Antenatal Care Visits, Institutional Births, and Associated Risk Factors in Afghanistan: Insights from the Multiple Indicator Cluster Survey 2022-2023.

INTRODUCTION: Insufficient use of antenatal care (ANC) services and institutional births services can elevate the maternal mortality risk in limited resource settings. Hence, the key objective of this study was to evaluate the potential association between the frequency of ANC visits and institutional birth services in Afghanistan, while also identifying other sociodemographic factors that may exert influence. Furthermore, we explored factors associated with the attendance of women at ANC visits during their pregnancy. METHODS: We employed data from the most recent Multiple Indicator Cluster Survey conducted in Afghanistan in 2022 to 2023 with a total of 8096 women aged 15 to 49. A complex survey weight-adjusted logistic regression model was used to examine factors related to institutional births, and a multinomial logistic regression model was fitted to assess the relationships between sociodemographic factors and ANC visits, adjusting for survey weights, cluster effects, and strata. RESULTS: Approximately 40% of the sample (n = 3247) had undergone 4 or more ANC visits, and 74.4% (n = 6,022) had opted for institutional birth. Women's higher education was found to be associated with ANC visits. The area of residence, wealth index, education levels of women, ownership of mobile phones, number of children, and number of ANC visits were associated with institutional births. Compared with women with no or one ANC visit, those with more than 3 visits had 31% higher odds (adjusted odds ratio, 1.31; 95% CI, 1.10-1.57) of accessing institutional births. DISCUSSION: Our findings indicate a significant association between ANC visits and use of institutional birth care. These findings carry implications for advancing safe motherhood and childbirth by enhancing women's social status.

Women's decision-making power can influence modern contraceptive use: Evidence from Bangladesh.

OBJECTIVES: It is generally believed that gender inequality and women's lack of decision-making power may restrict women's use of modern contraception, leading to high rates of unwanted pregnancies, abortions, and deaths. Evidence shows that empowered women are more likely to use modern contraception methods, but few studies have investigated this across multiple domains of empowerment. STUDY DESIGN: This study examined the associations between women's empowerment and modern contraception use in Bangladesh. Data from a sample of 16,834 married women aged 15-49 years from the Bangladesh Demographic and Health Survey 2017-2018 were analysed. METHODS: Complex survey weight adjusted logistic models were fitted to evaluate the associations after adjusting for clusters, strata, and sampling weights. RESULTS: indicate that just over half of the married women (55.7%) had used modern contraception methods. Women's empowerment was associated with contraceptive use, especially decision-making power. Women who had medium or high autonomy of household decision making were likely to have 20% (AOR = 1.20; 95% CI: 1.04-1.39) and 27% (AOR = 1.27, 95% CI: 1.11-1.45) increased odds of using modern contraceptives compared to those who scored low in the decision-making domain. The findings demonstrated strong evidence of direct influence of women's decision-making power on modern contraception use. The results also found influence of several socio-demographic factors including area of residence, husband's age, wealth index and mobile phone ownership on the use of modern contraceptives. DISCUSSION: Future interventions can focus on integrating women's empowerment into family planning programming, with a particular focus on enhancing women's autonomy in decision making.

Impact of Intimate Partner Violence on mental health among married women in Sri Lanka: a study based on Women's Wellbeing Survey-2019.

BACKGROUND: Sri Lankan married women have been reported to experience higher rates of intimate partner violence (IPV). However, research on its impact on mental health and how socio-demographic factors contribute to this association is limited. Therefore, this study aimed to examine the impact of IPV on the mental health of married women in Sri Lanka. METHODS: In this study, data from 1611 married women who participated in the 2019 Sri Lankan Women's Wellbeing Survey were analyzed. Two binary outcomes were considered: married women's mental health and their suicidal ideation. Binary logistic regression models were used to assess the association between mental health and suicidal thoughts in relation to IPV while controlling for socio-demographic factors. RESULTS: The results revealed that married women who experienced any form of violence by their spouse had a higher risk of having poor mental health conditions [AOR = 2.88 (2.20, 3.78)] and suicidal thoughts [AOR = 5.84 (4.10, 8.32)] compared to those who did not experience IPV. CONCLUSIONS: IPV is a substantial contributor to poor mental health and suicidal thoughts among Sri Lankan married women. There is an urgent need for policy interventions, such as community awareness programs, counseling services and enhanced legal protections for victims.

