Providing and receiving support through a tailor-made mobile app: a qualitative study on experience of professionals and family caregivers to persons with dementia.

BACKGROUND: The ageing population and the rise of persons with dementia (PWD) living at home have increased the need for support by family caregivers (FC). Research suggests that most FCs are unprepared for the complex role of informal caregiving. The use of mobile applications (apps) provide a cost-effective and efficient opportunity for community-based social care professionals to provide tailor-made support to FCs. The literature indicates that there are limited mobile apps available to meet the needs of the FCs to PWD living at home. The aim of this study was to explore how social care professionals and FCs to PWD living at home experience providing and receiving support through a tailor-made mobile app named STAV. METHODS: A qualitative descriptive design was applied. Data were collected through semi-structured interviews with 11 community-based social care professionals and 19 FCs of PWD living at home. The data were analyzed inductively using thematic analysis. RESULTS: The social care professionals and the FCs' experience of providing and receiving support through a mobile app was represented by the following themes: Accessibility to support - Bridging the gap, Engaging from a distance, and Limitations of the support. CONCLUSIONS: This study highlights the need for FCs to PWD to receive support that is tailor-made to their needs as caregivers. The findings from this study can help community-based social care providers plan and organize long-distance support for FCs to PWD living at home. The findings further support the use of a mobile app as a complement to traditional means of support for FCs to PWD which can facilitate their knowledge, awareness, and self-care management.

mHealth based intervention by social care professionals to support family caregivers to persons with dementia living at home in Sweden (Caregiver Connect): a randomized controlled trial.

BACKGROUND: The majority of persons with dementia in Sweden reside in their own homes with support from family members. Approximately, 12% of persons with dementia have immigrant background. Within the next 20 years, the number of persons with dementia who are non-ethnic Swedes is said to double. Family caregivers with immigrant backgrounds are noted to receive less support in the community than ethnic Swedes and rate their health status lower than ethnic Swedish peers. The Swedish National Board of Health and Welfare have highlighted the importance of follow-up support for family caregivers with immigrant backgrounds as there is a recognized gap in research and available information tailored to meet the needs of this group. PURPOSE OF THE STUDY: The purpose of the study is to test effectiveness of an mHealth based intervention through which community social workers can improve caregiving competence of non-European immigrant family caregivers of people with dementia living at home in Sweden. The overarching aim is to reduce caregiver burden and depressive symptoms, and improve quality of life. METHODS: A randomized controlled trial (RCT) including wait list control group will be performed consisting of an intervention group (A, n = 44) and a wait list control group (B, n = 44), totaling a sample size of 88. On completion of the 10-weeks long intervention in the intervention group, the intervention will be delivered to group B. Effect of the intervention will be analyzed between and within groups over time. The content of the educational component of the intervention is inspired by the iSupport manual developed by the World Health Organization. The contents, in the form of a booklet, aims to equip the family caregivers with structured information on understanding dementia as a condition and its management at home, including self-care guidance designed specifically for family caregivers themselves. DISCUSSION: Similar telephone-delivered intervention studies targeted for family caregivers to persons with dementia are ongoing in Malaysia and will start in India using the same booklet adapted to the local context. These studies will provide evidence on the effectiveness of using digital technologies to deliver support to those who may not be reached or adequately served by the traditional healthcare system. TRIAL REGISTRATION: ISRCTN registry, Registration number ISRCTN64235563.

Health-related quality of life among adult patients with cancer in Uganda - a cross-sectional study.

OBJECTIVES: The study aimed to investigate the prevalence and factors associated with poor health-related quality of life in adults with cancer in Uganda. METHODS: This cross-sectional study surveyed 385 adult patients (95% response rate) with various cancers at a specialised oncology facility in Uganda. Health-related quality of life was measured using the EORTC QLQ-C30 in the Luganda and English languages. Predetermined validated clinical thresholds were applied to the instrument in order to identify patients with poor health-related quality of life, that is, functional impairments or symptoms warranting concern. Multivariable logistic regression was used to identify factors associated with poor health-related quality of life in six subscales: Physical Function, Role Function, Emotional Function, Social Function, Pain and Fatigue. RESULTS: The mean age of the patients was 48 years. The majority self-reported poor functioning ranging between 61% (Emotional Function) to 79% (Physical Function) and symptoms (Fatigue 63%, Pain 80%) at clinically concerning levels. These patients were more likely to be older, without formal education and not currently working. Being an inpatient at the facility and being diagnosed with cervical cancer or leukaemia was a predictor of poor health-related quality of life. CONCLUSION: Improvement of cancer care in East Africa requires a comprehensive and integrated approach that addresses various challenges specific to the region. Such strategies include investment in healthcare infrastructure, for example, clinical guidelines to improve pain management, and patient education and support services.

