagement in positive behavioral choices, focusing on regular PA, and maintaining resourceful interpersonal social networks can mitigate the impact of mobility limitations on emotional dysfunction in later life.

Emotional and physical-related experiences as potential mechanisms linking physical activity and happiness: Evidence from the Ghana Aging, Health, Psychological Well-being, and Health-seeking Behavior Study.

This study examines the association between physical inactivity (PI) and happiness among Ghanaian older adults and whether emotional and physical-related experiences (EPE) mediate the association. Data from the Aging, Health, Psychological Well-being and Health-seeking Behavior Study (AgeHeaPsyWel-HeaSeeB) conducted in 2016-2018 among 1201 older Ghanaians were analyzed. Happiness was assessed with the self-rated and cross-culturally validated item on a 5-point scale. PI was evaluated with the International Physical Activity Questionnaire (IPAQ). Hierarchical linear regressions and mediation analyses were performed to estimate the hypothesized associations. Results showed that PI was significantly associated with lower levels of happiness (ß = -0.053, p < .001) net of potential confounders. The association of PI with happiness was attenuated and fully mediated by pain, sleep problems, loneliness, anxiety, and boredom. Moreover, in terms of the cross-level interaction effects, PI moderated the happiness-pain (ß = -0.029, p < .005), happiness-social isolation (ß = -0.024, p < .05), and happiness-boredom (ß = -0.023, p < .005) associations. Our data suggest that EPE may explain why PI decreases happiness in old age. Findings provide valuable insight into the interventions and decisions to improve subjective well-being and quality of life in old age.

Ageing Happily in Ghana: How Does Social Inclusion Contribute?

BACKGROUND: Promoting happiness has become increasingly important in old age for a wide range of reasons. In this study, we aim to examine the association between social inclusion (SI) and happiness among older adults in Ghana and identify the mediating factors. METHODS: The study included 1201 community-dwelling adults aged ≥50 (mean age = 66.4 ± SD 11.9 years; 63.3% female) from the 2016-2018 Ageing, Health, Psychological Well-being, and Health-seeking Behaviour Study. We assessed happiness with a self-rated and cross-culturally validated item on a five-point scale. SI was operationalised using the modified Berkman-Syme Social Network Index. The hypothesised associations were evaluated by hierarchical regressions and bootstrapping techniques from Hayes' PROCESS macro programme. RESULTS: The prevalence of happiness was 24.3% (all of the time), 43.6% (most of the time), 28.3% (little of the time), and 3.7% (none of the time). After controlling for potential confounders, higher SI was associated with increased levels of happiness (odds ratio (OR) = 1.36; 95% confidence interval (CI) = 1.16-2.51). Aside from family/friends contacts, all other SI domains positively influenced happiness (OR = 1.45-1.81). The link between SI and happiness was mediated by depressive symptoms (65.2%), generalised anxiety (30.1%), and sleep problems (9.5%). CONCLUSIONS: Our data suggest that psychological factors may largely explain the positive SI-happiness link. Efforts should target these factors to promote happiness in old age. Longitudinal analysis may confirm our findings.

How do lifestyle choices affect the link between living alone and psychological distress in older age? Results from the AgeHeaPsyWel-HeaSeeB study.

BACKGROUND: Social isolation is widespread and strongly associated with worsening health-related outcomes across the life-course. Despite this broad base of knowledge, there is a paucity of research on the interactive effect of lifestyle choices and living arrangements on later life psychological state particularly in low- and middle-income settings. The aim of this study is to examine the influence of living alone on psychological distress in older people and to explore the protective roles of social participation and physical activity participation. METHODS: We used cross-sectional data from the 2016-17 Aging, Health, Psychological Well-being and Health-seeking Behavior Study (AgeHeaPsyWel-HeaSeeB) involving a representative sample of 1200 adults aged 50+ years in Ghana. The study focused on a latent measure of Kessler Psychological Distress Scale (K10) and on the General Practice Physical Activity Questionnaire (GPPAQ). Ordinary Least Squares (OLS) regression models evaluated the interactive effects of living arrangements and lifestyle choices on the K10 score. RESULTS: Living alone was independent predictor of psychological distress in the overall sample, among females, urban dwellers and all age groups. However, lifestyle choices of physical activity and social participation significantly moderated these associations. Moreover, in the stratified analysis, physical activity moderated the association for males, rural-dwellers and those 65+ years whilst social participation moderated the association for females, urban-dwellers and those 50-64 years. CONCLUSIONS: Lifestyle choices i.e. social participation and physical activity, and demographic factors i.e. age, gender, and residential status strongly attenuate the positive association of living alone with the risk of psychological distress in older age. These findings may inform intervention initiatives targeted at improving mental health of chronically detached and isolated older people.