Protocol for a systematic review and meta-analysis of the prevalence of mental illness among nursing home residents.

BACKGROUND: There is a high prevalence of mental illness in nursing home residents compared to older adults living in the community. This was highlighted in the most recent comprehensive systematic review on the topic, published in 2010. In the context of a rapidly aging population and increased numbers of older adults requiring residential care, this study aims to provide a contemporary account of the prevalence of mental illness among nursing home residents. METHODS: This protocol was prepared in line with the PRISMA-P 2015 Statement. Systematic searches will be undertaken across six electronic databases: PubMed, Embase, Web of Science, PsycNET, CINAHL, and Abstracts in Social Gerontology. Peer-reviewed studies published from 2009 onwards which report the prevalence of mental illness within nursing home populations will be included. Database searches will be supplemented by forward and backward citation searching. Titles and abstracts of records will be screened using a semi-automated process. The full text of selected records will be assessed to confirm inclusion criteria are met. Study selection will be recorded in a PRISMA flowchart. A pilot-tested form will be used to extract data from included studies, alongside the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data. A study characteristics and results table will be prepared to present key details from each included study, supported by a narrative synthesis. Random-effects restricted maximum likelihood meta-analyses will be performed to compute pooled prevalence estimates for mental illnesses represented in the identified studies. Heterogeneity will be assessed using Cochran's Q and Higgins' I2 statistics. A Funnel plot and Egger's test will be used to assess publication bias. The GRADE approach will be used to assess the quality of the body of evidence identified. DISCUSSION: The study will provide a comprehensive and contemporary account of the prevalence of mental illness among nursing home residents. Meta-analyses will provide robust prevalence estimates across a range of presentations. Key insights will be highlighted, including potential sources of heterogeneity. Implications for residents, researchers, care providers, and policymakers will be noted. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD42023456226.

Validation of a modified problematic use of mobile phones scale to examine problematic smartphone use and dependence.

Over the past decade, the world population has experienced rapid and widespread adoption of smartphones due to their usefulness and convenience. However, researchers have identified a range of adverse behaviours associated with the adoption of smartphones and their higher use. These behaviours are collectively described as Problematic Smartphone Use and Dependence (PSUD). Despite growing research, the underlying processes and drivers leading to these behaviours are inadequately understood. This can partly be attributed to the absence of developed statistical tools and measures that allow researchers to build a comprehensive conceptual understanding of PSUD. To address this issue, this study proposes and evaluates a validated extension to the Problematic Use of Mobile Phones (PUMP) scale. The extension of this tool incorporates factors associated with substance dependence outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), including additional items to measure PSUD accurately, referred to as the modified problematic use of mobile phones (MPUMP) scale. The newly developed tool was used in a cross-sectional online survey during September and October 2022, drawing on 1018 adult Australian participants. Principal Component Analysis (PCA) and Exploratory Factor Analysis (EFA) were conducted to derive the underlying factors. The EFA revealed two distinct factors: Distraction and Dysregulation. Both factors exhibited high internal consistency, with Cronbach's Alpha coefficients of 0.92 and 0.86, respectively. A one-way analysis of variance (ANOVA) revealed significant variations inthe identified factors' mean scores across different socio-demographic characteristics. The study provides evidence that the MPUMP scale is a validated and reliable measure for accurately assessing PSUD. The study findings offer novel insights into the psychosocial and physical aspects of PSUD, providing a foundation for exploring the causes and potential interventions for PSUD.

Factors associated with married women's attitude toward intimate partner violence: A study on 20 low-and middle-income countries.

Intimate Partner Violence (IPV) is a global problem and has been reported to be significantly higher for women in Low and Middle-Income Countries (LMICs). The researchers analyzed Demographic and Health Survey (DHS) data of married women in 20 LMICs to examine those most vulnerable to accepting IPV by investigating associated risk factors. The researchers revealed a higher level of acceptance of IPV among illiterate women from poorer households in remote areas. Using these findings, the authors provide insight into ensuring and enhancing the living standards of these vulnerable women by making education more readily accessible.

