Barriers and facilitators to hepatitis C screening and treatment for people with lived experience of homelessness: A mixed-methods systematic review.

BACKGROUND: People experiencing homelessness have an increased risk of hepatitis C virus (HCV) infection, with rates higher than the general population. However, their access to HCV diagnosis is limited and treatment uptake is low. OBJECTIVES: To identify and describe the barriers and facilitators for HCV screening and treatment for adults with lived experience of homelessness in highly developed countries. METHODS: Bibliographic databases (Embase, MEDLINE, CINAHL and SocINDEX) and grey literature (Google, EThOS, the Health Foundation, Social Care Online, the World Health Organisation, Shelter, Crisis and Pathway) were searched. Two reviewers independently screened and appraised all studies. The Critical Appraisal Skills Programme tool and the Joanna Briggs Institute checklist were used. The analysis involved a three-stage process: coding, theme generation and theme mapping under Penchansky and Thomas's modified access model. RESULTS: Twelve papers/reports were included in the review. Several interacting factors influence access of people with lived experience of homelessness to HCV testing and treatment. Some mirror those identified for the general population. The precarious conditions associated with the lived experience of homelessness along with the rigidity of hospital settings and lack of awareness emerged as dominant barriers. Flexibility, outreach, effective communication, tailoring and integration of services were found to be important facilitators. Evidence from Black, Asian and minority ethnic groups is limited. CONCLUSIONS: People experiencing homelessness face multiple barriers in accessing and completing HCV treatment, relating to both their lived experience and characteristics of health systems. Although some barriers are readily amenable to change, others are more difficult to modify. The facilitators identified could inform future targeted measures to improve HCV diagnosis and treatment for people experiencing homelessness. Research is warranted into successful models to promote screening, diagnosis and treatment. PATIENT OR PUBLIC CONTRIBUTION: Our team includes a peer advocate, a hepatology nurse and a community volunteer, all with significant experience in promoting and engaging in HCV care and outreach for people experiencing homelessness. They contributed to the protocol, interpretation and reporting of the review findings.

Quad-dimensional acculturation, cultural integration, and life satisfaction of South Sudanese refugee young adults in the United States: A quasilongitudinal qualitative study.

OBJECTIVE: This study aims to describe acculturation among South Sudanese refugees (SSRes) as young adults in the U.S. based on a tridimensional (3D) acculturation framework. METHOD: Aligning with a community-based participatory research (CBPR) approach, the present study was designed to investigate in-depth individual experiences of SSRes in two phases, conducting 19 interviews in 2007 and 11 interviews in 2014-2015. The data analysis employed a modified grounded theory approach. RESULTS: A grounded theory emerged indicating that, over time, SSRes experienced quad-dimensional acculturation that included South Sudanese, mainstream American, African American, and African cultures and orientations. Although bidimensional acculturation was prominent in Phase 1, quad-dimensional acculturation emerged and was salient in Phase 2. Furthermore, participants who demonstrated an integrated perspective toward their acculturation tended to report higher life satisfaction scores than those who expressed conflicted perspectives. CONCLUSIONS: The findings have theoretical and practical implications for African refugees' adjustment and psychological well-being. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Restrained eating and risk of gaining weight and body fat in middle-aged women: a 3-year prospective study.

PURPOSE: Examine the extent to which restrained eating (RE) and changes in RE influence the risk of weight and fat gain over 36 months in women. DESIGN: Prospective cohort. SETTING: Several communities. SUBJECTS: Baseline and follow-up assessments were completed by 192 middle-aged women (ages 40.0 +/- 3 years). MEASURES: Body weight was measured with an electronic scale, body fat (BF) was assessed using the Bod Pod, energy intake was evaluated using 7-day weighed food records, physical activity was measured objectively using accelerometers, and RE was indexed using the Dutch Eating Behavior Questionnaire. ANALYSIS: Relative risk (RR) was calculated using incidence data. RESULTS: The risk of weight gain (> or = 1 kg) over the 36 months was 69% greater in women who did not increase in RE compared with their counterparts (RR = 1.69, 95% confidence interval [CI] = 1.12-2.52). The risk of substantial weight gain (> or = 3 kg) was 138% greater in women who did not increase in RE compared with women who did (RR = 2.38, 95% CI = 1.16-4.89), and the risk of gains in BF (> or = 1% point) was 49% greater (RR = 1.49, 95% CI = 1.02-2.17). Control of potential confounding factors, except changes in energy intake, had little influence on risk. CONCLUSION: Women who do not become more restrained in their eating over time are at much greater risk of gaining weight and BF compared with those who become more restrained.

