Cross-cultural adaptation of the Moroccan Arabic dialect version of the Primary Care Assessment Tool.

OBJECTIVE: To adapt the Primary Primary Care Assessment Tool-Adult Edition into the Moroccan Arabic dialect and to assess its reliability and validity from the perspective of Moroccan adult patients. METHOD: A committee of experts carried out the cross-cultural adaptation of the Primary Care Assessment Tool. The adapted questionnaire was subject to forward and backward translation and a pilot study. Exploratory factor analysis assessed the internal consistency, reliability, and construct validity of items and scales. Finally, descriptive statistics were performed on the final factor structure. RESULTS: A 43-item Moroccan Arabic dialect version of the Primary Care Assessment Tool-Adult Edition was developed. It consisted of six multi-item scales that represented the four main dimensions of primary care: first contact, continuity, comprehensiveness, and coordination. Four derived dimensions were included: cultural competence, communication, advice, and community orientation. All six scales demonstrated robust internal consistency, item-total solid correlations, and construct validity. The calculated Cronbach's alpha coefficients ranged from 0.78 to 0.90. CONCLUSIONS: Comprehensive metric analyses supported the reliability and validity of the Moroccan Arabic dialect version of the Primary Care Assessment Tool-Adult Edition in assessing core primary care domains from the patients' experience. This tool could be used for future research on primary care in Morocco.

General practitioners' knowledge, attitudes and practices towards health promotion in Morocco.

Background: Health promotion (HP) is a part of the general practitioners' (GPs) competencies defined by the World Organization of Family Doctors. The implementation of HP in their practice is unsatisfactory. Aims: The aim of this study was to explore GPs knowledge, attitudes and practices in Morocco about HP at the primary healthcare services. Methods: A cross-sectional study was conducted using an online self-administrated questionnaire including, knowledge, attitudes and practices of GPs toward HP. Descriptive and bivariate analyses were conducted. Results: Two hundred and forty GPs responded to our questionnaires, the sex ratio was 1.12 with an average age of 40.46 ± 9.05 years. More than half of our participants perceived HP as a concept indistinct from prevention, 70.4% believed that HP refers to the biomedical model. On a Likert scale of 1-5, the level of HP knowledge was 2.71 ± 1.13. The most discussed topics with the population were tobacco, alcohol, overweight and obesity. Statistically significant association was found between the competencies of GPs in lifestyle behaviours and the practice of this competence. Conclusion: The knowledge of GPs remains insufficient, and their practices focus more on the areas in which they feel competent, which requires the implementation of specific training for the development of GPs skills in HP.

Gender norms and access to sexual and reproductive health services among women in the Marrakech-Safi region of Morocco: a qualitative study.

INTRODUCTION: Improving access to sexual and reproductive health remains a public health challenge, especially for women, whose access is affected by several determinants, such as gender inequality, which is the underlying barrier to all other determinants. Many actions have been carried out, but much remains to be done before all women and girls can exercise their rights. This study aimed to explore how gender norms influence access to sexual and reproductive health services. METHOD: A qualitative study was conducted from November 2021 to July 2022. The inclusion criteria were women and men aged over 18 years old, living in the urban and rural areas of the Marrakech-Safi region in Morocco. A purposive sampling method was used to select participants. Data were obtained through semi-structured interviews and focus groups with selected participants. The data were coded and classified using thematic content analysis. RESULTS: The study highlighted inequitable, restrictive gender norms that lead to stigmatization and affect the sexual and reproductive healthcare-seeking behavior and access of girls and women in the Marrakech-Safi region. These most common gender norms for women include parental refusal, stigmatization, and social exclusion of girls from sexual and reproductive health education services; strong decision-making power of family members over contraceptive use and women's adherence to pregnancy monitoring and access to supervised delivery; and culturally constructed role allocation, assigning a reproductive role to women and making them responsible for the health of new-borns. CONCLUSION: Sexual and reproductive health projects must strive to be gender sensitive. Gender-blind projects are missed opportunities to improve health outcomes and advance gender equality.

Well-being assessment in medical students since the COVID-19 pandemic: a mixed method study.

