Social Ecological Influences on Nicotine/Tobacco Use Among Gender-Varying and Gender-Stable Adolescents and Adults in the USA.

BACKGROUND AND PURPOSE: Our study examined individual-, interpersonal-, community-, and policy-level associations with nicotine/tobacco use among gender-varying and gender-stable U.S. individuals. METHODS: Data from Waves 2-4 (2014/15-2016/18) of the Population Assessment of Tobacco and Health (n = 33,197 U.S. adolescents and adults aged ≥14 years) and state-level gender minority policy data were used. Using multivariable logistic regression, the odds of past-30-day nicotine/tobacco use at W4 were estimated as a function of gender stability/variability, psychological distress, number of tobacco products used by family/friends, anti-tobacco marketing exposure, and change in gender minority-related policies from 2015 to 2017. RESULTS: Gender-varying individuals had higher odds of nicotine/tobacco use compared with gender-stable individuals (AOR range = 1.7-2.3, p < .01). In the overall sample, positive change in gender minority policy protections (tallied from medium to high) was associated with lower odds of any nicotine/tobacco, other tobacco, and poly-tobacco use (AOR = 0.8, p < .05) compared to states with no change in their negative policies. Anti-tobacco marketing exposure was associated with lower odds of any tobacco, cigarette, e-cigarette, and poly-tobacco use compared with those who had no anti-tobacco marketing exposure (AOR = 0.9, p < .05). Higher psychological distress (AOR range = 1.7-2.4, p < .001) and an increasing number of tobacco products used by family/friends (AOR range = 1.1-1.3, p < .001) were associated with increased odds of nicotine/tobacco use. CONCLUSIONS: Multilevel prevention and intervention strategies are needed to reduce the risk of nicotine/tobacco use among gender-varying and gender-stable individuals.

Prior work has shown that individuals whose gender identity changes over time (i.e., gender-varying) have higher risk for nicotine/tobacco use compared with individuals whose gender identity remains consistent over time (i.e., gender-stable). This study examined individual-, interpersonal-, community-, and policy-level associations with nicotine/tobacco use among gender-varying and gender-stable U.S. adolescents and adults. We analyzed data from Waves 2­4 (2014/15­2016/18) of the Population Assessment of Tobacco and Health study (n = 33,197 U.S. adolescents and adults aged 14 years and above) and state-level gender identity policy data from the Movement Advancement Project. Among the overall sample, we found that a positive change in state-level policy protections was associated with lower odds of any nicotine/tobacco, other tobacco, and poly-tobacco use compared with states that had no change in their negative policies. Exposure to anti-tobacco marketing was associated with lower odds of any tobacco, cigarette, e-cigarette, and poly-tobacco use compared with those who had no exposure to anti-tobacco marketing. Higher psychological distress and an increasing number of tobacco products used by close friends and family were associated with increased odds of nicotine/tobacco use. Multilevel prevention and intervention strategies are needed to reduce the risk of nicotine/tobacco use among gender-varying and gender-stable individuals.

Facilitators and Barriers to Adherence to Anti-Retroviral Treatment Among Pregnant or Breastfeeding Women Living with HIV and Perinatally Infected Infants: A Scoping Review.

In 2022, 54% of 1.5 million children (age 0-14) living with HIV had access to anti-retroviral medication (ART). Adherence to ART for pregnant or breastfeeding HIV + women is critical for maintaining their personal health and to prevent mother-to-child-transmission (MTCT). For HIV + infants, adherence is essential to establish early viremic control and is contingent on caregiver administration. We conducted a scoping review to systematically identify and categorize the influences on ART adherence for pregnant or breastfeeding HIV + women and their HIV + infants. We searched databases in June 2023 and employed the Social-Ecological Model (SEM) to organize facilitators and barriers to adherence referenced in published articles. All articles published before 2016 were excluded due to updated guidelines from WHO on MTCT and ART. Our analysis included 52 articles. 50/52 took place in Africa and used cross-sectional and mixed-methods design. Barriers to adherence for pregnant or breastfeeding HIV + women included maternal education, self-efficacy, social support, and social/economic context. Barriers to infant adherence included development, nutrition, age of treatment initiation, disclosure, and ART side effects. Additional facilitators and barriers to adherence are presented at family, extra-familial, and socio-cultural SEM levels. Stigma was the most salient barrier referenced across the entire continuum of HIV care and all SEM levels. This review revealed a dearth of literature focusing on HIV + infants who are dependent on their caregivers for ART adherence and lack of a standard adherence measure. We identified multi-leveled influences on adherence impacting both the mother and infant and are amenable to public health intervention.