Main findings: The majority of adult patients attending specialized cancer care in Uganda report impaired physical and emotional functioning, and pain, at levels that merit clinical concern.Added knowledge: The large proportion of in- and outpatients with poor self-reported health-related quality of life indicates supportive care needs, exceeding corresponding figures from high-income settings.Global health impact for policy and action: Improvement of cancer care in East Africa requires a comprehensive approach that should include investment in healthcare infrastructure, e.g. clinical guidelines to improve pain management, and patient education and support services.

Families adapting to COVID-19 in urban Bangladesh: "It felt like the sky fell apart and we were in shock".

Background: The COVID-19 epidemic has especially impacted the urban population in Bangladesh. Studies on COVID-19 have primarily focused on the patient's perspective. It is important to understand the experience of family members who adopt caregiving roles, as the experience of COVID-19 also impacts, and is impacted by, household members. This study aimed to explore the challenges, preventative practices, health-seeking behaviour, and perspectives of navigating the health care system from the perspective of family members of persons who had recovered from COVID-19 during its initial outbreak in Bangladesh. Methods: Participants of this qualitative study were family members (n = 7) of persons who had recovered from COVID-19 (either suspected or confirmed). Semi-structured in-depth interviews were conducted over telephone. Thematic analysis was used to analyse the data. Results: Analysis revealed three key themes: changes in everyday practices and choice of health care, challenges and constraints, and unexpected positive outcomes. All the themes had temporal dimension to them with four distinct phases: early stage of COVID-19, strict lockdown phase, COVID-19 diagnosis and illness period and post COVID-19 recovery. Conclusion: The importance of maintaining social contact for psychological wellbeing during critical times was evident in the study. Online communication and social media enabled participants to remain 'socially connected' which further supported their mental health. Increased attention to hygiene practices both before, during and subsequent to COVID-19 infections within families was reported. Physical distancing in case of a suspected or confirmed COVID-19 case was found logistically and socially impractical in a densely populated city.

Experiences of aftermath of COVID-19 in relation to social, financial and health related aspects among previously hospitalized patients: a qualitative exploration.

Background: There is increasing evidence of long-term consequences of COVID-19. The world has seen multidimensional impact of the pandemic and Bangladesh is no exception to that. Policymakers in Bangladesh laid out strategies to curb the initial spread of COVID-19. However, long-term consequences of COVID-19 received little or no attention in the country. Evidence suggests that people presumed to be recovered face multidimensional post-covid consequences. This study aimed to describe the aftermath of COVID-19 in relation to social, financial and health related aspects among previously hospitalized patients. Methods: This descriptive qualitative study includes participants (n = 14) who were previously hospitalized for COVID-19 and returned home after recovery. The participants were part of a mixed method study from which they were purposively selected. Semi-structured in-depth interviews were conducted over telephone. Inductive content analysis was used to analyze the data. Results: Twelve sub-categories emerged from the data analysis which converged into five main categories. The main categories included perspective on physical health, financial struggle, life adjustment, interplay between different domains, and spontaneous support. Conclusion: The lived experiences of COVID-19 recovered patients highlighted multidimensional impact on their daily lives. Physical and psychological wellbeing found to be related to the effort of restoring financial status. People's perception about life altered due to pandemic, for few the pandemic was an opportunity to grow while others found it difficult to accept the hardship. Such multidimensional post COVID-19 impact on people's lives and wellbeing holds considerable implication for response and mitigation plan for future related pandemics.

Lessons learned from pandemic response to COVID-19 in Bangladesh: NGO-based emergency response framework for low- and middle-income countries.

