Expectations, experiences and challenges of nursing students using the virtual learning medium during the COVID-19 pandemic: A descriptive phenomenological study.

BACKGROUND: The COVID-19 pandemic caused several higher educational institutions to switch from traditional face-to-face to virtual learning medium. This abrupt shift came with new expectations, experiences and challenges to nursing/ midwifery students, particularly new users, and even more so when preparation, orientation, and support were lacking or ineffective. The present study therefore aimed at exploring the expectations, experiences and challenges of nursing students using the virtual learning medium during the COVID-19 pandemic. METHODS: This was a descriptive phenomenological design using 12 purposively sampled nursing and midwifery students from a public university in Ghana. With the aid of a semi-structured guide, individual face-to-face interviews were audiotaped, transcribed verbatim at a later time and deductively analyzed into themes using the customer experience execution model. RESULTS: Participants were aged 22-36 years and involved equal number of males and females (n = 6), with majority being Christians (n = 11). Six themes were generated from the study: (1) "Initial thoughts and emotions" described participants initial reactions to the virtual educational medium during the pandemic; (2) "Expectations with the virtual medium" referred to the participants' anticipations regarding the convenience offered by the virtual medium; (3) "Experiences with the virtual medium" depicted the participants' recognition of both positive and negative encounters while using the virtual learning platform; (4) "Evaluation and recommendation" described participants' reports of meeting expectations and recommendations they made to enhance virtual learning; (5) "Challenges and limitations of the virtual medium" typically represented the obstacles encountered by nursing/ midwifery students when they embraced the virtual medium; (6) "Prospects of the virtual medium" referred to participants' views on the future of the virtual medium. CONCLUSION: The study has brought to light that the virtual education environment comes with its own expectations, experiences and challenges to students. Provision of adequate support such as orientation and simulation laboratories by higher education institutions to satisfy students' needs is necessary to enhance nursing education.

A scoping review of the residual barriers to skilled birth attendance in Ghana: A conceptual framework and a fish bone analysis.

The achievement of the Sustainable Development Goals (SDGs) targets 3.1, 3.2 and 3.3.1 is strongly dependent on the effective utilization of skilled birth services. Despite advancements made in Skilled Birth Attendance (SBA) in Ghana, there are still instances of unassisted childbirths taking place. The aim of this study was to explore the residual barriers of SBA such as community- and health system-related factors affecting SBA in Ghana and to identify strategies for addressing them. An electronic search was done using PubMed, Popline, Science direct, BioMed Central, Scopus and Google scholar for peer reviewed articles as well as grey articles from other relevant sources, published between 200 and 2022 on community- and health system related factors influencing SBA in Ghana. Out of the 89 articles retrieved for full screening, a total of 52 peer-reviewed articles and 1 grey article were selected for the final review. The study revealed that cultural practices (community factors), low quality of service delivery due to the inappropriate behaviors, lack of competency of skilled birth attendants (SBAs) as well as the inefficient distribution of SBAs contribute to ineffective uptake of SBA (health system factors). Also, indirect costs are associated with the utilization of skilled delivery care even with the existence of 'free' delivery care policy under the national health insurance (policy factor). For Ghana to achieve the SDGs above and improve SBA, it is essential to enhance the quality of skilled delivery care by addressing the attitude and competencies of skilled birth professionals, while plans are put in place to expand and develop the Community-based Health Planning and Services (CHPS) strategy to help address the access barriers to SBA. More so, the 'free' delivery care policy should absorb all the costs associated with skilled delivery for pregnant women as it is intended for.

Perceptions and attitudes of women in the perinatal period towards male midwives in a rural district of Ghana: a descriptive, exploratory qualitative study.

