Vaccination status, awareness, and its correlates among healthcare workers in the Delhi-National Capital Region (NCR): a mixed-method study.

Introduction: Healthcare workers (HCWs) are on the frontline of infections. To safeguard HCWs from occupational exposure to infections and to curb nosocomial infection a set of vaccines has been recommended for them by the WHO. Hence, we aimed to assess the vaccination status, awareness, and its correlates amongst HCWs in the Delhi-NCR. Method: The study used a cross-sectional mixed-method approach from January to April 2023. For the quantitative arm, a structured questionnaire was circulated to the participants in conveniently-selected private and government tertiary care hospitals of the Delhi-NCR, both through e-survey using Google form, and in person, data were collected on socio-demographics, vaccination status, and awareness. SPSS version 25 was used for the analysis. For the qualitative arm, in-depth interviews were conducted and data were analyzed manually. Results: Out of 387 participants (62.8% males, 37.2% females), the awareness about the vaccines recommended for HCWs was 64.1%. However, only 15.3% of HCWs were completely aware of all the recommended vaccines. SARS CoV-2, Polio, Hepatitis B, and BCG had the highest vaccination coverage, 97.4%, 87.9%, 83.7%, and 50.9%, respectively. It was found that gender, education, type (private or governmental) of tertiary care hospital, and profession had a significance (p<0.05) on the vaccination status score and awareness of all WHO-recommended vaccines (AOR=7.6, 95% CI, 3.24-18.0). The qualitative arm further augmented the findings. Conclusion: The study reveals insufficient awareness and vaccination status regarding recommended vaccines. Prioritizing the preparation of unified standard guidelines for Indian HCWs and involving concerned stakeholders is crucial.

A National Evaluation of Undergraduate Nursing and Midwifery Curricula.

AIM: To conduct a comprehensive review of Undergraduate Nursing and Midwifery Curricula leading to registration in Ireland. DESIGN: A mixed methods approach using a curriculum evaluation framework that was underpinned by the philosophy and principles of appreciative inquiry. METHODS: Five separate workstreams completed an evaluation of national policy documents and international curriculum documents, a literature review and two phases of stakeholder engagement including a graduate survey and peer-grouped stakeholder focus groups. The workstreams were emulated for the professions of nursing and midwifery. RESULTS: National policy indicates a significant shift in healthcare delivery to the community environment, with a strong focus on the social determinants of health and a flexible interprofessional workforce. International curricula review revealed that nursing and midwifery education was split equally between academia and clinical practice at bachelor's degree level. Graduates were assessed for clinical competence with a variance of four to seven domains of competence evident for nurses and five principles for midwives. Direct entry midwifery was not widely available. The graduate survey identified that students were satisfied with the academic components of the curriculum; however, significant challenges in clinical placement were reported. Stakeholder focus groups reported a need for a learner-focused approach to the curricula, increased access to education, a deeper understanding and appreciation of the various roles required to educate nurses and midwives and a recognition of midwifery as a separate profession. CONCLUSION: There is a need for a significant revision of the current nursing and midwifery curricula to meet the future healthcare needs of the diverse patient population with a community-focused delivery. REPORTING METHOD: The good reporting of a mixed methods study was used to guide the development of this manuscript. PATIENT OR PUBLIC CONTRIBUTION: An Expert Advisory Group (EAG) was appointed to oversee the conduct of the research project and advise the research team as requested. There were five service user representatives included in the membership of the EAG. This included one representative from each of the divisions of the nursing and midwifery register in Ireland. A separate stakeholder engagement focus group was also conducted for the research upon the request from the service users.

Sentiment of Nurses Towards Artificial Intelligence and Resistance to Change in Healthcare Organisations: A Mixed-Method Study.

BACKGROUND: Research identified preliminary evidence that artificial intelligence (AI) has emerged as a transformative force in healthcare, revolutionising various aspects of healthcare delivery, from diagnostics to treatment planning. However, integrating AI into healthcare systems in Egypt is challenging, particularly concerning healthcare professionals' acceptance and adoption of these technologies. This mixed-method study aimed to explore the sentiment of nurses at different organisational levels towards AI and resistance to change in healthcare organisations. METHODS: A mixed-method design was employed, with quantitative data collected through a survey of 500 nurses using the general attitudes towards AI and resistance to change scale and qualitative data from semi-structured interviews with 17 nurses. Quantitative data were analysed using descriptive and inferential statistics, while qualitative data were analysed thematically. RESULTS: The survey demonstrated that positive attitudes were inversely correlated with resistance behaviour and resistance to change. Additionally, perceptions of AI's usefulness, ease of use and value were strongly and positively correlated with positive attitudes and negatively correlated with negative attitudes. Moreover, the influence of colleagues' opinions, self-efficacy for change and organisational support showed significant positive correlations with positive attitudes towards AI and negative correlations with negative attitudes. Qualitatively, nurses cited obstacles such as lack of familiarity with AI technologies, biases affecting decision-making, technological challenges, inadequate training and fear of technology replacing human interaction. Readiness for AI integration was associated with the necessity of training and the timing of AI use. CONCLUSION: Nurses demonstrated varied understanding of AI's applications and benefits. Some acknowledged its potential for efficiency and time-saving, while others highlighted a need for up-to-date knowledge. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Introduction and Effectiveness of Early Clinical Exposure Among Dental Students in Pre-clinical Prosthodontics.