BACKGROUND: Response to COVID-19 pandemic in Bangladesh was led by the Government of Bangladesh aided by Non-Government Organisations (NGO) among others. The aim of the study was to explore the activities of such an NGO to understand the philosophy, aspiration and strategy to plan and implement an effective response to COVID-19 pandemic in Bangladesh. METHODS: A case study of a Bangladeshi NGO called SAJIDA Foundation (SF) is presented. From September to November 2021, using document review, field observation and in-depth interviews, four aspects of their COVID-19 pandemic related activities was explored - a) why and how SF initiated their COVID response; b) what adaptations were made to their usual programmes; c) how SF's response to COVID-19 were designed and what were the anticipated challenges including overcoming measures; and d) perception of the staff about SF's activities related to COVID-19. Fifteen in-depth interviews were conducted with three groups of SF staff: frontliners, managers and leaders. RESULT: The impact of COVID-19 has been beyond health emergencies and posed multidimensional challenges. SF took a two-pronged approach - aid the government to respond to the emergency and adopt an all-inclusive plan to address diverse challenges related to overall well-being of the population. The underlying strategy of their response has been to: define the challenge of COVID-19 and identify required expertise and resources, ensure people's health and social wellbeing, adjust existing organisational processes, ensure functional partnership with other organisations for effective resource and task sharing, and safeguard health and wellbeing of the organisation's own employees. CONCLUSION: The findings suggest a '4C framework' including four components as the basis of a comprehensive response to emergencies by NGOs: 1. Capability assessment to identify who are in need and what is needed; 2. Collaboration with stakeholders to pool resources and expertise; 3. Compassionate leadership to ensure health and social safety of the employees which ensures their dedication in managing the emergency; and 4. Communication for quick and effective decision making, decentralisation, monitoring and coordination. It is expected that this '4C framework' can help NGOs to embark on a comprehensive response to manage emergencies in resource constrained low- and middle-income countries.

Evidence of mental health-related morbidities and its association with socio-economic status among previously hospitalized patients with symptoms of COVID-19 in Bangladesh.

Introduction: The long-term impact of COVID-19 on mental health, particularly in relation to socio-economic vulnerabilities, has received little attention. This study reports the prevalence of mental health-related symptoms among previously hospitalized patients after recovery from COVID-19, and its association with socio-economic status (SES). Methods: Data collection of this cross-sectional study was conducted during February-April 2021, among previously hospitalized patients with COVID-19 like symptoms, on average six months after their discharge from the hospital. Using DASS-21, a validated scale to document symptoms of depression, anxiety, and stress, information on mental health-related symptoms were recorded from 481 respondents along with sociodemographic and economic information through telephone interviews. Chi-square tests were performed to identify significant group differences. Multinomial logistic regression analyzed the association between the changes in socioeconomic characteristics and mental health-related symptoms. Relative index of inequality (RII), slope index of inequality (SII), and concentration index (CIX) were applied to capture relevant inequalities in relation to mental health-related symptoms. Results: Eleven percent of the respondents reported changes in employment status, nearly half changes in income and expenditure. Forty-five percent reported symptoms of depression, anxiety and/or stress, and 12% reported coexistence of all three symptoms. Women [Adjusted Odds Ratio, AOR: 2.95; 95% Confidence Interval, CI: 1.39-5.68], and those who reported changes in occupation [AOR: 3.04; 95% CI: 1.01-9.08] and expenditure [AOR: 2.46; 95% CI: 1.12-5.37] were more likely to report all three mental health-related symptoms compared to men and those without changes in occupation and expenditure. The older age group was less likely [AOR: 0.96; 95%CI: 0.93-0.99] to report coexistence of all three symptoms compared to their younger counterparts. Negative values of concentration index (CIX) indicate that any one mental health-related symptom was significantly concentrated among those with lower expenditure and poor SES. Conclusion: This study will help in addressing mental health-related challenges after recovery from COVID-19 among the identified vulnerable groups through relevant community-based and clinical response, including counseling services, in Bangladesh and similar LMIC contexts.

Value co-creation with family caregivers to people with dementia through a tailor-made mHealth application: a qualitative study.