Women's Attitudes Toward Intimate Partner Violence in Low- and Middle-Income Countries of Southern Asia.

PURPOSE: The present study identified the vulnerable IPV cohorts of South Asian women, and the prevalence of and predictors of the women's IPV acceptance. DESIGN: Cross-sectional survey - the United Nations Children's Fund multiple index cluster survey. SETTING: Many South Asian women are accepting of IPV. Studies mostly focus on individual countries. SUBJECT: 103 139 ever-married women from Bangladesh, Laos and Nepal. MEASURES: Women's attitudes toward IPV were measured using a set of five, fixed, binary responses. ANALYSIS: Following bivariate analysis, complex survey weight adjusted logistic regression models were fitted for individual country data, and the pooled sample. RESULTS: Of the sampled South Asian women 27.8% accepted IPV, and no major variation among countries in IPV acceptance. Education was the most reliable protector against IPV acceptance whereby, higher educational attainment systematically reduced IPV acceptance (OR = .61 [.56-.83]). Other significant protective factors were being un-married (Married OR = 1.34 [1.28-1.42]), having increased wealth (OR = .71 [.56-.83]), and being over 24 years old (OR = .88 [.83-.97]). CONCLUSION: Only education produced absolute consistency at the country and region level; there seems to be no blanket solution for regionally reducing women's IPV acceptance rates in Southern Asia. Focus on the least educated women and making education more accessible should be prioritised. Future IPV studies can consider measurement methods for women's direct exposure to patriarchal standards and within community interaction.

Factors and consequences associated with intimate partner violence against women in low- and middle-income countries: A systematic review.

Intimate Partner Violence (IPV) is a global public health issue, with notably high prevalence rates observed within Low-and Middle-Income Countries (LMICs). This systematic review aimed to examine the risk factors and consequences associated with IPV against women in LMICs. Following PRISMA guidelines, we conducted a systematic review using three databases: Web of Science, ProQuest Central, and Scopus, covering the period from January 2010 to January 2022. The study included only peer-reviewed journal articles in English that investigated IPV against women in LMICs. Out of 167 articles screened, 30 met the inclusion criteria, comprising both quantitative and mixed-method studies. Risk factors of IPV were categorised as: demographic risk factors (23 studies), family risk factors (9 studies), community-level factors (1 studies), and behavioural risk factors (14 studies), while consequences of IPV were categorised as mental health impacts (13 studies), physical impacts (5 studies), and societal impacts (4 studies). In this study, several risk factors were identified including lower levels of education, marriage at a young age, poor wealth indices, rural residential areas, and acceptance of gender norms that contribute to the prevalence of IPV in LMICs. It is essential to address these factors through effective preventive policies and programs. Moreover, this review highlights the necessity of large-scale, high-quality policy-driven research to further examine risk factors and consequences, ultimately guiding the development of interventions aimed at preventing IPV against women in LMICs.

Nurses' perspectives on medication errors and prevention strategies in residential aged care facilities through a national survey.

BACKGROUND: Medication errors are common in residential aged care facilities (RACFs) due to several factors. Effective medication management is essential to prevent medication errors among older people particularly due to the complexity of co-morbidities they can experience. OBJECTIVES: This study aimed to examine and quantify the contributing factors of medication errors from nurses' perspectives and the prevention strategies to reduce medication errors among older adults living in RACFs. METHODS: A survey with 140 completed responses from registered nurses (RNs) and endorsed enrolled nurses (EENs) working in RACFs across Australia were included in the study. The survey had 24 items, related to contributing factors of medication errors, and the prevention strategies. Descriptive statistics and exploratory factor analysis were used in the data analysis process. RESULTS: The study identified medication errors are caused by contributing factors such as use of agency staffing (70.4%) and delays in receipt of laboratory results (94.3%). However, it also identified suggestions to reduce medication errors in RACFs, for example use of electronic alerts (88.3%), and efficient laboratory communication (91.8%). Our results revealed three key factors for causes (workload, interprofessional involvement and interruptions) and suggestions (medication safety alerts, medication process improvement and effective reporting). CONCLUSION: Medication errors in RACFs are a global problem being one of the leading causes of morbidity and mortality. The knowledge and awareness of the factors associated with medication errors and the prevention strategies can guide potential quality improvement plans and contribute to minimisation of risk associated with medication safety in RACFs. IMPLICATIONS FOR PRACTICE: The study recommends strategies for best practices in medication management such as interprofessional collaboration, implementing standardised policies and electronic alerts to reduce medication errors in RACFs.