BACKGROUND: Lack of patient contact in the pre-clinical prosthodontics curriculum makes it difficult for the students to comprehend and correlate the series of complex steps involved in complete denture fabrication. Early clinical exposure in the second year of the undergraduate program will facilitate a smooth transition of dental students from pre-clinics to clinics, thereby helping to mitigate the lacunae existing in the present curriculum. MATERIALS AND METHODS: A non-randomized prospective educational interventional study was conducted among 50 second-year dental students. Early clinical exposure in the form of clinical demonstration for complete denture steps of border molding and jaw relation was given subsequent to the completion of didactic and laboratory sessions. Pre- and post-multiple-choice question tests were conducted to explore students' knowledge. Student perception towards early clinical exposure was assessed using a self-administered anonymous questionnaire, while faculty perception was gauged with the help of in-depth interviews. RESULTS: A statistically significant difference was observed when pre- and post-multiple-choice question test mean scores were compared, showing an overall improvement in students' knowledge following early clinical exposure. Students and faculty held a positive perception towards the program and found it to be useful in enhancing the overall learning experience of the students. Faculty expressed their concern regarding limited manpower, paucity of time, and difficulty in integrating early clinical exposure into the present timetable. CONCLUSION: Early clinical exposure can be integrated into the traditional pre-clinical prosthodontics curriculum with appropriate time and manpower allocation. Faculty sensitization and training workshops need to be conducted before implementing this program.

Evaluation of the Continuing Education Training "Beratende für Digitale Gesundheitsversorgung" ("Consultant for Digital Healthcare"): Protocol for an Effectiveness Study.

BACKGROUND: The digital transformation in health care requires training nursing and health professionals in the digitally competent use of digital assistive technologies (DAT). The continuing education training "Beratende für digitale Gesundheitsversorgung" ("Consultant for Digital Healthcare") was developed to fill this gap. The effectiveness of the training program will be assessed in this study. OBJECTIVE: The primary objective is to record and measure the participants' learning success. We will assess whether the previously defined teaching intentions, learning objectives, competencies, and participants' expectations have been achieved and whether a transfer of learning occurred. The secondary objective is participant satisfaction and feasibility of the training. The tertiary objective is the successful transfer of DAT by participants in their institutions. METHODS: Approximately 65 nursing and health care professionals will participate in the pilot phase of the further training and evaluation process, which is planned in a mixed methods design in a nonsequential manner. The different methods will be combined in the interpretation of the results to achieve a synaptic view of the training program. We plan to conduct pre-post surveys in the form of participant self-assessments about dealing with DAT and content-related knowledge levels. Exploratory individual interviews will also be conducted to build theory, to examine whether and to what extent competence (cognition) has increased, and whether dealing (affect) with DAT has changed. Furthermore, an interim evaluation within the framework of the Teaching Analysis Poll (TAP) will occur. The knowledge thereby gained will be used to revise and adapt the modules for future courses. To assess the transfer success, the participants create a practical project, which is carried out within the training framework, observed by the lecturers, and subsequently evaluated and adapted. RESULTS: We expect that the learning objectives for the continuing education training will be met. The attendees are expected to increase their level of digital competence in different skills areas: (1) theoretical knowledge, (2) hands-on skills for planning the application and practical use of DAT, (3) reflective skills and applying ethical and legal considerations in their use, (4) applying all that in a structured process of technology implementation within their practical sphere of work. CONCLUSIONS: The aim of this study and appropriate further training program are to educate nursing and health care professionals in the use of DAT, thereby empowering them for a structured change process toward digitally aided care. This focus gives rise to the following research questions: First, how should further training programs be developed, and which focus is appropriate for addressee-appropriate learning goals, course structure, and general curriculum? Second, how should a training program with this specific content and area be evaluated? Third, what are the conditions to offer a continued program? INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/57860.