Challenges and strategies for navigating Australian healthcare access: experience from Chinese international students.

BACKGROUND: Australia hosts over 680,000 international students, contributing $47.8 billion to the Australian economy in 2023, and Chinese students rank first among all nationalities. However, despite their considerable numbers, research focusing on their access to healthcare services is scant. This study aimed to explore barriers and supports regarding the utilisation of healthcare services among Chinese international students studying in Australia. METHODS: Semi-structured interviews were conducted in Chinese between October and December 2023 with 25 Chinese international students (age range, 19-30; female/male, n = 18/7; undergraduate/postgraduate/doctoral, n = 1/18/6) enrolled in three Australian universities to understand the healthcare challenges they encountered and the coping strategies they recommended. These interviews were recorded, and thematic analysis was applied to the interview data. An adapted social-ecological model was used to identify barriers and pragmatic strategies to deal with the challenges at different levels. RESULTS: Chinese international students in Australia faced healthcare barriers at different levels. Individual barriers included language and cultural disparities, lack of knowledge about the healthcare system, and reluctance to seek help. Institutional barriers involved high costs, difficulties regarding appointments, and procedures related to the referral system. Policy barriers included insurance coverage and reimbursement issues. The students interviewed for this study proposed individual-level strategies, such as trying various methods to reduce language barriers, seeking information online, and using online resources and consultations. A central appointment platform and multilingual medical service were recommended from students to medical institutions, while medical service guidance and psychological support were suggested to education institutions. Higher-level strategies were also reported, which were mainly pertaining to insurance terms and coverage for overseas students and improving the accessibility of medical information. CONCLUSIONS: Our study identifies barriers to healthcare access for Chinese international students in Australia, including culture-specific challenges. To mitigate these issues, we recommend self-directed health promotion, targeted support by education institutions, enhanced cross-cultural communication and expanded telemedicine by hospitals, and attention to insurance coverage. Future research should explore optimising these approaches to improve support systems and policy frameworks.

Current Practices in Operationalizing and Addressing Racial Equity in the Provision of Type 1 Diabetes Care: Insights from the Type 1 Diabetes Exchange Quality Improvement Collaborative Health Equity Advancement Lab.

OBJECTIVE: Medical racism contributes to adverse health outcomes. Type 1 Diabetes Exchange Quality Improvement Collaborative (T1DX-QI) is a large population-based cohort engaged in data sharing and quality improvement to drive system changes in T1D care. The annual T1DX-QI survey included questions to evaluate racial equity in diabetes care and practices to promote equity. METHODS: The annual T1DX-QI survey was administered to participating clinics in fall 2022 and had a 93% response rate. There were 50 responses (pediatric: 66% and adult: 34%). Questions, in part, evaluated clinical resources and racial equity. Response data were aggregated, summarized, and stratified by pediatric/adult institutions. RESULTS: Only 21% pediatric and 35% adult institutions felt that all their team members can articulate how medical racism contributes to adverse diabetes outcomes. Pediatric institutions reported more strategies to address medical racism than adult (3.6 vs 3.1). Organizational strategies to decrease racial discrimination included employee trainings, equity offices/committees, patient resources, and hiring practices. Patient resources included interpreter services, transportation, insurance navigation, and housing and food assistance. Hiring practices included changing prior protocols, hiring from the community, and diversifying workforces. Most institutions have offered antiracism training in the last year (pediatric: 85% and adult: 72%) and annually (pediatric: 64% and adult: 56%). Pediatric teams felt that their antiracism training was effective more often (pediatric: 60% and adult: 45%) and more commonly, they were provided resources (pediatric: 67% and adult: 47%) to help address inequities. CONCLUSION: Despite increased antiracism training, insufficient institutional support and perceived subeffective training still represent obstacles, especially in adult institutions. Sharing effective strategies to address medical racism will help institutions take steps to mitigate inequities.