The experiences of Sudanese unaccompanied minors in foster care.

Sudanese unaccompanied minors were separated from their parents in childhood and lived apart from their families in refugee camps for close to a decade before being resettled in the United States. This phenomenological study examines the refugees' experiences of living in American foster families after living in peer groups in the camps. Interviews with 18 young adults, 7 years after resettlement, revealed that nearly all of the youth struggled with parental authority initially, and nearly half of them changed placements because of relationship difficulties with their foster parents. Misunderstandings based on cultural differences often exacerbated conflicts. However, 15 of 18 youth currently had a positive relationship with at least 1 foster parent, sometimes with a parent from their second or third placement. Changing foster families is often considered a failure in the child welfare system, but several Sudanese youth reported that having supportive relationships helped them during the acculturation process whether those relationships developed during the first or last placement.

The Lost Boys of Sudan: coping with ambiguous loss and separation from parents.

The Lost Boys of Sudan were separated from their families by civil war and subsequently lived in three other countries-Ethiopia, Kenya, and the United States. In-depth interviews were conducted with 10 refugees about their experiences of separation from parents and ambiguous loss, and the coping strategies the youth used when they did not know if other members of their family were dead or alive. All of the youth reported using both emotion-focused and problem-focused coping strategies. The youth also discussed the importance of support from peers and elders while they lived in the refugee camps. In addition, they reflected on the psychological presence of parents who were physically absent, and the important role that hope of being reunited with parents played as they struggled with survival issues and ambiguous loss.

Precariously placed: Home, housing and wellbeing for older renters.

Older renters may encounter a wide range of challenges and constraints in their experiences of ageing, housing and community life that influence their wellbeing. We employ a two-part conceptualisation of precarity and resilience to investigate how housing-related precarities may impact upon experiences of ageing and home during later life. We draw on narratives collected through in-depth interviews with 13 older renters living in a particularly high-pressure housing market within the greater Auckland area. We ground our analysis in ideas of precarity and resilience evident in participants' experiences of being 'at home' at the scale of both the dwelling and wider community. Results show that experiences of renting and ageing can be complicated and compromised in diverse ways by interrelated aspects of precarity and resilience related to housing, community, health, financial and personal circumstances. Distance or isolation from services and healthcare, tourism-related infrastructural pressures, and community changes can intensify precarious experiences of home, and can have implications for older people's wellbeing, as well as their ongoing opportunities to age well in place. In addition to these potential precarities, older renters appear to draw strength from their familiarity with, attachment to, and enjoyment of, place and community. These responses demonstrate older renters' capacity for resilience to challenge and adversity when ageing in rented places.

'A level playing field': Young people's experiences of wheelchair basketball as an enabling place.

Using a novel case-study of a youth wheelchair basketball team in Auckland, New Zealand, we investigate the experiences of young people with physical disabilities in recreational sports places. We consider the 'enabling places' created by this sport, which can enhance disabled young people's wellbeing and social inclusion. Semi-structured interviews with the team's players and coordinators revealed logistical and societal challenges associated with facilitating youth-oriented sports, as well as those encountered by team members personally. They also identified physical health and social benefits experienced through involvement in wheelchair basketball. The material, social and affective dimensions of participants' experiences of wheelchair basketball elucidate the capacity for the sport, and its team members and settings, to affirm young people's identity and place-in-the-world. We conclude that youth-specific, inclusive sports generate enabling places that enhance young people's social inclusion, wellbeing and life enjoyment.

Partnering with Private Providers to Promote Long-Acting Contraceptives in Urban Bangladesh: A Mixed-Methods Feasibility Study.