Investigating factors affecting HIV/AIDS knowledge among women in low and middle-income countries in Asia.

Sustainable Development Goal 3 focuses on reducing HIV/AIDS spread, for which disseminating correct information on the disease is required. This study investigated factors associated with HIV/AIDS knowledge among women in several Asian LMICs. Global Multiple Indicator Cluster Survey-6 (MICS-6) for Bangladesh, Lao, Mongolia and Nepal were assessed. Bivariate analysis and generalised linear regression models were fitted. Overall, 60% of the respondents were aware or heard of the existence of HIV/AIDS, with 63.2% having transmission knowledge and 80.4% misconception knowledge. Results revealed that several demographic factors such as wealth index, education and access to information had a significant association with HIV/AIDS knowledge. Mongolia and Nepal have formal programmes in place that may provide policy and implementation advantages compared to Bangladesh and Lao.

Contraceptive use in South and South-East Asian region: assessment of sustainable development goal 3.7 through indicator 3.7.1.

BACKGROUND: Sustainable Development Goal (SDG) 3.7 concerns modern contraception use among women of reproductive ages. This study evaluated the progress of indicator 3.7.1 in 11 selected countries in South and South-East Asia and assessed the contribution of women's education to modern contraceptive use. METHODS: Generalized linear models for complex surveys were fitted to Demographic and Health Survey (DHS) data from 40 surveys conducted in Afghanistan, Bangladesh, Cambodia, India, Indonesia, Maldives, Myanmar, Nepal, Pakistan, Philippines and Timor Leste between 1990 and 2017, followed by a meta-analysis through forest plots. RESULTS: Modern contraceptive coverage in most of the selected countries climbed or remained stationary over the past decades. In four countries, <50% of women used contraception. In no country was contraception used by ≥80% women. Higher education was associated with 13% higher odds of modern contraceptive use (95% confidence interval: 1.07, 1.18) among women compared to primary level or no education. DISCUSSION: Completion of primary education is insufficient to broaden the coverage of modern contraceptive use. Greater national level effort from the selected countries is needed to lift the education levels of women to meet SDG 3.7 by 2030.

Self-reported use of technology by orientation and mobility clients in Australia and Malaysia before the COVID-19 pandemic.

Since the 1960s, many electronic travel aids have been developed for people with low vision or blindness to improve their independent travel skills, but uptake of these specialist devices has been limited. This study investigated what technologies orientation and mobility (O&M) clients in Australia and Malaysia have, use, like, and want to support their travel, to inform technology research and development. This two-phase mixed-methods study surveyed O&M clients face-to-face in Malaysia (n = 9), and online in Australia (n = 50). Participants managed safe walking using a human guide, long cane, or guide dog when their vision was insufficient to see hazards, but a smartphone is now a standard travel aid in both Australia and Malaysia. Participants relied on smartphone accessibility features and identified 108 apps they used for travel: for planning (e.g., public transport timetables), sourcing information in transit (e.g., GPS location and directions, finding a taxi), sensory conversion (e.g., camera-to-voice, voice-to-text, video-to-live description), social connections (e.g., phone, email, Facebook), food (e.g., finding eateries, ordering online), and entertainment (e.g., music, games). They wanted to 'carry less junk', and sought better accessibility features, consistency across platforms, and fast, reliable, real-time information that supports confident, non-visual travel, especially into unfamiliar places.

Factors Associated with Low Birthweight in Low-and-Middle Income Countries in South Asia.