Social support networks and psychological wellbeing in community-dwelling older Ghanaian cohorts.

BACKGROUND: Social support networks for older persons have been related to health outcomes including differences in psychological wellbeing (PWB). However, the specifics of this relationship remain unclear especially in sub-Saharan Africa. This study investigates the (1) relationship between aspects of social support and PWB among older persons in Ghana and (2) the extent to which this relationship is moderated by their education levels and locational characteristics. METHOD: The study included 1,200 community-residing individuals aged 50 years and older who participated in an Aging, Health, Psychological Wellbeing and Health-seeking Behavior Study (AHPWHB) conducted between July 2016 and February 2017. Logistic regression models evaluated the associations of social support and their interactions with education and locational variables in PWB. RESULTS: Several aspects of meaningful social support: family/friends contacts ( ß = 0.958, p < 0.05), couple focused ( ß = 0.887, p < 0.001), emotional bonds ( ß = 0.658, p < 0.005), attending social events ( ß = 0.519, p < 0.001) and remittances from children ( ß = 0.394, p < 0.005) significantly related to improved PWB in later life. These associations remained robust and largely strengthened after accounting for respondents' background and health-related factors. Education and locational characteristics substantially influenced the associations between social support and PWB. CONCLUSION: These findings suggest that especially in terms of PWB, aspects of meaningful social support networks are critical elements in later life. Strengthening opportunities for closer interpersonal relations with older persons may enhance their mental health, quality of life and independence.

Market vegetable hygiene practices and health risk perceptions of vegetable sellers in urban Ghana.

The paper examines the hygiene practices and health risk perception of vegetable sellers in urban Ghana. Based on a qualitative in-depth study of vegetable sellers drawn from five purposively sampled markets in Kumasi Metropolis, the study found that the vegetable sellers have generally low risk perception. Consequently, the vegetable handling practices by these market women remain largely unsafe presenting potential health risks to consumers. Regular monitoring by relevant agencies and sustained public education are therefore key for reducing market contamination which is critical for maintaining a healthy population.

Coliform Contamination of Peri-urban Grown Vegetables and Potential Public Health Risks: Evidence from Kumasi, Ghana.

Peri-urban vegetable farming in Ghana is an important livelihood activity for an increasing number of people. However, increasing quality and public health concerns have been raised, partly because freshwater availability for irrigation purposes is a major constraint. This paper investigated on-farm vegetable contamination and potential health risks using samples of lettuce, spring onions and cabbage randomly selected from 18 vegetable farms in peri-urban Kumasi, Ghana. Vegetable samples were tested for total coliform, fecal coliform, Escherichia coli and Salmonella spp. bacteria contamination using the Most Probable Number method. Results show high contamination levels of total and fecal coliforms, and Escherichia coli bacteria in all 18 vegetable samples. The mean total coliform/100 ml concentration for spring onions, lettuce and cabbage were 9.15 × 10(9), 4.7 × 10(7) and 8.3 × 10(7) respectively. The mean fecal coliform concentration for spring onions, lettuce and cabbage were also 1.5 × 10(8), 4.15 × 10(7) and 2.15 × 10(7) respectively, while the mean Escherichia coli bacteria contamination for spring onions, lettuce and cabbage were 1.4 × 10(8), 2.2 × 10(7) and 3.2 × 10(7) respectively. The level of total coliform, fecal coliform and Escherichia coli bacteria contamination in all the vegetable samples however declined as the distance between the main water source (Wiwi River) and farms increases. Nonetheless, all contamination levels were well above acceptable standards, and could therefore pose serious public health risks to consumers. Increased education and supervision of farmers, as well as public health and food hygiene education of consumers, are critical to reducing on-farm vegetable contamination and the health risks associated with consumption of such vegetables.