BACKGROUND: Digitalization has been recognized as an efficient and cost-effective solution to address the increasing need for care due to the ageing population and the rise in people with dementia. This has subsequently increased the need to also care for family caregivers in community settings. Another benefit of digitalization is the introduction of new service concepts within service-dominant logic namely, value co-creation, which is changing the dynamics in healthcare, transitioning from a provider-centric to a customer-centric approach. The literature indicates that this transition is a slow process in healthcare due to the complex service context consisting of multi-stakeholders, with a fragmented decision-making process. This has resulted in limited research on how individuals co-create value through technology. The study aimed to explore how family caregivers to people with dementia living at home, as consumers of healthcare services co-create value in a multi-stakeholder context through a tailormade mHealth application. METHODS: A qualitative explorative design was used. Data were collected through semi-structured interviews with 12 family caregivers of people with dementia living at home. The data were analyzed deductively using qualitative content analysis. RESULTS: The findings show how family caregivers to people with dementia as healthcare consumers, engaged with a mHealth application and other actors in their service network through different levels of value co-creation activities. CONCLUSION: This paper showed a willingness among family caregivers to people with dementia living at home, who mostly consisted of older people, to implement new technology to assist them with their caregiving tasks. The different value co-creation activities adopted by the family caregivers generated different levels of experiential value such as support, knowledge, and increased access to healthcare.

Factors in the psychosocial work environment of staff are associated with satisfaction with care among older persons receiving home care services.

Older persons in Sweden are increasingly encouraged to continue living at home and, if necessary, be supported by home care services (HCS). Studies have examined whether the work environment of staff has an impact on the experiences and well-being of older persons in residential care facilities, but few have examined such associations in HCS. This study examined associations between home care staff's perceptions of their psychosocial work environment and satisfaction with care among older people receiving HCS. The setting was 16 HCS work units. Two surveys were conducted, one on psychosocial working conditions of staff, one on satisfaction of older persons receiving HCS. For each work unit, data on individual satisfaction were matched to average values concerning psychosocial work conditions. Outcomes analysed with linear regressions were overall satisfaction and indices regarding assessment of performance of services, contact with staff and sense of security. The index for treatment by staff was analysed with ordered logistic regressions. Cluster correlated-standard error clustering on work units was used. Results showed that good working conditions were important for satisfaction with care, specifically overall satisfaction, treatment by staff and sense of security. The most important psychosocial work factors were work group climate, sense of mastery, job control, overall job strain, frustrated empathy, balancing competing needs, balancing emotional involvement and lack of recognition. Receiving more HCS hours was associated with stronger relationships between working conditions and satisfaction with care, especially with overall satisfaction and treatment by staff as outcomes. Managers and policymakers for home care need to acknowledge that the working conditions of home care staff are crucial for the satisfaction of older persons receiving HCS, particularly those receiving many HCS hours. Psychosocial work factors together with job strain factors are areas to focus on in order to improve working conditions for staff and outcomes for older persons.

"Working in the Dark": Experiences of Frontline Health Workers in Bangladesh During COVID-19 Pandemic.

Introduction: Frontline health workers (FHW) are working relentlessly to combat the COVID-19 pandemic globally. This is particularly challenging for low- and middle-income countries such as Bangladesh because of resource scarcity. Therefore, it is critical to understand the challenges of healthcare providers to help shaping a contextual pandemic response plan address current and future similar crises. Aim: This study aimed to describe the challenges faced by FHWs in Bangladesh in terms of information on COVID-19, managing patients with COVID-19, and what motivated them to continue providing service during the pandemic. Methods: This qualitative study explored the experiences of 18 FHWs who were purposely recruited from different health interventions of a development organization in Bangladesh. In-depth interviews and focus group discussions were conducted during July-August 2020 using a semi-structured interview guide. The interviews were transcribed verbatim and content analysis was used to analyze the data which led to four categories. Results: Four main categories and ten sub-categories emerged from the analysis. Categories derived from the analysis were as follows: i) experiences of the FHWs regarding information on COVID-19: "Working in the dark", ii) experience of providing care: "Patients are grateful", iii) impact on personal/family life: "Life is still in lockdown" and iv) motivation to carry on providing care. Conclusion: FHWs desire a stable information source to prepare themselves for future health care crises. Organizational support is essential for them to overcome physical and mental struggles and keep themselves motivated to continue service provision during pandemics.

Comparison of Swedish nurses' attitudes toward involving families in care over a decade.