Child with Low Birth Weight (LBW) has a higher risk of infant mortality, learning difficulties in childhood due to stunted growth and impaired neurodevelopment, is more likely to develop heart diseases and diabetes in adulthood. This study aimed to evaluate the latest demographic and health surveys (DHSs) across multiple countries in South Asia to determine the factors associated with LBW among these countries. Latest available DHS data across Afghanistan (2015, n = 29,461), Bangladesh (2018, n = 20,127), Nepal (2016, n = 12,862), and Pakistan (2018, n = 15,068) were analysed. Complex survey adjusted generalized linear models were fitted to investigate the association of birth weight with sociodemographic and decision-making factors. Pakistan had the highest proportion of LBW at 18% followed by Afghanistan and Bangladesh at around 14% and Nepal had the lowest (13%). Children born in Pakistan were more likely to have LBW children than Afghanistan (AOR = 2.17, 95% CI = 1.49-3.14). Mothers living in rural areas (AOR = 0.77, 95% CI = 0.61-0.97), with highly educated partners and belonging to richer families were less susceptible to having child with LBW. To reduce 30% LBW in-line with the World Health Organisation's 2025 goal, policymakers in SA should focus on women in urban areas with low-educated partners belonging to poor households to ease LBW burden.

Health awareness and skilled birth attendance: An assessment of sustainable development goal 3.1 in south and south-east Asia.

BACKGROUND: The United Nation's Sustainable Development Goal 3.1 aims to reduce maternal mortality worldwide to 70 per 100,000 live births by 2030, which requires greater skilled birth attendant (SBA) coverage and increased health awareness. By evaluating relevant sociodemographic factors, this study aimed to identify different groups of women who lack health awareness and access to SBA services in eight selected low-and-middle-income countries (LMICs) of South and South-East Asia (SSEA), namely, Afghanistan, India, Indonesia, Myanmar, Nepal, Pakistan, Philippines, and Timor-Leste. METHODS: Nationally representative Demographic and Health Surveys (DHS) on women aged 15-49 years were analysed with a pooled sample of 95,521. Complex survey-adjusted logistic regression models were fitted to assess sociodemographic factors, SBA coverage, and health awareness. RESULTS: Women with higher health awareness were 44.4% (95% CI:1.32-1.58, p<0.001) more likely to access SBAs compared to the rest. Women and/or their partners with no or primary-level education, who were poorer, became young mothers (≤20 years), not involved in decision-making, or hardly exposed to media were less likely to seek SBAs and have higher health awareness. Women in rural areas with more children were also less likely to use SBAs. Timor-Leste, Afghanistan, Myanmar, and Nepal underperformed on SBA coverage amongst the selected LMICs of the SSEA region. CONCLUSION: Health education and mass-media-driven awareness could be an interventional avenue for LMICs to increase SBA coverage. Future studies comparing health policies within the SSEA region are required to identify reasons behind some nations' underperformance, while others are on track to achieve SDG 3.1.

Married Women's Attitude toward Intimate Partner Violence Is Influenced by Exposure to Media: A Population-Based Spatial Study in Bangladesh.

This study estimated the attitudes of women toward accepting IPV at district level in Bangladesh and examined its relationship with sociodemographic predictors including exposure to media (e.g., newspaper, radio and television) using the Multiple Indicator Cluster Survey-2019 with a sample of 63,689 women. Around 25.6% women accepted IPV that geographically varied from 1.78% (Pirojpur) to 57.14% (Kurigram). Women regularly exposed to media were 17% less likely to accept IPV. Attitude toward accepting IPV was found to be higher among the illiterate women in disadvantaged circumstances, patriotically from poorer households living in remote areas, which suggest that planned interventions are needed for this vulnerable group of women to improve their living status by providing access to education and media. Further research is necessary to assess the impact of women's empowerment on their attitude toward acceptance of IPV.

Knowledge About HIV/AIDS and Its Transmission and Misconception Among Women in Bangladesh.

