The Hindi Version of the Breastfeeding Self-Efficacy Scale-Short Form: Reliability and Validity Assessment.

BACKGROUND: Despite the cultural sanctity and elevation of breastfeeding practices, nearly one in two Indian women nationwide are unable to practice exclusive breastfeeding (EBF). Early identification of mothers at risk of reduced breastfeeding through a suitable instrument can enable targeted interventions for breastfeeding support. OBJECTIVES: We conducted this study with the objectives of translation into Hindi and to psychometrically test the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) and to ascertain the sociodemographic and other correlates of breastfeeding self-efficacy. METHODS: The BSES-SF was translated into Hindi using a back and forth translation process to ensure linguistic validity. We enrolled a total of 210 married women who were mothers of infants at an urban primary health center in Delhi, India. RESULTS: The Cronbach's alpha for the Hindi translation of the BSES-SF was 0.87 with all except one correlation coefficient <0.3. We conducted an exploratory factor analysis using principal component analysis that revealed a two-component solution, which explained 47.9% and 16.7% of the total variance, respectively. Mothers perceiving higher social support registered significantly higher mean BSES-SF scores, indicating a greater confidence in their breastfeeding abilities (P = 0.01). However, breastfeeding self-efficacy was unrelated to the mother's age, parity, and education. The women planning to breastfeed partially had lower BSES-SF scores compared to the woman adhering to EBF norms (P < 0.001). CONCLUSION: The Hindi version of the BSES-SF demonstrates good reliability and validity and can also explain previous and planned breastfeeding behavior in mothers of infants.

The determinants of out-of-pocket health-care expenses for diabetes mellitus patients in India: An examination of a tertiary care government hospital in Delhi.

OBJECTIVE: To assess the determinants of out-of-pocket (OOP) expenses on diabetes-related treatment incurred in patients attending outpatient clinics in a tertiary care hospital in Delhi, India. STUDY DESIGN: A cross-sectional analysis of baseline data from a quasi-experimental study was conducted over 8 months in 2016 in a major tertiary care hospital in Delhi. METHODS: The study included 375 diabetes patients up to 65 years of age on treatment for at least a year without significant complications. Data were collected through a patient interview schedule. RESULTS: Of the previous six scheduled appointments, at least two missed appointments were seen in 267 (71.2%) patients. The average patient's OOP expenditure on diabetes-related medicines was ₹63.5 a month, a similar amount was spent on traveling to and from health facilities. Sixty-four (17.1%) patients took antidiabetic medication for <85% of the days in the previous 3 months. CONCLUSION: There exists a high burden of missed clinic appointments among diabetes patients in tertiary care government health settings in India. This appears to be related to the high cost in terms of both time and money involved in attending appointments for the modest benefit of a dispensation of a 15-day drug refill. Health policy measures focused on strengthening medication coverage need to explore the balance of costs and benefits when determining the frequency of clinical appointments in these settings.

Improving the assessment of medication adherence: Challenges and considerations with a focus on low-resource settings.

Improving patient survival and quality of life in chronic diseases requires prolonged and often lifelong medication intake. Less than half of patients with chronic diseases globally are adherent to their prescribed medications which preclude the full benefit of treatment, worsens therapeutic outcomes, accelerates disease progression, and causes enormous economic losses. The accurate assessment of medication adherence is pivotal for both researchers and clinicians. Medication adherence can be assessed through both direct and indirect measures. Indirect measures include both subjective (self-report measures such as questionnaire and interview) and objective (pill count and secondary database analysis) measures and constitute the mainstay of assessing medication adherence. However, the lack of an inexpensive, ubiquitous, universal gold standard for assessment of medication adherence emphasizes the need to utilize a combination of measures to differentiate adherent and nonadherent patients. The global heterogeneity in health systems precludes the development of a universal guideline for evaluating medication adherence. Methods based on the secondary database analysis are mostly ineffectual in low-resource settings lacking electronic pharmacy and insurance databases and allowing refills without updated, valid prescriptions from private pharmacies. This significantly restricts the choices for assessing adherence until digitization of medical data takes root in much of the developing world. Nevertheless, there is ample scope for improving self-report measures of adherence. Effective interview techniques, especially accounting for suboptimal patient health literacy, validation of adherence questionnaires, and avoiding conceptual fallacies in reporting adherence can improve the assessment of medication adherence and promote understanding of its causal factors.

An Epidemiological Study on Burden of Hearing Loss and Its Associated Factors in Delhi, India.

INTRODUCTION: Hearing loss is the second most common cause of years lived with disability (YLD). The present study was conducted with an objective to determine the prevalence, severity, and sociodemographic correlates of hearing loss among people aged 3 months and above in selected areas of Delhi, India. MATERIAL AND METHODS: A community-based cross-sectional study was conducted in selected rural and urban areas of Delhi among population aged 3 months and above. Of the total sample size of 664, 85 study subjects (17 households) were taken from the rural area, and 579 (116 households) were taken from urban areas. The hearing test and ear examination was carried out using handheld oto-acoustic emission (OAE) in children <5 years of age and pure tone audiometry in individuals above 5 years of age. SPSS software was used for data analysis. Chi-square test was used to analyze difference between proportions. RESULTS: Overall prevalence of hearing loss was 25.1%. Conductive hearing loss was present among 61 (10.3%) subjects, mixed hearing loss was found among 5 (0.8%) subjects, and sensorineural hearing loss among 94 (15.8%) subjects. On OAE, 62 (89.9%) children passed the test, and 7 (10.1%) were referred. Increasing age, female gender, and low education were significantly associated with hearing loss. CONCLUSION: There was high prevalence of hearing loss in the study sample. Urgent interventions are required to identify individuals with hearing loss so that its serious complications can be reduced.