BACKGROUND: Involving families in care benefits both patients and their families. Sweden was one of the first countries to introduce family nursing, but its effect on nurses' attitudes toward involving families in care was unknown. First, this study aimed to investigate registered nurses' attitudes about the importance of involving families in nursing care. Second, it aimed to compare these attitudes over a decade. METHODS: This comparative study was based on data from two separate studies. Data were collected using the Families Importance in Care - Nurses' Attitudes questionnaire. The first phase of data collection took place in 2009, and the second phase was conducted in 2019. RESULTS: Overall, the nurses were positive towards involving families in care, both in 2009 and 2019. Overall, no significant difference was found between the two studies from 2009 and 2019. On a subscale level, nurses reported significantly higher levels on family as a resource in the study from 2009 compared to the study from 2019. The opposite was shown for the subscales family as a burden and family as an own resource. According to the R2 values (0.002 - 0.04), the effect sizes were small. CONCLUSION: In Sweden, nurses' attitudes toward involving families in care did not change over the studied decade, despite changes in nursing, healthcare-system, and society.

Providing dementia care using technological solutions: An exploration of caregivers' and dementia coordinators' experiences.

AIM AND OBJECTIVES: To explore the experiences of caregivers of persons with dementia and dementia coordinators regarding their collaboration in care for a person with dementia and the feasibility of using technology in this collaboration. BACKGROUND: Caregivers of persons with dementia have a significant risk of developing physical strain and psychological stress due to caregiver burden. Internationally, the use of technology is rapidly evolving in health care. Dementia coordinators employed in municipalities in Denmark support caregivers of persons with dementia, thus helping management of life with dementia. The cooperation between dementia coordinators and caregivers is essential, and the use of technology in everyday life is inevitable. METHODS: A qualitative, exploratory, descriptive design was used. Data were derived from five focus group interviews in which 13 caregivers and 14 dementia coordinators participated. The participants' narratives were used to elucidate their experiences and attitudes, and data were analysed using thematic analysis. The study reports according to the COREQ checklist. RESULTS: The analysis revealed three themes: the need for creating a safety net in everyday life, the need for moving together in the right direction and the need for handling technology while preserving relational interaction. CONCLUSIONS: Technology might be used as a mediator to help ease some caregiving tasks or the burden of caregiving. However, technology is an area in which the caregivers must rely on their competences and initiatives. Even though the collaboration between caregivers and dementia coordinators was beneficial and supportive, dementia coordinators experienced technology as outside the core elements of their daily work. RELEVANCE TO CLINICAL PRACTICE: We suggest further discussion regarding who is best suited to support caregivers in making choices regarding which technologies to implement in caring for a person with dementia. If this discussion is not taken seriously, there is a risk of leaving caregivers in a technological quagmire.

Nurses' Attitudes Toward the Importance of Families in Nursing Care: A Multinational Comparative Study.

The aim of this study was to examine nurses' attitudes about the importance of family in nursing care from an international perspective. We used a cross-sectional design. Data were collected online using the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) questionnaire from a convenience sample of 740 registered nurses across health care sectors from Sweden, Ontario, Canada, and Hong Kong, China. Mean levels of attitudes were compared across countries using analysis of variance (ANOVA). Multiple regression was used to identify factors associated with nurses' attitudes and to test for interactions by country. Factors associated with nurse attitudes included country, age, gender, and several practice areas. On average, nurses working in Hong Kong had less positive attitudes compared with Canada and Sweden. The effects of predictors on nurses' attitudes did not vary by country. Knowledge of nurses' attitudes could lead to the development of tailored interventions that facilitate nurse-family partnerships in care.

Sociodemographic, economic, physical, and mental health status of previously hospitalised patients with COVID-19 symptoms in Bangladesh: Protocol for a mixed-method study.