BACKGROUND: Asian and pacific region countries are high risk countries for human immunodeficiency virus/ acquired immune deficiency syndrome (HIV/AIDS). Although the prevalence of HIV/AIDS is low in Bangladesh but women in Bangladesh have been identified as susceptible due to associated socioeconomic exposures. There are various misconceptions associated with HIV/AIDS transmission among the women in low- and middle-income countries including Bangladesh, which lead to a negative attitude towards the HIV/AIDS-infected. The purpose of this study was to assess the overall knowledge, transmission, and misconception about HIV/AIDS among the women in Bangladesh as well as its spatial distribution across the country. METHODS: The study used data from the UNICEF (United Nations Children's Fund) Multiple Indicator Cluster Survey (MICS) 2019, with a sample of 64 346 women. This was a cross-sectional, population-based survey of Bangladeshi women aged 15-49 conducted using a multistage, cluster sampling technique. Three binary outcome variables considered were knowledge about HIV/AIDS, knowledge about HIV/AIDS transmission and knowledge on myths and misconceptions on HIV/AIDS along with 10 predictors based on past literature. Bivariable analysis using chi-square tests of association was conducted to examine the unadjusted percentage differences of the outcome variables for each of the predictor variables and their associations. Multiple binary logistic regression models were then fitted to evaluate the association between the outcome variables and the predictors after adjusting for survey cluster, strata, and weights. All analysis was conducted in R software (V 2.5.0). RESULTS: The percentage of women who held knowledge about HIV/AIDS, knowledge about HIV/AIDS transmission and knowledge on misconceptions about transmission of HIV were on average 60.3%, 52.2% and 71.7% respectively. The models indicated that women regularly exposed to media were 79%, 18% and 19% significantly more likely (odds ratio, OR: [95% CI] = 1.79: [1.70, 1.89]; 1.18: [1.10 1.26] and 1.19: [1.11, 1.27]) to have heard about HIV, aware about HIV transmission, and have less misconceptions about HIV respectively compared to those who were not exposed to media. Overall results indicate that women from peripheral districts living far from metropolitan cities were most unaware of HIV and had higher misconceptions about AIDS. CONCLUSION: The findings of this study should assist policy-makers and program implementers to focus on raising awareness to educating women about how HIV/AIDS is transmitted. Furthermore, interventions should be made by targeting the most disadvantaged groups, including younger women with low education living in rural areas, from poor households and limited access to information. Also, education on HIV transmission in Bangladesh should integrate cultural and ethnic considerations of HIV/AIDS.

Digital Storytelling for Health-Related Outcomes in Older Adults: Systematic Review.

BACKGROUND: Older adults face a unique set of challenges and may experience a range of psychological comorbidities. Digital storytelling is an emerging tool for sharing and recording lived experiences and may have the potential to support well-being but is yet to be systematically reviewed for use among older adults. OBJECTIVE: The aim of this review is to examine the methods for creating digital stories, the health-related outcomes associated with creating digital stories, and the potential for implementing digital storytelling with older adults. METHODS: We systematically searched electronic databases to identify articles published in English that reported on at least one health-related outcome of digital storytelling for participants aged ≥60 years. Data were extracted and synthesized using qualitative content analysis and summarized in tables. The methodological quality of the studies was assessed using the Mixed Methods Appraisal Tool. RESULTS: A total of 8 studies were included in the review. Participants were primarily community-dwelling older adults living with dementia, involving family caregivers and professional care staff. Studies have taken various approaches to digital storytelling and reported diverse benefits associated with digital storytelling, including improvements in mood, memory, social engagement, and quality of relationships. Although the potential for implementation was not widely examined, some studies have presented evidence for acceptability and feasibility. Generally, studies were of high quality, despite the absence of comparator groups and confounder analyses. CONCLUSIONS: The evidence reviewed suggests that despite the various approaches taken, digital storytelling shows promise as an effective approach for supporting well-being in older adults. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42019145922; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019145922. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/15512.

Inter-relationships among key reproductive health indicators in sub-Saharan Africa focusing on the central role of maternal literacy.

BACKGROUND: Indicators of reproductive health (RH) are expected to be both inter-related and associated with key social determinants. As the provision of RH services is usually integrated, the effort to improve one RH component should influence the other components. However, there is a lack of evidence-based models demonstrating the inter-relationships. The purpose of this study was to examine the inter-relationships among key RH indicators and their relationship with women's literacy in sub-Saharan Africa (SSA). METHODS: Data were sourced from the most recent demographic and health survey conducted between 2010 and 2016 in 391 provinces of 29 SSA countries. We examined seven RH indicators along with women's literacy. The unit of analysis was at the provincial level. Structural equation modelling was used to examine the strength of relationships among these indicators and with women's literacy, using the total standardized effect sizes. Significance tests and 95% confidence intervals (CIs) for these effects were calculated using a bias-corrected bootstrap method. RESULTS: RH indicators are strongly interrelated and are associated with women's literacy. The strongest relationship is observed between women's literacy rate and the contraception prevalence rate, with a total standardized effect size of 0.79 (95% CI 0.74-0.83). The model of inter-relationships developed in this study may guide the design, implementation and evaluation of RH policies and programmes. CONCLUSIONS: The key challenge in reducing fertility in SSA is to reduce people fertility desire. This could mainly be addressed by enhancing integrated approaches especially between the education and health sectors.