Implementing peer support work in mental health care in Germany: The methodological framework of the collaborative, participatory, mixed-methods study (ImpPeer-Psy5).

BACKGROUND: Starting in the 1990s in the United States, individuals with lived experience of mental health crises and recovery have been employed as peer support workers (PSWs) internationally. However, the implementation of PSW in clinical contexts remains challenging. METHODS: This manuscript presents and discusses the methodological framework of the ImpPeer-Psy5 study on the PSW implementation in the German mental healthcare sector. This study used a mixed-methods and collaborative research approach, as well as participatory research strategies. After describing the study design, populations, teamwork and assessments, the epistemic challenges of its methodological framework will be critically discussed and how it has iteratively shaped the object of study. DISCUSSION AND PRACTICAL IMPLICATIONS: The healthcare, policy and funding context of PSW implementation as well as the study's methodological framework have differently influenced the ways in which the implementation of PSW has been conceived in this study. The choice of a collaborative or participatory methodological framework is advised to better align research questions and procedures to the specific needs and challenges of PSWs and other stakeholders concerned with PSW implementation. PATIENT AND PUBLIC CONTRIBUTION: The research team of the ImpPeer-Psy5 study was collaboratively staffed by a portion of researchers who also identify as users or survivors of psychiatric services. A nonprofit organization for the training of PSWs served as a practice partner throughout the research process. Different participatory formats involve a significant number of diverse stakeholders relevant to PSW implementation.

Parents' perceptions of patient safety in paediatric hospital care-A mixed-methods systematic review.

AIM(S): To identify and summarize evidence on paediatric patient safety in a hospital setting from parents' point of view. DESIGN: A mixed-methods systematic review. PROSPERO ID: ID number CRD42023453626. DATA SOURCES: PubMed, Scopus, ScienceDirect, the Cochrane Library and the Wiley database were searched in July 2023. REVIEW METHODS: Two researchers independently applied eligibility criteria, selected studies and conducted a quality appraisal. Data-based convergent synthesis and thematic content analysis were employed. RESULTS: Twelve studies were included: eight qualitative research studies, two cross-sectional studies, one non-randomized experimental study and one mixed-methods study. The results were grouped into two themes-parental perceptions of inclusion in paediatric patient safety and parental perceptions of exclusion from paediatric patient safety-and comprised seven main subthemes: comfort in communication, parental engagement, communication difficulties, withdrawal from activity, uncertainty about available information and threats to patient safety. CONCLUSIONS: Parents are willing to be engaged in care but require support from healthcare professionals, as they are often anxious about the condition of their children and actions they believe might be helpful. They need to be treated as valuable partners and be engaged in communication and decision processes. IMPACT: The development and implementation of interventions involving parents in ensuring the safety of hospitalized paediatric patients should be of the utmost priority to healthcare organizations, as the common theme throughout the included studies was the need for improved communication with and recognition of parents as allies. REPORTING METHOD: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist was followed. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Delirium care burden of intensive care nurses caring for patients undergoing open-heart surgery: A mixed-method research.

BACKGROUND: Delirium is an acute confusional state characterized by inattention, cognitive dysfunction and an altered level of consciousness. Delirium causes negative outcomes in patients, and patients with delirium increase the workload of nurses. Therefore, it is important to recognize the challenges and burdens experienced by nurses caring for patients with delirium. AIM: To determine the subjective burden experienced by intensive care nurses caring for patients who have undergone open-heart surgery. STUDY DESIGN: A mixed-method sequential explanatory design. A non-probability purposive sampling method was used for the quantitative stage. Using OpenEpi, we employed the method of sample calculation with an unknown universe. The sample size of the quantitive study comprised 130 nurses. Quantitative data were collected with Google survey. For gathering qualitative data, online video interviews were conducted with 10 nurses, an interpretive phenomenological approach was used and content analysis was performed. RESULTS: In the quantitative phase, we found that the subjective burden was high. In the qualitative phase, five main themes emerged: difficulty in recognizing delirium, physical burden, emotional burden, burden in care management of patients with delirium and the effect of patients with delirium on other patients. The nurses experienced physical and emotional burden in delirium management and felt lonely while caring for patients with delirium. CONCLUSIONS: Because nurses play a key role in the care of patients with delirium, reducing the burden nurses experience when caring for patients with delirium should be considered important in ensuring that this patient population receives adequate care. RELEVANCE TO CLINICAL PRACTICE: Delirium patients create a care burden for intensive care nurses. To reduce this burden of care, in-service training in patient management and bedside teaching support should be provided to nurses. Furthermore, the use of a valid scale to diagnose delirium should be integrated into health policies. Nurses should not be left alone in the management of delirium. Managing delirium patients with a team including physicians, nurses and professionals from other health disciplines will ensure that patients receive high-quality care, thereby reducing the care burden of nurses.