CONTEXT: Bangladesh's pluralistic health system has diversified opportunities for clients to obtain family planning, but public-private partnerships could improve access to services, particularly in urban areas. METHOD: Sixteen providers, clients and program managers were interviewed to assess perspectives on a family planning orientation and demand-side financing referral program tested in Mirpur, Bangladesh. The 15-month program, conducted in 2015-2016, was designed to encourage private providers to identify non-family planning clients with unmet contraceptive needs, promote choice of a broader contraceptive mix and refer clients to one of three public or nonprofit clinics for provision of their preferred method. Use of the system was assessed by tracking referral slips. RESULTS: Most stakeholders reported that it was acceptable and feasible to discuss fertility intentions with clients presenting for non-family planning matters. Providers were able to alleviate clients' misconceptions and fears concerning long-acting contraceptive methods, but were unable to address patriarchal and religious barriers. The majority of referrals were done by private providers who had a pre-existing relationship with one of the family planning clinics and referred clients to that clinic; overall, documented referrals accounted for 13% of provision of reversible and permanent methods at that clinic during the study period. CONCLUSIONS: Providing private practitioners with appropriate training on contraceptives and referral could improve Bangladeshi women's access to long-acting and other contraceptive methods in urban areas, and may be useful for other types of health workers. Further study of suitable referral systems is warranted.

RESUMEN Contexto: El sistema de salud pluralista de Bangladesh diversificó las oportunidades para que las clientas obtuvieran servicios de planificación familiar, pero las alianzas público-privadas podrían mejorar el acceso a los servicios de planificación familiar, particularmente en las zonas urbanas. Método: Dieciséis proveedores de servicios, clientes y gerentes de programas fueron entrevistados para evaluar las perspectivas sobre un programa de orientación de planificación familiar y de referencia financiado por el lado de la demanda, que fue probado en Mirpur, Bangladesh. El programa de 15 meses, realizado en 2015­2016, fue diseñado para alentar a los proveedores privados a identificar clientas de servicios distintos a la planificación familiar con necesidades anticonceptivas insatisfechas, promover la elección de una mezcla de anticonceptivos más amplia y referir a las clientas a una de las tres clínicas públicas o sin fines de lucro para la obtención de su método preferido. El uso del sistema se evaluó mediante el seguimiento de los recibos de referencia. Resultados: La mayoría de las partes interesadas informó que era aceptable y factible discutir las intenciones de fecundidad con las clientas que se presentan para asuntos distintos a la planificación familiar. Los proveedores pudieron atenuar las ideas falsas y los temores de las clientas sobre los métodos anticonceptivos de acción prolongada, pero no pudieron abordar las barreras patriarcales y religiosas. La mayoría de las referencias fueron realizadas por proveedores privados que tenían una relación preexistente con una de las clínicas de planificación familiar y refirieron a las clientas a esa clínica; en general, las referencias documentadas representaron el 13% de la provisión de métodos reversibles y permanentes en esa clínica durante el período de estudio. Conclusiones: Brindar a los profesionales privados capacitación adecuada sobre anticonceptivos y referencias podría mejorar el acceso de las mujeres de Bangladesh a métodos anticonceptivos de larga duración y de otro tipo en áreas urbanas; y puede ser útil para otros tipos de trabajadores de la salud. Se justifica el estudio adicional de sistemas de referencia adecuados.