Bodily Pain in Physical Function and the Role of Physical Activity Among Community-Dwelling Adults Aged 50-69 Years in Ghana.

BACKGROUND: Older adults who experience pain are likely to report higher functional limitations (FL) and lower physical activity (PA) levels. However, the extent to which PA explains the association of pain with FL is largely unknown, particularly in low- and middle-income countries. This study estimates whether and how much pain in FL is mediated by PA engagement. METHODS: We used cross-sectional data from 770 adults aged 50-69 years who participated in the Aging, Health, Psychological Well-being, and Health-seeking Behavior Study in Ghana. FL and pain characteristics were defined using the Medical Outcomes Study Short Form-36. PA was assessed by the International Physical Activity Questionnaire-Short Form. Bootstrapped mediation analyses estimated the direct and indirect hypothesized associations. The control variables included age, sex, residential type, level of education, monthly income, social isolation, emotional distress, multimorbidity, and self-rated health. RESULTS: After adjusting for potential confounders, higher pain interference (ß = 0.091, p < .05) and higher pain severity (ß = 0.075, p < .05) were associated with greater FL. The bootstrapping analyses showed that PA mediated the pain interference-FL association, accounting for approximately 58% (ß = 0.124, Boots 95% confidence interval (CI): 0.078-0.175) of the total effect (ß = 0.215, Boots 95% CI: 0.095-0.335). Similarly, PA mediated the association between pain severity with FL, accounting for approximately 37% (ß = 0.044, Boots 95% CI: 0.001-0.094) of the overall effect (ß = 0.119, Boots 95% CI: -0.011 to 0.249). CONCLUSIONS: Our data suggest that the higher pain severity and pain interference may lead to higher FL in middle and old age, and the associations are partially explained by PA. Effective and low-cost PA participation could be targeted in efforts to reduce the effect of pain on physical functioning among middle-aged and older adults.

Depopulation or vaccination? Tackling the COVID-19 crisis in prisons in Africa.

Several attempts have been made by the global public health efforts and national governments to contain the spread and vulnerabilities to COVID-19. Evidence, however, shows a disproportionate upsurge in COVID-19 cases in correctional facilities such as prisons, particularly, in low- and middle-income countries (LMICs). The poor adherence to COVID-19 preventive protocols in these settings has raised a serious "moral panic" among the public. There are public health concerns about the most effective and state-of-the-art approach to tackling the continuous spread of the virus in prisons. This paper discusses the feasibility of depopulation and vaccination rollouts in combating COVID-19 in correctional facilities with a particular focus on African prisons. The paper proposes selective and strategic depopulation of prisoners, effective prioritization of vaccination among prisoners, and general sensitization of prisoners toward vaccine disbursement in this total institution.

Flood exposure and psychological distress among Ghanaian adults in flood-prone settings.

Urban floods have long-term mental health implications, yet this subject remains largely neglected in flood-related studies. This paper examines the psychological distress (PD) of adults exposed to floods in Ghana. Cross-sectional data involving 767 flood-prone community-dwelling household heads aged ≥20 years were analyzed [mean = 47.3 years (SD = 13.7); males = 61.4%]. We used the Exposure to Flood-related Events Scale, and PD was assessed with the Kessler Psychological Distress Scale (K10). Ordinary Least Squares (OLS) regressions evaluated crude and adjusted associations of flood exposure with PD. The mean scores of PD (37[SD = 8]) and exposure to flood events (6[SD = 3]) significantly varied by age and sex (p < .05). After full adjustment for potential confounders, exposure to flood events was significantly and positively associated with PD index in the total sample (ß = 0.030; p < .005), among male participants (ß = 0.019; p < .05) and female participants (ß = 0.048; p < .001). Furthermore, age-wise analysis revealed significant association of flood exposure with PD in young adults (ß = 0.033; p < .001) but not in older adults (ß = 0.048; p = .062). Exposure to floods increased the risk of PD. Policy and public health efforts to manage PD should include selective flood reduction interventions, including land use regulations and sustained public education.

Food insecurity and geriatric functional limitations: Observational analysis from the AgeHeaPsyWel-HeaSeeB Survey.