The factors related to depressive symptoms in urban older adults in South Korea: a study based on the Seoul Aging Survey.

PURPOSE: This study aims to comprehensively examine the determinants of depression among urban older adults in Seoul, utilizing the social-ecological model to address multifaceted influences. METHODS: A comprehensive analysis was conducted using data from the 2022 Seoul Aging Survey, which surveyed 2,914 individuals aged 65 and above. A multiple logistic regression analysis was performed to identify factors contributing to depressive symptoms, including socio-demographic characteristics, health behaviors and status, research accessibility, social support, and environmental influences. RESULTS: This study revealed that poor subjective health (OR = 1.47) and the presence of multiple chronic diseases (OR = 1.59) significantly increased the risk of depressive symptoms among urban older adults. From a social support standpoint, living alone was associated with a higher risk of depression (OR = 1.66), low food security (OR = 2.56), and low digital competency (OR = 2.70) were all significant predictors of depressive symptoms. Additionally, a lack of engagement with cultural facilities (OR = 2.15) was identified as a critical environmental factor contributing to depression. CONCLUSIONS: The findings underscore the need for comprehensive policy and practical interventions aimed at preventing chronic disease, enhancing social support networks, improving digital literacy, ensuring food security, and expanding access to healthcare and cultural facilities. Such measures are crucial in mitigating depression among urban older adults, thereby enhancing their overall well-being and quality of life.

Teachers' perception on physical activity promotion in kindergarten children in China: a qualitative study connecting social-ecological model.

BACKGROUND: Globally, the majority of kindergarten-aged children face obesity issues and insufficient physical activity (PA) engagement. Regular PA participation can provide various health benefits, including obesity reduction, for kindergarten-aged children. However, limited studies have investigated the factors influencing kindergarten-aged children's PA engagement from the perspective of their teachers. This qualitative study aimed to identify factors that could help promote PA among kindergarten-aged children from teachers' perspectives, including facilitators, barriers, and teachers' recommendations. METHODS: Fifteen kindergarten teachers (age range: 28-50 years; mean age: 38.53 years) with teaching experience ranging from 2 to 31 years (mean: 16.27 years) were recruited from Shanghai municipality, Henan, and Jiangsu provinces in China. One-on-one semi-structured interviews were conducted via face-to-face (n = 7) or telephone (n = 8) to gather insights into factors influencing PA promotion among kindergarten-aged children. The interviews were audio-recorded, transcribed, and analyzed using a constant comparison approach based on grounded theory, which involved open, axial, and selective coding processes. RESULTS: The study revealed mutual theoretical support between themes and the social-ecological model (SEM), as factors identified in the study are distributed at various levels of the SEM. Twelve factors were identified at four levels of the SEM: (1) intrapersonal level (children's personality and skills), (2) interpersonal level (family, peers, and teachers influence), (3) organizational level (school environment and resources, opportunities for kindergarten teachers' training and children's PA, design and organization of PA, and PA that children need), (4) community level (family-school partnerships). CONCLUSION: Various factors at different levels can influence kindergarten-aged children's PA. The study's findings revealed that these factors are distributed across the first four levels of SEM, with the majority being at the organizational level. These multilevel findings are expected to assist in developing and implementing more effective PA interventions for kindergarten-aged children. Future research is warranted to identify strategies for promoting PA among kindergarten-aged children at the policy level of the SEM.

"They made me feel like I mattered": a qualitative study of how mobile crisis teams can support people experiencing homelessness.