Nursing students' perceptions of a good death: A mixed method study.

BACKGROUND: Social aging tendencies and increasing chronic disease burdens draw people's attention to the concept of a good death. OBJECTIVE: This study investigated how Chinese nursing students perceive a good death. DESIGN: A mixed quantitative and qualitative design. PARTICIPANTS AND SETTING: Four hundred and ninety-three nursing students from one mainland China university and one Macao SAR university participated in the study. METHODS: The Good Death Inventory (Chinese version) was used to collect quantitative data. Qualitative data was collected through semi-structured interviews. Four hundred seventy-two questionnaires were collected, and 21 participants were interviewed. Quantitative and qualitative data were analyzed through statistics and thematic analysis, respectively. RESULTS: Chinese nursing students gained an average score of 3.76 ± 0.39 in GDI-C. Students from mainland China, female, and with senior grades scored higher in the GDI-C (p < 0.05). Students' good death perception comprised four themes: positive psychological status, no physical suffering, open and supportive social surroundings, and spiritual/religious perfection. Mainland China and Macao students showed high consistency in their ranking of good death dimensions. The first five rankings in GDI-C were domains of being respected as an individual, dying in a favorite place, preparation for death, good relationships with family/medical staff, and environmental comfort. The last five rankings in GDI-C were domains of religious and spiritual comfort, independence, unawareness of death, pride and beauty, and not being a burden to others. CONCLUSION: Chinese nursing students had a moderate degree of good death perception, characterized by the emphasis on social domains. Nursing students from mainland China and Macao SAR shared a similar perception of a good death in the Chinese context. More hospice care opportunities should be provided to students to train their empathy. Educators should guide students to apply principles of respect/dignity and open communication in the nursing practice.

Self-care styles of patients with chronic obstructive pulmonary disease: A mixed methods case study.

BACKGROUND: In people affected by chronic obstructive pulmonary disease (COPD), self-care is crucial for improving quality of life, decreasing symptom burden, and reducing health care-related costs. Unlike other chronic conditions, little is known about the factors that influence different self-care styles in COPD patients. OBJECTIVES: To explore the factors that could influence the self-care styles of patients with COPD. METHODS: A mixed methods case study design was used. Quantitative and qualitative data were collected at the same stage in a purposive sample of patients with COPD through questionnaires, interviews, and focus groups. Data were analyzed separately and then integrated to compare the cases. RESULTS: Thirty-seven patients with COPD were recruited from an outpatient clinic, pulmonary rehabilitation unit and online in a patient support group. On average, participants scored below the level of adequacy in all self-care dimensions. Self-care maintenance was influenced by patient age, education level, and economic status. Most participants reported performing self-care behaviors, while some did not because they found it difficult or because they did not recognize their importance. When the quantitative and qualitative data of patients with higher and lower levels of self-care were integrated, four different styles of self-care were identified according to COPD severity, psychological distress and level of self-efficacy: proactive, inactive, reactive, and hypoactive. CONCLUSIONS: Personal, clinical, psychological, and social factors not only influence the level of self-care performed by COPD patients but also contribute to the understanding of different self-care styles. This knowledge could support health care professionals in tailoring educational interventions.

A Mixed-Method Study of the Utilization and Determinants of Private Health Insurance Schemes in the Residents of Rural Communities in Central India: A Study Protocol.

Background Private health insurance plays a critical role in healthcare financing, yet its utilization and determinants in rural settings still need to be studied, particularly in Central India. This study aims to address this gap by investigating the utilization and determinants of private health insurance schemes among residents of rural communities in Central India. Materials and methods A convergent parallel mixed-method study design, consisting of quantitative and qualitative approaches, will be employed. Quantitative data will be collected through structured questionnaires administered to residents aged 18 and above within the field practice area of a tertiary medical college hospital. Qualitative data will be gathered through in-depth interviews with key stakeholders. Statistical analysis will include descriptive and inferential statistics, while thematic analysis will be employed for qualitative data (CTRI Number CTRI/2024/06/069155). Conclusion The findings of this study will provide valuable insights into the utilization and determinants of private health insurance schemes in rural communities of Central India. By identifying barriers and facilitators to insurance uptake, policymakers and healthcare providers can develop targeted interventions to improve healthcare access and affordability in rural areas. In addition, the study will contribute to the existing literature on private health insurance utilization in India, informing future research endeavors and policy initiatives.