Introduction: Not much is known about the long-term consequences of COVID-19, popularly known as long COVID. This is particularly so in terms of patterns and clusters of symptoms over time, sociodemographic and economic characteristics of patients, and related clinical history. This is crucial for resource-constrained health systems such as Bangladesh to address long COVID as a forthcoming challenge. This protocol aims to investigate the consequences of COVID-19 over time for physical and mental health and how these are associated with demographic and socio-economic factors. Methods and analysis: This mixed-method study collected information on all patients with symptoms of COVID-19 admitted to and discharged after recovery from a COVID-19-dedicated hospital in Bangladesh (N = 942), from April to December 2020. The sources of data were admission records and discharge certificates from the hospital for clinical history, cross-sectional survey on physical and mental health (assessed by DASS21 scale)-related symptoms and socioeconomic changes after recovery, and qualitative in-depth interviews on experiences of COVID-19. Interviews were conducted over the phone. Quantitative analysis was done to estimate the prevalence of physical and mental health consequences of COVID-19 after recovery and the association with socio-economic and demographic information. The qualitative analysis was performed using a thematic analysis approach. Discussion: It is imperative to understand the post-COVID consequences and related health and non-health aspects to inform evidence-based policymaking, especially for resource-poor contexts such as Bangladesh. Given the dearth of evidence in this regard, the proposed study will contribute to bridging this knowledge gap. It is important to note that this study is one of the few which presents information on post-COVID-19 consequences in the context of low- and middle-income countries and the first in Bangladesh.

Psychometric properties of the EORTC QLQ-C30 in Uganda.

BACKGROUND: Self-reported measures play a crucial role in research, clinical practice and health assessment. Instruments used to assess self-reported health-related quality of life (HRQoL) need validation to ensure that they measure what they are intended to, detect true changes over time and differentiate between subjects. A generic instrument measuring HRQoL adapted for use among people living with cancer in Uganda is lacking; therefore, this study aimed to evaluate the psychometric properties of the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 in patients with cancer in Uganda. METHODS: Adult patients with various types of cancer (n = 385) cared for at the Uganda Cancer Institute answered the EORTC QLQ-C30 in Luganda or English language, the two most spoken languages in the country. The two language versions were evaluated with regard to data quality (floor and ceiling effects and missing responses), reliability (internal consistency) and validity (construct, known-group and criterion). Construct validity was examined through confirmatory factor analysis (CFA). Mean scores were compared between groups differing in disease stage to assess known-group validity. Criterion validity was examined according to associations between two QLQ-C30 subscales (Global quality of life and Physical function) and the Karnofsky Performance Scale (KPS). RESULTS: Floor and ceiling effects were observed for several scales in the Luganda and English versions. All EORTC scales with the exception of Cognitive function (Luganda α = 0.66, English α = 0.50) had acceptable Cronbach's alpha values (0.79-0.96). The CFA yielded good fit indices for both versions (RMSEA = 0.08, SRMR = 0.05 and CFI = 0.93). Known-group validity was demonstrated with statistically significant better HRQoL reported by patients with disease stages I-II compared to those in stages III-IV. Criterion validity was supported by positive correlations between KPS and the subscales Physical function (Luganda r = 0.75, English r = 0.76) and Global quality of life (Luganda r = 0.59, English r = 0.72). CONCLUSION: The Luganda and English versions of the EORTC QLQ-C30 appear to be valid and reliable measures and can be recommended for use in clinical research to assess HRQoL in adult Ugandans with cancer. However, the cognitive scale did not reach acceptable internal consistency and needs further evaluation.

Care of family caregivers of persons with dementia (CaFCa) through a tailor-made mobile app: study protocol of a complex intervention study.

BACKGROUND: Globally, family members account for the main source of caregiving of persons with dementia living at home. Providing care to family members with dementia often has negative health consequences for caregivers such as stress, depression and low quality of life. Yet, formal support for family caregivers (FCs) is limited. Telehealth technology has the potential to provide health care and social support to FCs. This study aims to assess the effectiveness of providing support by healthcare professionals (HPs) through a mobile app in reducing stress, depressive symptoms and loneliness, and improving mental health and quality of life of FCs of persons with dementia. METHODS: Using a pragmatic intervention design, this study will use pre- and post-intervention assessment to evaluate the effectiveness of the proposed intervention in a sample of 78 FCs of persons with dementia (PWD). The intervention will be implemented by approximately 5 HPs specialized in dementia care based in the municipalities in Sweden. The main thrust of the intervention is to provide professional support, with help of an interactive mobile app, to family members in their caregiving role for PWDs. Qualitative interviews with HPs and FCs form the groundwork of the development of the mobile app. By using the app on smart phone or tablet, the FC, in groups of 8-10, will communicate with peers and a HP exchanging ideas on how to deal with PWD's behavioral and cognitive changes and get support. They will also be able to discuss stressful events and access mindfulness exercises focused on themselves. Quantitative data will be collected before and at three time points after the 8-week intervention to assess changes in the health outcomes of the FCs. In-depth interviews will be conducted after the intervention to capture the experiences of FCs and HPs regarding the ease of use and acceptability of the app. DISCUSSION: This tailor-made mobile app has the high potential to be a practical platform for supporting FCs to alleviate stress and improve mental health irrespective of distance to the nearest health care or social service center. TRIAL REGISTRATION: ISRCTN, ISRCTN46137262 . Registered 10 October 2019.