BACKGROUND: Mobile crisis teams (MCTs) can be important alternatives to emergency medical services or law enforcement for low-acuity 911 calls. MCTs address crises by de-escalating non-violent situations related to mental health or substance use disorders and concurrent social needs, which are common among people experiencing homelessness (PEH). We sought to explore how an MCT in one city served the needs and supported the long- and short-term goals of PEH who had recently received MCT services. METHODS: We conducted 20 semi-structured interviews with service recipients of the Street Crisis Response Team, a new 911-dispatched MCT implemented in San Francisco in November 2020. In the weeks after their encounter, we interviewed respondents about their overall MCT experience and comparisons to similar services, including perceived facilitators and barriers to the respondent's self-defined life goals. We analyzed interview transcripts with thematic analysis to capture salient themes emerging from the text and organized within a social-ecological model. RESULTS: Nearly all respondents preferred the MCT model over traditional first responders, highlighting the team's person-centered approach. Respondents described the MCT model as effectively addressing their most immediate needs (e.g., food), short-term relief from the demands of homelessness, acute mental health or substance use symptoms, and immediate emotional support. However, systemwide resource constraints limited the ability of the team to effectively address longer-term factors that drive crises, such as solutions to inadequate quality and capacity of current housing and healthcare systems and social services navigation. CONCLUSIONS: In this study, respondents perceived this MCT model as a desirable alternative to law enforcement and other first responders while satisfying immediate survival needs. To improve MCT's effectiveness for PEH, these teams could collaborate with follow-up providers capable of linking clients to resources and services that can meet their long-term needs. However, these teams may not be able to meaningfully impact the longstanding and complex issues that precipitate crises among PEH in the absence of structural changes to upstream drivers of homelessness and fragmentation of care systems.

Barriers to physical activity in the Iranian population: findings from the STEPwise surveillance 2021.

BACKGROUND: Physical inactivity is a critical predictor of all-cause mortality and many non-communicable diseases (NCD) including coronary heart disease, diabetes, hypertension, dementia, and several cancers. The main objective of this study was to determine the main barriers to physical activity based on the STEPwise Surveillance in Iran in 2021, to guide policymakers in developing the most effective physical activity increasing strategies. METHODS: This cross-sectional study was conducted on 27,515 female and male individuals aged over 18 years from the STEPwise Surveillance 2021. The barriers to physical activity according to the modified version of barriers questionnaire and intrapersonal, interpersonal, economic, cultural, and environmental domains based on social-ecological models were determined. Association between barriers domain and physical activity level was assessed. RESULTS: Lack of time due to job commitments (31.4%) and family (19.3%) and inappropriate physical conditions including illness, pain, injury, disability, and fatigue (30.4%) were the most frequent barriers to physical activity. Interest in sedentary leisure time activities including virtual space, computer games and watching TV were the next frequent barriers to physical activity (10.01%). Intrapersonal domain had the highest frequency (62.9%) and cultural domain had the lowest frequency (2.3%). Intrapersonal and interpersonal barriers reduced the odds of engaging in physical activity (OR: 0.62, P value < 0.001, OR: 0.76, P value < 0.001). CONCLUSION: Intra- and inter-personal domain barriers might reduce the odds of being active. Developing action plans addressing these factors is suggested to increase physical activity levels.

A quarantine paradox: understanding Gender-Based Violence (GBV) in post-COVID-19 era: insights from Golden Valley mining community, Zimbabwe.

The COVID-19 pandemic has brought unprecedented challenges globally, with a notable surge in gender-based violence (GBV) incidents. This descriptive, exploratory study conducted in the Golden Valley mining community in Kadoma, Mashonaland West Province, Zimbabwe, delves into the challenges faced by GBV survivors during and after the pandemic, alongside community perceptions of GBV in the post-COVID-19 era. Guided by Bronfenbrenner's Social-Ecological Model which offers insights into the various levels of influence on GBV behavior and experiences,aiding in the development of contextually relevant prevention strategies. The study used qualitative methods such as interviews and focus group discussions, there were 24 study participant classified by random and convenient sampling techniques including traditional and community leaders, gbv surviours medical personnel and male and female, community members. The research followed the COREQ guidelines to transparently document the research process and findings. The research sheds light on the multifaceted nature of GBV exacerbated by societal norms and economic instability in a low-income, masculine-dominated work culture experience in the COVID-19 period. Findings underscore the urgent need for comprehensive prevention programs, effective legislation, and community engagement to address GBV in post-pandemic communities. The research provides valuable lessons for enhancing GBV prevention efforts globally, emphasizing the significance of survivor voices and addressing root causes of GBV.

Identifying the Determinants of Hookah Smoking Among the Youth; A Mixed-Methods Study.