Adoptees' experiences of using direct-to-consumer genetic testing and determinants of this use: A mixed study in Quebec.

Adoptees' use of direct-to-consumer genetic testing (DTC-GT) is known to raise both ethical and emotional issues, and it can also challenge their identity. The objective of the present study was to describe the experiences of DTC-GT use among adoptees living in Quebec and to better understand the benefits and disadvantages of use. We adopted a mixed method approach whereby a questionnaire comprising standardized scales was administered to 143 adoptees who had used genetic testing and 40 adoptees who had not. Semi-structured interviews were performed with five respondents from the DTC-GT use group. The quantitative and qualitative data were analyzed and integrated together using the Pillar Integration Process. The results highlighted familial reunion as the primary motivation for the use of DTC-GT among responding adoptees. Reported challenges included needing help with results interpretation, as well as the need for autonomy in the ownership of the results. Participants describe not being particularly concerned by potential ethical issues, describing the benefits of the tests as more important than possible disadvantages. Overall, participants had a good experience of using DTC-GT, and users were less anxious. Various factors associated with the use and experience of use were highlighted (age, psychological distress, community membership, etc.). The results from this study provide much-needed information about adoptees' needs regarding DTC-GT, highlight key risk factors, and introduces best practice recommendations so that adoptees are properly informed and supported when pursuing DTC-GT.

Potential, Pitfalls, and Future Directions for Remote Monitoring of Chronic Respiratory Diseases: Multicenter Mixed Methods Study in Routine Cystic Fibrosis Care.

BACKGROUND: The current literature inadequately addresses the extent to which remote monitoring should be integrated into care models for chronic respiratory diseases (CRDs). OBJECTIVE: This study examined a remote monitoring program (RMP) in cystic fibrosis (CF) by exploring experiences, future perspectives, and use behavior over 3 years, with the aim of developing future directions for remote monitoring in CRDs. METHODS: This was a mixed methods, multicenter, observational study in 5 Dutch CF centers following a sequential explanatory design. Self-designed questionnaires using the technology acceptance model were sent out to people with CF who had a minimum of 12 months of experience with the RMP and local health care professionals (HCPs). Questionnaire outcomes were used to inform semistructured interviews with HCPs and people with CF. Qualitative findings were reported following the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Anonymous data on use frequency of all people with CF were analyzed. RESULTS: Between the second quarter of 2020 and the end of 2022, a total of 608 people with CF were enrolled in the program, and a total of 9418 lung function tests and 2631 symptom surveys were conducted. In total, 65% (24/37) of HCPs and 89% (72/81) of people with CF responded to the questionnaire, and 7 HCPs and 12 people with CF participated in semistructured interviews. Both people with CF and HCPs were positive about remote monitoring in CF care and found the RMP a good addition to daily care (people with CF: 44/72, 61%; HCPs: 21/24, 88%). Benefits ranged from supporting individual patients to reducing health care consumption. The most valued monitoring tool was home spirometry by both people with CF (66/72, 92%) and HCPs (22/24, 92%). Downsides included the potential to lose sight of patients and negative psychosocial effects, as 17% (12/72) of people with CF experienced some form of stress due to the RMP. A large majority of people with CF (59/72, 82%) and HCPs (22/24, 92%) wanted to keep using the RMP in future, with 79% (19/24) of HCPs and 75% (54/72) of people with CF looking forward to more replacement of in-person care with digital care during periods of well-being. Future perspectives for the RMP were centered on creating hybrid care models, personalizing remote care, and balancing individual benefits with monitoring burden. CONCLUSIONS: Remote monitoring has considerable potential in supporting people with CF and HCPs within the CF care model. We identified 4 practice-based future directions for remote monitoring in CF and CRD care. The strategies, ranging from patient driven to prediction driven, can help clinicians, researchers, and policy makers navigate the rapidly changing digital health field, integrate remote monitoring into local care models, and align remote care with patient and clinician needs.

Exploring the Role of Masturbation as a Coping Strategy in Women.

Objectives: Recent findings suggest that individuals tend to engage in masturbation more frequently when experiencing elevated levels of psychological stress, and there appears to be distinguishable effects on stress response based on clitoral and vaginal stimulation. In this concurrent mixed-method study, we aimed to investigate this association in more detail using a convenience sample of 370 women. Methods: Quantitative data were used to examine whether higher psychological distress was associated with higher levels of masturbation frequency depending on the mode of stimulation, while qualitative data gave further insight into this association. Results: In regression analysis, higher levels of general and subscale-specific psychological distress were significantly associated with higher clitoral, but not combined clitoral and vaginal masturbation frequency. Qualitative content analysis showed that masturbation was used as a reliable coping strategy and self-care strategy which induced positive affective states, such as happiness and relaxation. Very few women reported negative feelings associated with masturbation. Mixed-method analysis revealed that women who indicated to use of masturbation for coping or self-care or who reported negative feelings did not differ in their level of psychological distress from women who did not report using it. The positive effects of masturbation were not related to the mode of stimulation. Conclusions: Results showed the complexity of how psychological distress is related to sexual activity and point to the potential benefits of masturbation for dealing with psychological distress and for enhancing general well-being. Our results have various implications for researchers, clinicians, and society.