Use of technology by orientation and mobility professionals in Australia and Malaysia before COVID-19.

PURPOSE: Orientation and Mobility (O&M) professionals teach people with low vision or blindness to use specialist assistive technologies to support confident travel, but many O&M clients now prefer a smartphone. This study aimed to investigate what technology O&M professionals in Australia and Malaysia have, use, like, and want to support their client work, to inform the development of O&M technologies and build capacity in the international O&M profession. MATERIALS AND METHODS: A technology survey was completed by professionals (n = 36) attending O&M workshops in Malaysia. A revised survey was completed online by O&M specialists (n = 31) primarily in Australia. Qualitative data about technology use came from conferences, workshops and interviews with O&M professionals. Descriptive statistics were analysed together with free-text data. RESULTS: Limited awareness of apps used by clients, unaffordability of devices, and inadequate technology training discouraged many O&M professionals from employing existing technologies in client programmes or for broader professional purposes. Professionals needed to learn smartphone accessibility features and travel-related apps, and ways to use technology during O&M client programmes, initial professional training, ongoing professional development and research. CONCLUSIONS: Smartphones are now integral to travel with low vision or blindness and early-adopter O&M clients are the travel tech-experts. O&M professionals need better initial training and then regular upskilling in mainstream O&M technologies to expand clients' travel choices. COVID-19 has created an imperative for technology laggards to upskill for O&M tele-practice. O&M technology could support comprehensive O&M specialist training and practice in Malaysia, to better serve O&M clients with complex needs.Implications for rehabilitationMost orientation and mobility (O&M) clients are travelling with a smartphone, so O&M specialists need to be abreast of mainstream technologies, accessibility features and apps used by clients for orientation, mobility, visual efficiency and social engagement.O&M specialists who are technology laggards need human-guided support to develop confidence in using travel technologies, and O&M clients are the experts. COVID-19 has created an imperative to learn skills for O&M tele-practice.Affordability is a significant barrier to O&M professionals and clients accessing specialist travel technologies in Malaysia, and to O&M professionals upgrading technology in Australia.Comprehensive training for O&M specialists is needed in Malaysia to meet the travel needs of clients with low vision or blindness who also have physical, cognitive, sensory or mental health complications.

Preliminary evidence for the impact of digital life stories about aged care residents on staff knowledge and understanding regarding those residents; A single arm trial.

AIMS AND OBJECTIVES: This study aimed to examine the impact of digital stories about aged care residents on staff knowledge and understanding regarding those residents. BACKGROUND: More than a quarter of a million older Australians live in residential aged care facilities. This living arrangement can inhibit the expression of a person's sense of identity. Without objects and cues that reflect the person's selfhood, it can be difficult for a person to express their uniqueness. Staff may not sufficiently appreciate the resident's individuality and therefore may not be able to customise care for the resident. DESIGN: This study used a single-arm trial design. METHODS: The study was conducted in four residential aged care facilities. Short digital life stories (3-4 min) of eight residents were constructed by student volunteers over 6 months. Participants (n = 53 care staff) completed a self-report measure of their knowledge and understanding of a resident before and after watching the resident's story. The study adhered to guidelines for Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) (see Appendix S1). RESULTS: Pre- and post-test scores of the measure were compared using paired samples t-tests. These scores changed significantly, showing an improvement of knowledge and understanding regarding residents. CONCLUSIONS: Watching digital life stories were associated with improvements in knowledge and understanding by staff, and hence have the potential to foster a greater level of understanding of residents by such staff, and more person-centred care practices within residential aged care facilities. RELEVANCE TO CLINICAL PRACTICE: Digital stories about aged care residents are quick and efficient methods for improving aged care staff members' knowledge and understanding of the residents under their care. With such understanding, staff may be able to better customise care for residents, thereby validating residents' sense of identity and elevating residents' quality of life.