RÉSUMÉ Contexte: Au Bangladesh, le système de santé pluraliste a diversifié, pour les clientes, les possibilités d'obtention de la planification familiale, mais les partenariats public-privé pourraient améliorer l'accès aux services, en particulier dans les milieux urbains. Méthode: Des entretiens ont été organisés avec 16 prestataires, clientes et gestionnaires de programme afin d'évaluer les points de vue concernant un programme d'orientation sur la planification familiale et d'aiguillage à financement du côté de la demande testé à Mirpur (Bangladesh). Mené en 2015­2016 sur une période de 15 mois, ce programme était conçu pour encourager les prestataires privés à identifier les clientes hors planification familiale qui présentaient un besoin de contraception non satisfait, à promouvoir le choix d'un éventail de contraception plus large et à orientation les clientes vers l'une de trois cliniques publiques ou à but non lucratif pour l'obtention de leur méthode préférée. L'utilisation du système a été évaluée par suivi des fiches de recommandation. Résultats: La plupart des intervenants ont déclaré qu'il était acceptable et faisable de parler des intentions de fécondité avec les clientes se présentant pour des raisons autres que la planification familiale. Les prestataires ont réussi à dissiper les idées fausses et les craintes des clientes concernant les méthodes contraceptives de longue durée, mais ils n'ont pas pu résoudre les obstacles de nature patriarcale et religieuse. Dans la majorité des cas, les orientations provenaient de prestataires privés qui avaient une relation préexistante avec l'une des cliniques de planification familiale et aiguillaient leurs clientes vers cette clinique. Globalement, les recommandations documentées ont représenté 13% de la prestation de méthodes réversibles et permanentes dans cette clinique pendant la période de l'étude. Conclusions: L'offre aux praticiens privés d'une formation appropriée sur la contraception et l'aiguillage pourrait améliorer l'accès des Bangladaises aux méthodes contraceptives longue durée ou autres dans les milieux urbains. Elle pourrait être utile aussi à d'autres types d'agents de santé. Il y a lieu de procéder à une étude approfondie des systèmes d'aiguillage appropriés.

Evaluating the impact of Marie Stopes International's digital family planning counselling application on the uptake of long-acting and permanent methods of contraception in Vietnam and Ethiopia: a study protocol for a multi-country cluster randomised controlled trial.

BACKGROUND: Maintaining quality of care in family planning (FP) counselling in low-resource settings is challenging. Job aids can help providers give more accurate and client-specific advice but require a provider to use them effectively and consistently. Marie Stopes International (MSI) have designed the tablet-computer based Digital Counselling Application (DCA), which prompts structured, supportive, client-specific and unbiased FP counselling. We hypothesise that a systematic exploration of clients' fertility intentions, medical eligibility and preferences will increase their uptake of long acting and permanent methods of contraception (LAPMs). METHODS/DESIGN: We will conduct a two-armed, parallel, cluster randomised control trial across all MSI clinics (clusters) in Ethiopia (24) and Vietnam (11), randomising 18 clinics to the intervention group and 17 to the control group. Intervention providers will attend a two-day DCA-use training programme, and use DCA in their FP counselling sessions. Usual care providers will counsel clients as before. We aim to recruit 75 clients who have had FP counselling per clinic (2625 total), following them up via two telephone interviews, initially within 2 days and then at 4 months. The primary outcome is defined as the proportion of clients who report choosing a LAPM following FP counselling and will include switchers (FP counselling clients who switch from using any other FP method) and adopters (FP counselling clients who adopt any FP method having not previously been using one). We will also collect secondary outcomes at the initial follow-up (including the proportion of clients reporting being recommended a LAPM by a provider and a range of measures of client experience and satisfaction) and at the 4-month follow-up (including a range of measures of continuation rates for different FP method types). In the intervention arm, we will also conduct mixed-methods sampling to assess how providers use DCA (using an observational survey of provider-client interactions), and understand users' experiences of receiving and giving DCA-based FP counselling (through in-depth interviews). DISCUSSION: This trial will provide novel information on the feasibility and acceptability of health worker delivered FP counselling using DCA, with robust evidence on its effectiveness at increasing the uptake of LAPMs in low-resource settings. TRIAL REGISTRATION: ISRCTN, ISRCTN11040557 . Registered on 2 March 2017 (retrospectively registered).

Correction to: Evaluating the impact of Marie Stopes International's digital family planning counselling application on the uptake of long-acting and permanent methods of contraception in Vietnam and Ethiopia: a study protocol for a multi-country cluster randomised controlled trial.

Following publication of the original article [1], the authors requested a correction be made, indicating L. Bates as the first author only. There is no joint first authorship.

Carrying water may be a major contributor to disability from musculoskeletal disorders in low income countries: a cross-sectional survey in South Africa, Ghana and Vietnam.