Clients' satisfaction with cervical cancer screening services and influencing factors at public health facilities in Debre Markos town, Northwest Ethiopia, 2022/23: a convergent parallel mixed method.

BACKGROUND: Satisfaction is defined as the perceived fulfillment of patient or client needs and desires through the delivery of healthcare services. In developed countries, more than 60% of women have been screened for cervical cancer. However, only 12% of women in sub-Saharan Africa have been screened for precancerous cervical lesions. There is limited evidence on client satisfaction with cervical cancer screening services (CSCCSS) in Ethiopia, particularly, there is no study conducted by mixed method in the Amhara region. OBJECTIVE: The study aimed to assess clients' satisfaction with cervical cancer screening services and influencing factors among women screened in Debre Markos town public health facilities in Northwest Ethiopia, 2022/23. METHODS: A convergent parallel mixed methods design was conducted in Debre Markos town's public health facilities from October 10th, 2022 to January 10th, 2023. For the quantitative wing, a total of 401 cervical cancer screening service users were selected using a systematic random sampling technique. Data were collected using an interviewer-administered structured questionnaire. Clients were interviewed on exit in a private area far from the screening unit and the data were entered into Epi-data version 4.6.0.2, then exported to STATA version 14 for analysis. A binary logistic regression model was fitted to identify factors associated with client satisfaction with cervical cancer screening services. The qualitative data were collected through in-depth and key informant interviews using a semi-structured topic guide. The data were analyzed using a thematic analysis approach with Open code software (version 4.0.2.3). RESULT: The quantitative wing revealed that overall, 65% (95% CI: 60-69) of respondents were satisfied with the cervical cancer screening services they received. Gender of the provider (AOR: 6.11, 95% CI: 3.23-11.55, p-value = 0.000), waiting time (AOR: 4.77, 95% CI: 1.32-17.31, p-value = 0.017), clients' knowledge (AOR: 0.26, 95% CI: 0.12-0.59, p-value = 0.001), and clients' attitude (AOR: 6.43, 95% CI: 3.43-12.03, p-value = 0.000) were significantly associated with CSCCSS. QUALITATIVE RESULT: The thematic analysis revealed three themes. Theme 1: facility-related barriers (shortage of skilled manpower, shortage of infrastructure, providers' skill gap, unavailability of full service, leadership problem, long waiting time). Theme 2: client-related barriers (poor knowledge and attitude, gender preference). Theme 3: facility-related facilitators (free service, presence of supportive partners). CONCLUSION: According to the findings of this study, two-thirds of clients were satisfied with cervical cancer screening services, which was lower than the national target of 80%. Long waiting time, male gender of the service provider, unfavorable attitude, and good knowledge of clients were identified as significant factors negatively affecting client satisfaction with cervical cancer screening.

Value chain interventions for improving women's economic empowerment: A mixed-methods systematic review and meta-analysis: A systematic review.