BACKGROUND: International literature suggests that food insecurity is linked with increased risks of functional impairment. However, data on the mediational mechanisms underlying this association are largely lacking. This study investigates the indirect relationship (via mental distress) between food insecurity and functional limitations among older adults in Ghana and evaluates the moderating effect of age, sex, and physical activity in this association. METHODS: The analytic sample comprised 1201 adults aged ≥50 years from the AgeHeaPsyWel-HeaSeeB study 2016-2017. We assessed food insecurity using hunger and skipped breakfast-related items. Seven mobility and activities of daily living-related difficulties assessed functional limitations. We used a moderated mediation analysis with the Hayes' PROCESS Macro v3.5 to model the hypothesized associations. RESULTS: About 36% of the sample were functionally limited, and 44% and 9% revealed moderate and severe food insecurity respectively. Food insecurity was associated with increased odds of having functional limitations after full adjustment for potential confounders (OR = 1.25, 95% CI: 1.05-1.50). However, this association was buffered by physical activity; those who engaged in physical activity were 23% less likely to suffer food insecurity-induced functional limitations compared to physically inactive (OR = 0.77, 95% CI: 0.67-0.88). Mental distress significantly mediated the food insecurity-functional limitations association and explained 86.9% of the association (total effect: OR = 2.85; 95% CI: 1.42-2.71; direct effect: OR = 1.05; 95% CI: 1.21-1.87; indirect effect: OR = 1.34; 95% CI: 1.36-2.24). CONCLUSIONS: Food insecurity is a risk factor for functional limitations in old age. Interventions to address food insecurity may benefit functional abilities via regular physical activity and improved mental health outcomes.

Loneliness and physical function impairment: Perceived health status as an effect modifier in community-dwelling older adults in Ghana.

BACKGROUND: Although loneliness and physical function impairment (PFI) are common geriatric syndromes and public health issues, little is known about how their associations vary via self-perception of health. We examine how loneliness is associated with PFI, and whether the association is modified by perceived health status. METHODS: We conducted a cross-sectional analysis of 1201 adults aged ≥ 50 years from the Aging, Health, Psychological Well-being and Health Seeking Behavior Study (AgeHeaPsyWel-HeaSeeB) in Ghana. We assessed loneliness using the three-item short-form of the UCLA Loneliness Scale, and PFI was measured with a seven-item scale on mobility-related deficiencies. Adjusted logistic regressions and moderation analysis evaluated the hypothesized associations. RESULTS: The prevalence of moderate, severe loneliness, and PFI were 37.5%, 17.7%, and 36.1%, respectively. Regressions showed that loneliness was associated with a 23% increased risk of PFI after adjusting for several potential confounders (OR = 1.23; 95%CI = 1.03-2.81). PFI sub-types revealed similar risks. The loneliness-PFI association was significantly moderated by perceived health status such that a positive health perception attenuated the effect of loneliness on PFI (OR = 0.46, 95%CI = 0.23-0.90). CONCLUSIONS: Individuals who were lonely had significantly higher odds for PFI but the effect was tempered by perceived health status. Social policy and public health practices for healthy aging should address loneliness and negative health perception among older people.

A two-mediator serial mediation chain of the association between social isolation and impaired sleep in old age.

Poor sleep is a long-term public health issue that has become increasingly prevalent among socially isolated older adults. However, research on the mechanisms explaining the link between social isolation and impaired sleep (IS) remains limited, particularly in low- and middle-income countries. This study explored the serial mediating effects of loneliness and mental distress on the association of social isolation with IS among Ghanaian older adults. We analyzed data from 1201 adults aged ≥ 50 from Ghana's AgeHeaPsyWel-HeaSeeB study (mean age = 66.14, SD = 11.85, age range = 50-111; women = 63.28%). Measures included the UCLA 3-item Loneliness Scale, modified Berkman-Syme Social Network Index, Sleep Quality Scale, and Mental Distress Questionnaire. We used bootstrapping techniques from Hayes' PROCESS macro program to estimate the hypothesized serial mediation. Social isolation was significantly associated with IS (ß = 0.242, p < 0.001). Crucially, social isolation indirectly predicted IS via three significant mediating pathways. Loneliness accounted for 17.6% (ß = 0.054, CI = 0.096, 0.016), mental distress accounted for 6.5% (ß = 0.020, 95% CI = 0.004, 0.040), and loneliness and mental distress accounted for 32.2% (ß = 0.099, 95% CI = 0.065, 0.138) of the overall effect. The total mediating effect was 56.4%. These findings suggest that the social isolation-sleep link is respectively and serially explained by loneliness and mental distress. Social integrative interventions for sleep quality in old age should target mental and emotional well-being.