Introduction: Since the COVID-19, changes have occurred for the Moroccan medical students, which represent a vulnerable population. Coping with this situation could be difficult. Our objective was to estimate and understand the psychosocial barriers to the medical students' well-being at the Faculty of Medicine and Pharmacy of Marrakesh (FMPM) by evaluating their coping strategies, difficulties and needs. Methods: We conducted a mixed method study among pre-graduate medical students. For the quantitative part, we did a cross-sectional study using an online four-part self-administered questionnaire. We compared Likert scales of perceived well-being before and one year after the lockdown. The scales ranged from 0 (very low state of well-being) to 10 (complete state of well-being). Coping strategies were assessed by the Brief-COPE questionnaire. The qualitative perspective was a case-study with semi-structured interviews using an interview guide based on the literature review. Finally, a one-phase triangulation analysis, underlined by a convergence model, was done. Results: We had 355 participants for the quantitative part (participation rate of 16.6%). The mean age was 19.2±1.6. The female/male sex ratio was 1.8. The first cycle students represented 76%. The well-being mean state was better before than after the pandemic (7.8 vs 5.4; p<0.001). The main coping strategy was the acceptance of the situation (5.8±1.7). According to the students, their principal need for promoting their well-being at the faculty was having courses about technologies for studies (89.3%). For the qualitative part, we interviewed 16 students. Thirteen had a decline of their well-being after the lockdown. Isolation and adaptation to e-learning were the principal difficulties. However, mainly, they adopted engaging in coping strategies. Conclusion: The medical students' well-being decreased since the COVID-19 pandemic. Students adopting coping strategies were in the best well-being state. Psychosocial and solution-based measures should be put in place at the FMPM to foster the students' well-being.

The social accountability of nursing training institutes in Morocco: The knowledge, perceptions and realization of its aspects.

INTRODUCTION: The social accountability (SA) challenges health professional training institutes to reorient their missions to train the graduates aligned with the society's priority needs and produce quality, population centered care. The objective was to assess the knowledge, perceptions, and implementation of SA by nursing education institutions. METHOD: The cross-sectional observational survey was conducted at the Higher Institute of Health Professions and Techniques of Marrakech (ISPITS-M) and its annexes between May 17 and June 4, 2020, using a mixed methodology. The data were collected through an online questionnaire, which was tested with 11 students and teachers. It was completed by 50 teachers and 213 students, recruited on a voluntary basis and was developed based on the literature review, aspects and principles of social accountability. In addition, eight semi-structured interviews were performed with administrative staff recruited by purposive sampling. RESULTS: Out of a total of 924 students and 75 teachers, 213 students and 50 teachers participated in the survey, with a response rate of 23% and 67% simultaneously. The average age was 40.2±8.9 years for the teachers and 19.7±1.3 years for the students. 36% of the students had no knowledge of SA; teachers and leaders had different perceptions and the concreteness of the aspects of SA was low. The students felt they were less prepared in social determinants of health (85%), community lifestyles to be served (85%), outreach care, and frontline work (83%). CONCLUSION: The knowledge of SA is average; there is a need to raise awareness of SA in addition to strengthening training programs and the concretization of actions in this direction.

Structured headache services as the solution to the ill-health burden of headache: 1. Rationale and description

In countries where headache services exist at all, their focus is usually on specialist (tertiary) care. This is clinically and economically inappropriate: most headache disorders can effectively and more efficiently (and at lower cost) be treated in educationally supported primary care. At the same time, compartmentalizing divisions between primary, secondary and tertiary care in many health-care systems create multiple inefficiencies, confronting patients attempting to navigate these levels (the "patient journey") with perplexing obstacles.High demand for headache care, estimated here in a needs-assessment exercise, is the biggest of the challenges to reform. It is also the principal reason why reform is necessary.The structured headache services model presented here by experts from all world regions on behalf of the Global Campaign against Headache is the suggested health-care solution to headache. It develops and refines previous proposals, responding to the challenge of high demand by basing headache services in primary care, with two supporting arguments. First, only primary care can deliver headache services equitably to the large numbers of people needing it. Second, with educational supports, they can do so effectively to most of these people. The model calls for vertical integration between care levels (primary, secondary and tertiary), and protection of the more advanced levels for the minority of patients who need them. At the same time, it is amenable to horizontal integration with other care services. It is adaptable according to the broader national or regional health services in which headache services should be embedded.It is, according to evidence and argument presented, an efficient and cost-effective model, but these are claims to be tested in formal economic analyses.