Background: Value chain interventions have become widespread throughout the international development sector over the last 20 years, and there is a need to evaluate their effectiveness in improving women's welfare across multiple dimensions. Agricultural value chains are influenced by socio-cultural norms and gender dynamics that have an impact on the distribution of resources, benefits, and access to opportunities. While women play a critical role in agriculture, they are generally confined to the least-valued parts of the value chain with the lowest economic returns, depending on the local, social and institutional contexts. Objectives: The review assesses the effectiveness of approaches, strategies and interventions focused on women's engagement in agricultural value chains that lead to women's economic empowerment in low- and middle-income countries. It explores the contextual barriers and facilitators that determine women's participation in value chains and ultimately impact their effectiveness. Search Methods: We searched completed and on-going studies from Scopus, Web of Science Core Collection (Social Sciences Citation Index [SSCI], Science Citation Index Expanded [SCI-EXPANDED], Conference Proceedings Citation Index - Science [CPCI-S], Conference Proceedings Citation Index - Social Science & Humanities [CPCI-SSH], and Emerging Sources Citation Index [ESCI]), International Bibliography of the Social Sciences, EconLit, Business Source Premier, APA PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane, Database of Systematic Reviews, CAB Abstracts and Sociological Abstracts. We also searched relevant websites such as Consortium of International Agricultural Research Centers (CGIAR); the International Fund for Agricultural Development (IFAD); AgriProFocus; the Bill & Melinda Gates Foundation (BMGF); Donor Committee for Enterprise Development; the UN Food and Agriculture Organisation (FAO); the International Labour Organisation (ILO); the Netherlands Development Organisation; USAID; the Swiss Agency for Development and Cooperation; the International Food Policy Research Institute; World Agroforestry; the International Livestock Research Institute; the Foreign, Commonwealth & Development Office; the British Library for Development Studies (BLDS); AGRIS; the IMMANA grant database; the 3ie impact evaluation database; Innovations for Poverty Action (IPA); The Abdul Latif Jameel Poverty Action Lab (J-PAL); the World Bank IEG evaluations; the USAID Development Data Library; Experience Clearinghouse; the proceedings of the Agriculture, Nutrition and Health Academy conference; the proceedings of the Centre for the Study of African Economies (CSAE) Conference; the proceedings of the North East Universities Development Consortium (NEUDC) Conference; and the World Bank Economic Review. The database search was conducted in March 2022, and the website search was completed in August 2022. Selection Criteria: The review includes value chain interventions evaluating the economic empowerment outcomes. The review includes effectiveness studies (experimental and non-experimental studies with a comparison group) and process evaluations. Data Collection and Analysis: Two review authors independently assessed studies for inclusion, extracted data, critically appraised the studies, and synthesised findings. Results: We found that value chain interventions are successful in improving the economic conditions of their intended beneficiaries. The interventions were found to improve women's economic outcomes such as income, assets holdings, productivity, and savings, but these effects were small in size and limited by low confidence in methodological quality. The meta-analysis suggests that this occurs more via the acquisition of skills and improved inputs, rather than through improvement in access to profitable markets. The qualitative evidence on interventions points to the persistence of cultural barriers and other constraints. Those interventions implemented in Sub-Saharan Africa and South Asia are consistently more successful for all outcomes considered, although there are few studies conducted in other areas of the world. Conclusions: The review concludes that value chain interventions empower women, but perhaps to a lesser extent than expected. Economic empowerment does not immediately translate into empowerment within families and communities. Interventions should either moderate their expectations of empowerment goals, or they should be implemented in a way that ensures higher rates of participation among women and the acquisition of greater decision-making power.

Online peer support for mental health in individuals with post-acute sequelae of COVID-19: A pre-post pilot study with mixed methods.

Aim: This pilot examined the effect of online peer support on mental health problems among individuals with post-acute sequelae of COVID-2019 (PASC). Methods: A single-arm pre-post design of online peer-support design consisting of eight sessions of 1 h per week with three to six participants and two facilitators per group was performed. Participants were recruited from online communities, social media, and medical clinics for the PASC between May and August 2023. The degrees of depression, anxiety, loneliness, social withdrawal, and self-esteem were measured pre- and post-intervention. Participants' statements during the sessions were analyzed using thematic analyses. Results: Of the 18 participants, three dropped out of the interventions, and 17 (including two participants who dropped out) completed the pre- and post-intervention questionnaires. Depression severity significantly decreased in the paired t-test and linear mixed model. The following interactions were extracted: conveying the same feelings, dealing with difficulties, showing empathy, enhancing the atmosphere, and adapting to suit health conditions. Impressions extracted from participating in the interventions included feelings of emotional support, a sense of bonding, changes in perspective, changes in behaviors or new actions through participation, inadequacy during sessions, and adverse effects associated with participation. Conclusion: Online peer support may be helpful in treating depression in individuals with PASC.

'There is no such word as palliative care for us at the moment': A mixed-method study exploring the perceptions of healthcare professionals on the need for palliative care in Bhutan.

Background: The need for palliative care is ever-increasing globally. However, it is least developed or not available in most low-and-middle-income-countries including Bhutan. Objective: This study was aimed at exploring the perspectives of Bhutanese healthcare professionals on the need for palliative care in the country. Design: This is a cross-sectional, mixed-method study. Setting/subjects: The study sites included all levels of healthcare in Bhutan and involved doctors, nurses, physiotherapists, pharmacists, health assistants and Drungtshos (traditional physicians). Data were collected through surveys, focus group discussions and in-depth interviews. Results: While the majority of the participants were directly involved in taking care of terminally ill and dying patients, only 14% had received some form of palliative care training for a duration ranging from 1 day to 6 weeks. Ninety-five percent of the participants reported that they faced challenges related to lack of palliative care knowledge and skills; limited resources including analgesics; shortage of doctors and nurses and lack of a palliative care team; issues with low illiteracy and financial challenges among patients; and policies and other systemic issues. The qualitative data generated four major themes: past adverse experiences; unique and complex needs for palliative care; challenges faced while caring for terminally ill and dying patients; and the urgent need for palliative care in Bhutan. Conclusion: Bhutanese healthcare professionals had very limited exposure to palliative care. This study identified a crucial need for palliative care and informs the development of an appropriate palliative care model for Bhutan.