Hookahs have been rising in popularity in the United States (U.S.) especially among the youth yet not much research has been carried out to understand the various predictors of hookah use among youth. We have thus conducted a cross-sectional study with a mixed-methods triangulation design to identify the hookah use determinants at different levels of the Social Ecological Model among youth. Participants between the ages of 18-24 years were sampled purposively, between April to November 2023, following a snowballing technique from various communities in Virginia and California, United States. Data were collected via a survey, one-on-one interviews, and focus groups. The study had a total sample size of 20. We found that participants smoked for a median of 5 times in the past 30 days. The main determinants of hookah smoking included the limited knowledge of health effects and addiction, positive attitude, family and peer influence, use as a means to socially connect with others, culture, social acceptability, lack of education at school and work place, access to hookah bars and smoke shops, and lack of strict enforcement of laws to ban smoking of youth. Educational interventions should be implemented by public health authorities to target the youth, their social and communities to provide education on hookah harm and addictiveness and to restrict access to- and the production, distribution, marketing and sales of hookahs.

Building public engagement and access to palliative care and advance care planning: a qualitative study.

BACKGROUND: Research evidence suggests that a lack of engagement with palliative care and advance care planning could be attributed to a lack of knowledge, presence of misconceptions and stigma within the general public. However, the importance of how death, dying and bereavement are viewed and experienced has been highlighted as an important aspect in enabling public health approaches to palliative care. Therefore, research which explores the public views on strategies to facilitate engagement with palliative care and advance care planning is required. METHODS: Exploratory, qualitative design, utilising purposive random sampling from a database of participants involved in a larger mixed methods study. Online semi-structured interviews were conducted (n = 28) and analysed using reflexive thematic analysis. Thematic findings were mapped to the social-ecological model framework to provide a holistic understanding of public behaviours in relation to palliative care and advance care planning engagement. RESULTS: Three themes were generated from the data: "Visibility and relatability"; "Embedding opportunities for engagement into everyday life"; "Societal and cultural barriers to open discussion". Evidence of interaction across all five social ecological model levels was identified across the themes, suggesting a multi-level public health approach incorporating individual, social, structural and cultural aspects is required for effective public engagement. CONCLUSIONS: Public views around potential strategies for effective engagement in palliative care and advance care planning services were found to be multifaceted. Participants suggested an increase in visibility within the public domain to be a significant area of consideration. Additionally, enhancing opportunities for the public to engage in palliative care and advance care planning within everyday life, such as education within schools, is suggested to improve death literacy and reduce stigma. For effective communication, socio-cultural aspects need to be explored when developing strategies for engagement with all members of society.

The socio-ecological determinants of help-seeking practices and healthcare access among young men: a systematic review.

Delayed engagement with health services is a key contributor to poorer health outcomes experienced by men. Patterns of health service usage which reduce the opportunity for disease prevention and health promotion appear to be especially prominent amongst young men. To identify the multiple and intersecting determinants of young men's help-seeking practices and health services usage, this review uses the social ecological model (SEM) to guide a critical synthesis of the literature on barriers and facilitators experienced by young men in accessing health services. A systematic review was conducted across five databases (MEDLINE, Embase, PsychINFO, CINAHL and Scopus). Included studies presented primary data regarding young men's (12-24 years) barriers and/or facilitators to seeking and accessing health care. Thirty-one studies (24 qualitative and 7 quantitative) underwent data extraction, quality appraisal and thematic analysis under the guiding framework of the SEM. Seven key themes were constructed, encapsulating the perceived barriers and facilitators to help-seeking and accessing health care experienced by young men, including masculine attitudes, health literacy, social pressure, service accessibility, economic factors, service characteristics and cultural attitudes. These findings highlight the complex interplay between the individual, interpersonal, organizational and societal factors impacting young men's healthcare engagement. They also illuminate avenues for multifaceted, context-specific interventions to enhance healthcare accessibility for this group, including addressing health literacy gaps, providing culturally sensitive care and reducing cost barriers.

Parental Travel Behaviors and Children's Independent Mobility: A MultiSite Study.