The effect-modification of physical activity on the association of pain with impaired physical function in aging adults.

OBJECTIVES: Pain is prevalent among older adults and may result in impairment in physical function. However, little is known about the effect-modification of this relationship by physical activity (PA) participation. This large and representative study sought to estimate the effect of pain on physical function among older adults in Ghana and evaluate whether PA modifies this association. METHODS: Data came from 1201 adults aged ≥50 years participating in the AgeHeaPsyWel-HeaSeeB Study in Ghana. Pain constructs were defined using the Medical Outcomes Study Short Form-36 (MOS SF-36). PA was assessed using the International Physical Activity Questionnaire short form (IPAQ-SF) and physical function impairment was measured by seven-item domains based on the activities of daily living (ADL) and instrumental ADL (IADL). Adjusted hierarchical OLS regressions were fitted to estimate the direct and moderating relationships between pain facets, PA, and impaired physical function. RESULTS: The relationships of pain severity (ß = 0.348, p < .001), and pain interference (ß = 0.424, p < .001) with impaired physical function were robust after full adjustment for confounding variables. Persons with pain experiences had significantly increased impaired physical function risks. PA significantly modified the association between pain severity (ß = -0.232, p < .001) and pain interference (ß = -0.143, p < .001) with impaired physical function. CONCLUSIONS: Our data indicate that the relationships of pain with physical function impairment are modified by PA intensity. Future studies are warranted to understand the indirect effect of pain on functional limitations and how PA promotion could manage pain and improve functional ability in aging adults.

The Capabilities of Nurses for Complementary and Traditional Medicine Integration in Africa.

OBJECTIVE: Despite the political commitment of national governments and collaborative efforts by the World Health Organization (WHO) toward the actualization of intercultural healthcare system over the past decades, sub-Saharan African countries feature medical cohabitation rather than a truly integrated medical system. This hospital-based cross-sectional study analyzed the capabilities of nurses for complementary and traditional medicine (CTM) integration in Africa. METHOD: Practicing nurses (n = 210) were recruited to respond to the CTM Health Belief Questionnaire (CHBQ) in December 2016. Normality of data was evaluated using Kolmogorov-Smirnov statistic with a Lilliefors significance correction. The authors assessed the relationship among nurses' knowledge, personal use, and clinical practice of CTM, using Spearman's Rank Order Correlation (rho). The differences and associations in continuous and categorical baseline variables were determined with Mann-Whitney U test/Kruskal-Wallis H test and Pearson's Chi-square test, respectively, at p < 0.05 as statistically significant. RESULTS: The overall mean score of nurses' knowledge of CTM therapies was 38 (interquartile range [IQR] 16). This low CTM-related knowledge reflected in the poor mean performance score of 30 (IQR 17) and 22 (IQR 6) for personal use and clinical practice of CTM, respectively, among nurses. Nurses, therefore, lacked the confidence to recommend CTM therapies to patients. Yet, nurses exhibited a high positive attitude to CTM (72.7 ± 12.5). In addition to significant associations among CTM-related knowledge, education (p = 0.023), and religion (p < 0.001), the study found a positive and statistically significant correlation among CTM-related knowledge, personal use (r = 0.556, p < 0.001), and professional practice of CTM (r = 0.349, p < 0.001). CONCLUSION: Given their substantial role in the primary and public healthcare system, improving nurses' knowledge of CTM through evidence-based nursing education and training remains the surest way to achieve appropriate CTM integration in Africa as outlined in the WHO Traditional Medicine Strategy 2014-2023.

Nurses' knowledge, clinical practice and attitude towards unconventional medicine: Implications for intercultural healthcare.