'There is no such word as palliative care for us at the moment': A study exploring the perceptions of healthcare professionals on the need for palliative care in Bhutan Palliative care is least developed in most low-and-middle-income-countries. This study was aimed at exploring the perspectives of healthcare professionals on the need for palliative care in Bhutan. Utilising both quantitative and qualitative approaches, the study sites included all levels of healthcare in Bhutan and involved doctors, nurses, physiotherapists, pharmacists, health assistants and Drungtshos (traditional physicians). Data were collected through surveys, focus group discussions and in-depth interviews. While the majority of the participants were directly involved in taking care of terminally ill and dying patients, only 14% had received some form of palliative care training for a duration ranging from one day to six weeks. Ninety five percent of the participants reported that they faced challenges related to lack of palliative care knowledge and skills; limited resources including analgesics; shortage of doctors and nurses and lack of a palliative care team; issues with low illiteracy and financial challenges among patients; and policies and other systemic issues. The qualitative data generated four major themes: past adverse experiences; unique and complex needs for palliative care; challenges faced while caring for terminally ill and dying patients; and the urgent need for palliative care in Bhutan. Bhutanese healthcare professionals had very limited exposure to palliative care. This study identified a crucial need for palliative care and informs the development of an appropriate palliative care model for Bhutan.

Autoimmune rheumatic transitional care model development.

AIM: To develop a transitional care model for autoimmune rheumatic disease patients based on the needs analysis. METHOD: Mixed Method, Explanatory sequential design (QUAN-qual) has been conducted. Quantitative data were collected through medical record and structured interviews. Qualitative study has been done through Focused Group Discussion (FGD), based on problems met in previous quantitative study. We have done the coding processed, followed by determining categories and themes to reach the intercoder agreement with peer-debriefing. Analysis of the final results of research was assisted by the external auditor to form a model of care. RESULT: The quantitative data collection from 27 patients showed that the transition age was 18-19 year-old, age of onset 4-17 year-old, 23 patients (85, 2%) with SLE, 4 patients (14.8%) with JIA. Two patients (7.4%) had different diagnosis from the pediatric clinic, 1 patient (3.7%) had no diagnosis from previous clinic. Drug switching during transition occurred in 14 patients (51.9%) and 3 patients (11.1%) has no known medication history. Data regarding disease activity at initial diagnosis were not available in 26 patients (96.3%). The combined FGD analysis found several key words related to "the need of change" in RSCM autoimmune rheumatic transitional care. CONCLUSION: A development of transitional care model for autoimmune rheumatic disease consist of documents about service algorithm, transfer documents, systematic work protocols with education check list has been done.

Effectiveness and Acceptability of Cognitive Behavioral Therapy and Family Therapy for Gaming Disorder: Protocol for a Nonrandomized Intervention Study of a Novel Psychological Treatment.

BACKGROUND: Gaming disorder (GD) is a new official diagnosis in the International Classification of Diseases, 11th Revision, and with its recognition, the need to offer treatment for the condition has become apparent. More knowledge is needed about the type of treatment needed for this group of patients. OBJECTIVE: This study aims to evaluate the effectiveness and acceptability of a novel module-based psychological treatment for GD based on cognitive behavioral therapy and family therapy. METHODS: This study is a nonrandomized intervention study, with a pretest, posttest, and 3-month follow-up design. It will assess changes in GD symptoms, psychological distress, and gaming time, alongside treatment satisfaction, working alliance, and a qualitative exploration of patients' and relatives' experiences of the treatment. RESULTS: This study started in March 2022 and the recruitment is expected to close in August 2024. CONCLUSIONS: This study evaluates the effectiveness and acceptability of a psychological treatment for patients with problematic gaming behavior and GD. It is an effectiveness trial and will be conducted in routine care. This study will have high external validity and ensure that the results are relevant for a diverse clinical population with psychiatric comorbidity. TRIAL REGISTRATION: ClinicalTrials.gov NCT06018922; https://clinicaltrials.gov/study/NCT06018922. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56315.