PURPOSE: Children who are allowed greater independent mobility (IM) are more physically active. This study investigated associations between parents' current travel mode to work, their own IM and school travel mode as a child, and their child's IM. METHODS: Children in grades 4 to 6 (n = 1699) were recruited from urban, suburban, and rural schools in Vancouver, Ottawa, and Trois-Rivières. Parents reported their current travel mode to work, IM, and school travel mode as a child. Children self-reported their IM using Hillman's 6 mobility licenses. Multiple imputation was performed to replace missing data. Gender-stratified generalized linear mixed models were adjusted for child age, parent gender, urbanization, and socioeconomic status. RESULTS: The older a parent was allowed to travel alone as a child, the less IM their child had (boys: ß = -0.09, 95% confidence interval [CI], -0.13 to -0.04; girls: ß = -0.09, 95% CI, -0.13 to -0.06). Girls whose parents biked to work (ß = 0.45, 95% CI, 0.06-0.83) or lived in Trois-Rivières versus other sites (ß = 0.82, 95% CI, -0.43 to 1.21) had higher IM. IM increased with each year of age (boys: ß = 0.46, CI, 0.34-0.58; girls: ß = 0.38, 95% CI, 0.28-0.48). CONCLUSION: Parents who experienced IM later may be more restrictive of their child's IM. This may help explain the intergenerational decline in children's IM.

Clinician-perceived barriers and facilitators for the provision of actionable processes of care important for persistent or chronic critical illness.

AIM: To explore clinician-perceived barriers to and facilitators for the provision of actionable processes of care important for patients with persistent or chronic critical illness. DESIGN: Qualitative descriptive interview study. METHODS: Secondary analysis of semi-structured telephone interviews (December 2018 - February 2019) with professionally diverse clinicians working with adults experiencing persistent or chronic critical illness in Canadian intensive care units. We used deductive content analysis informed by the Social-Ecological Model. RESULTS: We recruited 31 participants from intensive care units across nine Canadian provinces. Reported intrapersonal level barriers to the provision of actionable processes of care included lack of training, negative emotions and challenges prioritizing these patients. Facilitators included establishment of positive relations and trust with patients and family. Interpersonal barriers included communication difficulties, limited access to physicians and conflict. Facilitators included communication support, time spent with the patient/family and conflict management. Institutional barriers comprised inappropriate care processes, inadequate resources and disruptive environmental conditions. Facilitators were regular team rounds, appropriate staffing and employment of a primary care (nurse and/or physician) model. Community-level barriers included inappropriate care location and insufficient transition support. Facilitators were accessed to alternate care sites/teams and to formalized transition support. Public policy-level barriers included inadequacy of formal education programs for the care of these patients; knowledge implementation for patient management was identified as a facilitator. CONCLUSION: Our results highlighted multilevel barriers and facilitators to the delivery of actionable processes important for quality care for patient/family experiencing persistent or chronic critical illness. IMPACT: Using the Social-Ecological Model, the results of this study provide intra and interpersonal, institutional, community and policy-level barriers to address and facilitators to harness to improve the care of patients/family experiencing persistent or chronic critical illness. REPORTING METHOD: Consolidated criteria for reporting qualitative studies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Optimizing a mentorship program from the perspective of academic medicine leadership - a qualitative study.

BACKGROUND: Effective mentorship is an important contributor to academic success. Given the critical role of leadership in fostering mentorship, this study sought to explore the perspectives of departmental leadership regarding 1) current departmental mentorship processes; and 2) crucial components of a mentorship program that would enhance the effectiveness of mentorship. METHODS: Department Division Directors (DDDs), Vice-Chairs, and Mentorship Facilitators from the Department of Medicine at the University of Toronto Temerty Faculty of Medicine were interviewed between April and December 2021 using a semi-structured guide. Interviews were audio-recorded and transcribed verbatim, then coded. Analysis occurred in 2 steps: 1) codes were organized to identify emergent themes; then 2) the Social Ecological Model (SEM) was applied to interpret the findings. RESULTS: Nineteen interviews (14 DDDs, 3 Vice-Chairs, and 2 Mentorship Facilitator) were completed. Analysis revealed three themes: (1) a culture of mentorship permeated the department as evidenced by rigorous mentorship processes, divisional mentorship innovations, and faculty that were keen to mentor; (2) barriers to the establishment of effective mentoring relationships existed at 3 levels: departmental, interpersonal (mentee-mentor relationships), and mentee; and (3) strengthening the culture of mentorship could entail scaling up pre-existing mentorship processes and promoting faculty engagement. Application of SEM highlighted critical program features and determined that two components of interventions (creating tools to measure mentorship outcomes and systems for mentor recognition) were potential enablers of success. CONCLUSIONS: Establishing 'mentorship outcome measures' can incentivize and maintain relationships. By tangibly delineating departmental expectations for mentorship and creating systems that recognize mentors, these measures can contribute to a culture of mentorship.