OBJECTIVE: The aim of this hospital-based, cross-sectional study was to examine nurses' knowledge, personal and professional practices and attitude towards complementary and alternative medical therapies in urban Ghana. METHOD: Using convenience sampling technique, cross-sectional data were collected from 210 registered and practicing nurses with self-administered questionnaire based on the Complementary and Alternative Medicine (CAM) Health Belief Questionnaire (CHBQ). Descriptive statistics and the associations between variables were calculated using Pearson's Chi-square test and/or Fisher's exact test with p < 0.05. RESULTS: The mean score of nurses' knowledge on CAM therapies was low (mean ± SD, 38.39 ± 10.11; possible range, 18-72) which was built on nurses' personal experiences. Nurses, therefore, lacked the confidence to recommend CAM therapies to patients. Despite the isolated cases of non-herbal supplements, relaxation techniques, massage and prayer healing, the study found an overall low personal use of CAM (mean ± SD, 32.97 ± 10.78; possible range, 18-72) among nurses over the last 12 months. Yet, nurses exhibited a positive attitude towards CAM (mean ± SD, 72.7 ± 12.5, possible range, 67-110). We observed significant associations among nurses' CAM knowledge and education [χ2 (2) = 6.69, p = 0.035] and religion [χ2 (2) = 7.96, p = 0.019]; nurses' personal use of CAM and income [χ2 (2) = 16.07, p < 0.001] and religion [χ2 (2) = 18.65, p < 0.001]; and nurses' clinical CAM use and income [χ2 (2) = 7.01, p = 0.030]. CONCLUSION: Despite the overall positive attitude towards CAM therapies, Ghanaian nurses do not perceive themselves to have sufficient knowledge of CAM. Integrating CAM education into the nurses' training curriculum can improve CAM knowledge and professional practice among nurses, and in turn, enhance evidence-based patient care within the framework of intercultural healthcare system in Ghana.

Pulled in or pushed out? Understanding the complexities of motivation for alternative therapies use in Ghana.

The impact of strong cultural beliefs on specific reasons for traditional medicine (TRM) use among individuals and populations has long been advanced in health care and spatio-medical literature. Yet, little has been done in Ghana and the Ashanti Region in particular to bring out the precise "pull" and "push" relative influences on TRM utilization. With a qualitative research approach involving rural and urban character, the study explored health beliefs and motivations for TRM use in Kumasi Metropolis and Sekyere South District, Ghana. The study draws on data from 36 in-depth interviews with adults, selected through theoretical sampling. We used the a posteriori inductive reduction model to derive broad themes and subthemes. The "pull factors"-perceived benefits in TRM use vis-à-vis the "push factors"-perceived poor services of the biomedical treatments contributed to the growing trends in TRM use. The result however indicates that the "pull factors," viz.-personal health beliefs, desire to take control of one's health, perceived efficacy, and safety of various modalities of TRM-were stronger in shaping TRM use. Poor access to conventional medicine accounted for the differences in TRM use between rural and urban areas. Understanding the treatment and health-seeking behaviour of a cultural-related group is critical for developing and sustaining traditional therapy in Ghana.

Does spatial location matter? Traditional therapy utilisation among the general population in a Ghanaian rural and urban setting.

Despite the recognition for rising consumption rate of traditional medicine (TRM) in health and spatio-medical literature in the global scale, the impact of location in traditional therapy use has been explored least in Ghana. This paper analysed the role of spatial variation in TRM use in Kumasi Metropolis and Sekyere South District of Ashanti Region, Ghana. A retrospective cross-sectional and place-based survey was conducted in a representative sample (N=324) selected through systematic random sampling technique. Structured interviewer-administered questionnaires were espoused as the main research instruments. Data were analysed with Pearson's Chi-square and Fisher's exact tests from the Predictive Analytics Software (PASW) version 17.0. The study found that over 86% reported TRM use. Whilst majority (59.1%) of the respondents had used TRM two or more times within the last 12 months, biologically-based therapies and energy healing were common forms of TRM accessed. Although, the use of TRM did not vary (p>0.05), knowledge about TRM, modalities of TRM and the sources of TRM differed significantly across geographically demarcated rural and urban splits (p<0.005). The study advances our understanding of the spatial dimensions as regards TRM utilisation.