BACKGROUND: The Sustainable Development Goals include commitments to end poverty, and promote education for all, gender equality, the availability of water and decent work for all. An important constraint is the fact that each day, many millions of women and children, and much less frequently men, carry their household's water home from off-plot sources. The burden of fetching water exacerbates gender inequality by keeping women out of education and paid employment. Despite speculation about the potential health impacts of fetching water, there is very little empirical evidence. We report the first large study of the health impacts of carrying water on women and children. METHODS: A cross-sectional survey was conducted in South Africa, Ghana and Vietnam during 2012. It investigated water carrying methods and health status. Because areas of self-reported pain were correlated we undertook factor analysis of sites of reported pain, to interpret patterns of pain reporting. Regression analysis using Generalised Estimating Equations (GEE) investigated water carrying as a risk factor for general health and self-reported pain. RESULTS: People who previously carried water had increased relative risk of reporting pain in the hands (risk ratio RR 3.62, 95% confidence interval CI 1.34 to 9.75) and upper back (RR 2.27, 95% CI 1.17 to 4.40), as did people who currently carry water (RR hand pain 3.11, 95% CI 1.34 to 7.23; RR upper back pain 2.16, 95% CI 1.25 to 3.73). The factor analysis results indicate that factor 1, 'axial compression', which is correlated with pain in the head and upper back, chest/ribs, hands, feet and abdomen/stomach, is associated with currently (0.30, 95% CI 0.17 to 0.43) or previously (0.21, 95% CI 0.01 to 0.42) carrying water. Factor 2, 'soft tissue strain', which is correlated with pain in the neck, shoulders/arms, lower back and hips/pelvis or legs, is marginally negatively associated with currently (-0.18, 95% CI -0.32 to -0.04) carrying water. The factor 'axial compression' was more strongly associated with carrying water containers on the head. CONCLUSIONS: Participants who reported a history of current or past water carrying more frequently reported pain in locations most likely to be associated with sustained spinal axial compression in the cervical region. Given the fact that cervical spinal conditions are globally one of the more common causes of disability, our findings suggest that water carrying, especially by head loading is a major contributing factor in musculoskeletal disease burden in low income countries. Our findings support the proposed indicator for monitoring SDG6.1: "Percentage of population using safely managed drinking water services at home."

Facilitators and Barriers to Uptake of an Extended Seasonal Malaria Chemoprevention Programme in Ghana: A Qualitative Study of Caregivers and Community Health Workers.

BACKGROUND: Seasonal Malaria Chemoprevention (SMC) is currently recommended for children under five in areas where malaria transmission is highly seasonal. We explored children's caregivers' and community health workers' (CHWs) responses to an extended 5-month SMC programme. METHODS: Thirteen in-depth interviews and eight focus group discussions explored optimal and suboptimal 'uptake' of SMC to examine facilitators and barriers to caregivers' uptake. RESULTS: There did not appear to be major differences between caregivers of children with optimal and sub-optimal SMC uptake in terms of their knowledge of malaria, their perceptions of the effect of SMC on a child's health, nor their understanding of chemoprevention. Caregivers experienced difficulty in prioritising SMC for well children, perceiving medication being for treatment rather than prevention. Prior to the study, caregivers had become accustomed to rapid diagnostic testing (RDT) for malaria, and therefore blood testing for malaria during the baseline survey at the start of the SMC programme may have positively influenced uptake. Facilitators of uptake included caregivers' trust in and respect for administrators of SMC (including CHWs), access to medication and supportive (family) networks. Barriers to uptake related to poor communication of timings of community gatherings, travel distances, absence during SMC home deliveries, and limited demand for SMC due to lack of previous experience. Future delivery of SMC by trained CHWs would be acceptable to caregivers. CONCLUSION: A combination of caregivers' physical access to SMC medication, the drug regimen, trust in the medical profession and perceived norms around malaria prevention all likely influenced caregivers' level of uptake. SMC programmes need to consider: 1) developing supportive, accessible and flexible modes of drug administration including home delivery and village community kiosks; 2) improving demand for preventive medication including the harnessing of learnt trust; and 3) developing community-based networks for users to support optimal uptake of SMC.

Sudanese refugee youth in foster care: the "lost boys" in America.

This study examined the resettlement experiences of unaccompanied Sudanese refugee youth placed in foster care from the perspectives of the youth, foster parents, and agency caseworkers. Youth experienced considerable success. The challenges of adjusting to school and family life, however, suggest a need for funding to support more intensive educational services, more cultural training and support for foster parents and school personnel, and flexibility to provide services in more culturally appropriate modalities.