A Qualitative Study on Psychosocial Challenges of Patients With Cancer in Ethiopia Using the Social-Ecological Model.

Cancer diagnosis and treatment can be physically arduous, disrupting patients' social and work lives. Understanding the extent of these problems is key to addressing patients' needs, but specific psychosocial challenges have not yet been well studied in resource-limited settings. A qualitative study was conducted in the capital and two regions of Ethiopia with the aim of exploring psychosocial challenges among cancer patients. A total of 14 in-depth interviews (IDIs) and 16 focus group discussions (FGDs) were done with cancer patients, health professionals, community representatives, and religious leaders. Four separate interview guides were used to facilitate the interviews and discussions. All transcribed documents, field notes, and reflexive memos were entered into NVivo 12 software, and deductive thematic analysis using the social-ecological model was applied to summarize the main findings. At an individual level, emotional distress, suicidal risk, denial, and refusal of treatment were identified immediately after diagnosis while hopelessness, feeling depressed, and fear of death were commonly reported psychosocial challenges during the course of treatment. Involvement of family members in major treatment decisions was recognized at an interpersonal level. Our result also revealed that cancer patients had strong social support from family members and close friends. In the community, traditional medicine and religious rituals were considered an alternative treatment for cancer. The findings indicate that counselling and psychoeducation are crucial for cancer patients, family members, and close friends. Awareness creation programmes should be delivered through collaboration with religious leaders and traditional healers.

Factors associated with clinical nurse's mental health: a qualitative study applying the social ecological model.

BACKGROUND: The prevalence of burnout, depression, and anxiety among Chinese nurses was 34%, 55.5%, and 41.8% respectively. Mental health problems have significant impacts on their personal well-being, work performance, patient care quality, and the overall healthcare system. Mental health is influenced by factors at multiple levels and their interactions. METHODS: This was a descriptive qualitative study using phenomenological approach. We recruited a total of 48 nurses from a tertiary hospital in Changsha, Hunan Province, China. Data were collected through focus group interviews. Audio-recorded data were transcribed and inductively analysed. RESULTS: Four major themes with 13 subthemes were identified according to the social ecological model: (1) individual-level factors, including personality traits, sleep quality, workplace adaptability, and years of work experience; (2) interpersonal-level factors, encompassing interpersonal support and role conflict; (3) organization-level factors, such as organizational climate, organizational support, career plateau, and job control; and (4) social-level factors, which included compensation packages, social status, and legislative provision and policy. CONCLUSIONS: Our study provides a nuanced understanding of the multifaceted factors influencing nurses' mental health. Recognizing the interconnectedness of individual, interpersonal, organizational, and social elements is essential for developing targeted interventions and comprehensive strategies to promote and safeguard the mental well-being of nurses in clinical settings. TRIAL AND PROTOCOL REGISTRATION: The larger study was registered with Chinese Clinical Trial Registry: ChiCTR2300072142 (05/06/2023) https://www.chictr.org.cn/showproj.html?proj=192676 . REPORTING METHOD: This study is reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Bolstering Access to HIV-Related Health care in Zimbabwe Among Young Mothers Living With HIV: Lessons Learned on HIV Health Promotion From Zvandiri's Young Mentor Mother Program.