The Assessment of Student Doctors' attitude towards disabled people after teaching them a module.

OBJECTIVE: Assessing the attitude of medical students towards people with disabilities after teaching them a disability module. METHODS: Several themes were taught. To assess the attitude of disability before and after the course, we used the ATDP (Attitude towards disabled persons) scale after translating it from English into Classical Arabic using the translation-back translation method. RESULTS: 250 students benefited from this course. 78 of them were subjected to evaluation, including 20 male students (25.64%) and 58 female students (74.35%). There was no significant difference in the ATDP score between before and after among boys (before 72 (66.75-81.5) vs 72 (66, 81.5) after, p: 0.32). Among girls, there was a decrease in the ATDP score (74 (67.5-83.25) vs 70 (65-80.25), p: 0.03). No significant difference was found according to gender before and after. The ATDP construct validation in classical Arabic had a Cronbach's alpha of 0.60. The test-retest (ICC) 0.825. CONCLUSION: Although the perception towards disabled people has negatively changed among girls and while unchangeable within boys, this disability module in our faculty was a first experience in Morocco. It would be desirable to develop other educational methods in this subject matter.

Social accountability: Attitudes and awareness among undergraduate medical students in Morocco.

INTRODUCTION: As future health professionals, medical students should be aware of their social accountability and their role in the society. The aim was to assess the attitudes and awareness of medical students regarding the social accountability and to identify the factors determining their attitudes and possible levers for action. METHODS: Online survey among undergraduate students at the medical school in 2019 (N = 2128). The data collection tool was developed based on the literature review, the principles of social accountability SR and the toolkit (The development of the Students' Toolkit on Social Accountability of Medical Schools was a collaboration between the International Federation of Medical Students' Associations (IFMSA) and the Training for Health Equity Network (THEnet). The data were collected in December by LimeSurvey software version 1.90 and analyzed by SPSS version 16 according to the usual descriptive and bivariate. The Fisher test was used to compare two percentages and the Student t-test to compare two means on two independent samples (significance level was 0.05). The verbatims were grouped and analyzed. RESULTS: 271 students participated (response rate = 12.7%). The mean age was 20.6±2.6 years (N = 257). The Female/Male ratio was 1.85. Only 33.5% had heard of social accountability. It was linked to "commitment to the community" in 75.1% of cases, "to be a good citizen" in 66.1% and "to be responsible for one's actions" in 56.4%. Nearly 79% thought that students did not really have a role in society and that they should focus on their studies. Being a member of an association was a factor determining the positive attitude towards the SA (82.1% versus 65.2%, p=0.031). Students believed that the school had some strategies of social accountability. The results of the verbatim emphasize the need to multiply the practices and opportunities for interaction with the social environment for students. CONCLUSION: The level of knowledge of the concepts by the students seems to be average. It would be necessary to look for the means to plead in favor of reinforcing our school strategies to concretize the principles of SR while training the students.

Determinants of Maternal Health Services Use among Vulnerable Women in a Rural Community in the Moroccan High Atlas.

Several factors affect the use of maternal health care services in developing countries. The aim was to describe the knowledge and attitudes of women in a rural area of the Moroccan High Atlas regarding aspects of maternal health, and to identify the determinants of use of maternal health care services. A cross-sectional study of 87 participants was conducted in a mountainous area near Marrakech utilizing two sampling methods (a door-to-door approach, and a mobile health caravan). Fisher test was used to compare two proportions, and the non-parametric Mann-Whitney test to compare two means (p value was 0.05). Median participants' age was 24 years old [15-60]. Findings indicated that husband's education (p=0.005), woman's age (p=0.011), awareness of warning signs during pregnancy (p=0.01) and use of health center for other purposes other than pregnancy (p=0.007) were important influencing factors for use of prenatal consultation services. Factors that influenced supervised birth outcomes were the age of the woman (p=0.013), her education (p=0.027) and a positive attitude towards monitoring her pregnancy by a health professional (p=0.006). To improve utilization rates for maternal health services, these factors must be considered when designing interventions that aim to improve the quality of these services in the community.