Experiences of Older Persons in Seeking Care at a Private Hospital in Urban India.

Objective: The study aims to describe the experiences of older persons in seeking health care in a private hospital in urban India. Methods: Semi-structured interviews were conducted with 50 older persons admitted in or visiting a private hospital in Hyderabad city in India between the period November 2017 and April 2018. The data were analyzed using Content Analysis. Results: Dimensions related to payment mechanisms, quality of health care staff, and hospital quality were reported to be important for the older persons. Payment mechanisms were related to discounts, insurance support, and reducing out-of-pocket expenditure. Quality of care was related to optimizing hospital operational processes like discharge time, standard of treatment, and trustworthiness of the medical staff. Discussion: Payment mechanism can be made friendly for the older persons. Quality of hospital including its staff can be enhanced by developing geriatric-specific competencies which can help them to understand and treat complex health problems specific for the older population.

Impact of Intimate Partner Violence on Infant Temperament.

Intimate partner violence (IPV) during the first year postpartum is common in Bangladesh, and many infants are exposed to hostile and aggressive environment. The aim of the current study was to investigate how IPV (physical, emotional, and sexual) impacts on the mother's perception of her infant's temperament 6 to 8 months postpartum, and whether maternal depressive symptom at 6 to 8 months postpartum is a mediator in this association. A total of 656 rural Bangladeshi women and their children 6 to 8 months postpartum were included in this study. Data were collected by structured interviews. The women were asked about physical, sexual, and emotional IPV; depressive symptoms (Edinburgh Postnatal Depressive Symptoms [EPDS]); and their perception of infant temperament assessed by the Infant Characteristic Questionnaire (ICQ). Descriptive analyses were conducted for prevalence of IPV and maternal depressive symptoms. Mediation analysis was conducted with a series of linear regressions with types of IPV as independent variables, ICQ including its subscales as dependent variables and maternal depressive symptoms as potential mediator. All the analyses were adjusted for the woman's and her husband's ages and number of children of the couple. Nearly 90% of the mothers reported some kind of IPV at 6 to 8 months postpartum. All types of IPV were directly associated with the mother's perception of her infant as unadaptable. Maternal depressive symptom was a mediating factor between physical IPV and the ICQ subscales fussy-difficult and unpredictable. In addition, depressive symptoms mediated between sexual and emotional IPV, and the mother's perception of the infant as unpredictable. The results showed that IPV influenced how mothers perceived their infant's temperament. It is important that health care professionals at maternal and child health services enquire about IPV with possibilities to refer the family or the mother and infant for appropriate support.

Young witnesses of intimate partner violence: screening and intervention.

Intimate partner violence is a public health problem worldwide. Many children witness intimate partner violence at home and are affected by it. Regardless of the degree of exposure, children growing up in violent homes experience negative effects in the form of externalising behaviour and internalising symptoms which call for targeted interventions for children. The aim of the study is to map i) the available methods of detecting child and adolescent witnesses of intimate partner violence and ii) the interventions to support them. Three databases, PubMed, PsychInfo and Social Services Abstracts, were searched for scientific publications spanning over 20 years (1997-2017). This resulted in 2,406 publications of which 15 were finally selected after screening. Analysis of the articles resulted in three categories. The process of detecting children and adolescents who witnessed IPV in their homes varied in the included studies. The children were most commonly identified through their mother or other caregivers. Very few studies were based on children's own reporting of their experiences, but were rather based on the mothers' proxy reports. Studies distinguishing between the different forms of violence witnessed by children were few. It was uncommon that children were directly identified or screened for witnessing IPV in the family.