HIV disproportionately affects adolescent girls and young women living in Southern Africa. Rates of perinatal HIV transmission are high in this population, emphasizing the need for targeted health promotion and public health programming to improve the health of young mothers living with HIV. Zvandiri, a non-profit organization in Zimbabwe, created the Young Mentor Mother (YMM) program in response to this issue. This health promotion program uses peer-led service delivery conducted by trained young mothers living with HIV, called YMMs. We conducted semi-structured virtual interviews (N = 29) among Zvandiri staff and YMMs to identify benefits and challenges, and to inform future program scaling. We applied thematic analyses to the transcriptions. Participant narratives revealed several themes, including three key benefits from the YMM program: (1) peer support, (2) holistic care, and (3) women's empowerment. Participants also shared barriers to the success of the program, reflecting two overarching dimensions: (1) barriers related to scaling up the YMM program and (2) challenges related to addressing socio-structural factors. Barriers to scale-up included limited funds and resources, and food insecurity. Socio-structural challenges included HIV-related stigma, cultural and geographic differences, and intimate partner violence (IPV). These challenges align with the social-ecological model, whereby structural factors (lack of funding, food insecurity), community factors (HIV-related stigma, socio-cultural differences in accepting HIV care), and interpersonal factors (IPV) affect the implementation and scale-up of the program. We recommend future adopters of the YMM program to tailor the model for their community, prioritize peer supporter's well-being, foster women's empowerment, and adopt a holistic care approach.

Barriers and facilitators to physical activity for young adult women: a systematic review and thematic synthesis of qualitative literature.

BACKGROUND: Physical activity (PA) has many benefits in preventing diseases and maintaining physical and mental health. Women, in particular, can benefit from regular PA. However, women's PA did not increase over the past decade globally, and the situations faced by women are often gender-specific. Healthy young adult women's PA does not receive as much attention as older women and adolescent girls, yet, they face the same situation of low level of PA. This review aims to explore and synthesise the self-identified barriers and facilitators to young adult women's participation in PA from qualitative research studies and offer suggestions for future studies and programs designed for this population. METHODS: A systematic search was conducted in Pubmed, Web of Science, Scopus, Medline, and SPORTDiscus for studies published between January 2000 to February 2022 to identify qualitative studies on the barriers and facilitators of young adult women's PA between ages 18 to 40. The search yielded 694 studies initially, of which 23 were included. The research quality of included studies was appraised using the Critical Appraisal Skills Programme (CASP) tool. Data were extracted and thematically analysed based on the tenets of the social-ecological model (SEM). RESULTS: Identified barriers and facilitators were grouped into different levels of the SEM, with the most frequently cited factors being time, body image and societal beauty standards, family duty and social support, religious and cultural norms, organisation and community facilities and environment, safety issues and physical environment. Descriptive data were thematically analysed and synthesised in line with the five levels: body image, health and beauty; multiple roles, support, and PA; religious identity, cultural identity, and PA; safety issues and women's fears. CONCLUSIONS: This qualitative synthesis revealed in-depth information on barriers and facilitators influencing young adult women's PA. It highlighted that the factors young adult women face are diverse at different levels yet holistic and intertwined. Future studies on young adult women's PA should address the social-cultural influence and would benefit from applying multilevel strategies employing the SEM model. It is critical to create an open and inclusive environment and offer more opportunities for women. TRIAL REGISTRATION: PROSPERO CRD42021290519.

The epidemiology of homicide among older adults: retrospective analysis using data from the Victorian Homicide Register.

Older adult homicide is unique and under-researched, requiring immediate attention due to the rapidly ageing population. The current study aims to contribute to the description of homicide at the individual, interpersonal, incident and community levels. This research comprised a whole of state jurisdiction population-based retrospective analysis of homicide deaths of older adults aged 65 years and older reported to the Coroner between 2001 and 2015. Descriptive statistical analyses were conducted to compare older adult homicides by sex and the deceased-offender relationship. There were 59 homicide incidents involving 23 female and 36 male deceased (median age=72 years) and 16 female and 41 male offenders (median age=41 years). Individual factors included the following: Deceased frequently had a recorded physical illness (66%), and over one-third were born overseas (37%) or had recent contact with general practitioners and human services (36%). Offenders frequently had a history of illicit drug or alcohol use (63%), diagnosed mental illness (63%) and historical exposure to violence (61%). Interpersonal factors included the following: The deceased-offender relationship tended to be intimate or familial (63%). Incidents factors included the following: incident predominantly occurred in the victim's home (73%), involving the use of a sharp object (36%), bodily force (31%) or blunt force (20%). The older adult homicide is characterised by poor health in the victim, mental illness, substance abuse or a history of conflict in the either the victim or the offender, familial deceased-offender relationship and the home as the incident location. The results identify future prevention opportunities in clinical and human services settings.