OBJECTIVE: The study sought to explore the perceptions and attitudes of women in the perinatal period towards the reproductive health services of male midwives. DESIGN: The study adopted an in-depth exploratory descriptive design for data collection and themes extracted using thematic analysis. SETTING: Antenatal and postpartum units of two primary healthcare facilities in the Kwabre-East District of Ghana. PARTICIPANTS: 20 women in the perinatal period who were receiving antenatal care and delivery services from the facilities included in the study were recruited through purposive sampling. FINDINGS: Divergent views emerged among our participants regarding the acceptability and utilisation of perinatal services provided by male midwives. Some participants perceived male midwives as patient, supportive, caring, compassionate and skilful at their work while the negative attitude related to some participants perceiving their interactions with male midwives as an opportunity for sexual violation. Positive attitudes emanated from male midwives' empathetic behaviour, reception, privacy and confidentiality of information. Conversely, negative attitudes arose from a lack of awareness of the changing female gender domination in midwifery, fear and misconceptions. Finally, participants faced various challenges, rooted in culture, which impacted their acceptance of male midwifery services. CONCLUSIONS: Factors influencing participants' negative perceptions and attitudes towards male midwives were born out of culturally motivated and gender-sensitive stereotyping rather than male professional midwifery competencies. The study outcome provides the basis and the need for a community-based intervention to effect changes in the perception and attitude of women in the perinatal period towards male midwifery practice in the affected communities. Increasing awareness of the existence of male midwives in the communities would contribute to increasing acceptance and utilisation of their services among women in the perinatal period in Ghana.

Contraceptive use by number of living children in Ghana: Evidence from the 2017 maternal health survey.

BACKGROUND: There is a significant literature describing the link between parity and contraceptive use. However, there is limited knowledge about the disaggregation by parity of the type of contraceptives. In this study, we describe the use of contraceptives by parity among women of reproductive age in Ghana, focusing on use of highly effective methods (injection, pill, intrauterine device, implant, and sterilization). METHODS: Using the 2017 Ghana Maternal Health Survey, a nationally-representative cross-sectional household survey, we describe contraceptive method use by number of living children among sexually active women of reproductive age. We then estimated predictors of use of highly effective contraception in a multilevel logistic regression model. RESULTS: Most women in this survey are not using any method of contraception, although this varies by whether or not they have begun childbearing. Contraceptive method use varies by number of living children. Before having children, natural (periodic abstinence and withdrawal) and episodic (condoms) methods dominate. Once a woman has one living child, method preference changes to injectables and implants. Factors associated with using a highly effective method of contraception are: having >3 children, being in a relationship, having had an abortion, being younger than age 30, and having had sexual intercourse within days of answering the survey (p < .001 for all). CONCLUSION: In this analysis, the number of living children a woman has, her age, and timing of last intercourse are the most significant predictors of using a highly effective method of contraception. However, the majority of participants in this study report not using any method of contraception to avoid unwanted pregnancies. Future research that attempts to unpack the disconnect between not wanting to become pregnant and not using contraception is warranted.

Being the nurse for my child at home: A qualitative analysis of parental recognition, appraisal, and reactions to childhood cancer in Ghana.

Parental involvement in childhood cancer care is of utmost importance, but the understanding of parental recognition, appraisal, and reactions to childhood cancer in settings such as Ghana is limited. We conducted an empirical phenomenological study to explore these aspects among Ghanaian parents. Twenty parents were purposively sampled to participate in semi-structured interviews between June and September 2022. All interviews were transcribed and analysed using an inductive thematic approach. We found that parents recognised symptoms through personal observation and their child's self-report, often perceiving them as non-severe. Emotional reactions upon receiving their child's cancer diagnosis included psychological distress, fear, doubts, and confusion. Enduring emotions experienced by parents were fears of disease recurrence and impending death of their child. Parents assumed the role of nurses at home, monitoring therapy effects, managing pain and symptoms, and dressing wounds. In conclusion, parents in Ghana play a crucial role in the recognition, diagnosis, and treatment pathways of childhood cancer. To enhance their ability to recognise symptoms and take timely actions, it is recommended to implement media programs and health education initiatives targeting parents.

Impact of childhood and adolescence cancer on family caregivers: a qualitative analysis of strains, resources and coping behaviours.

BACKGROUND: The physical demands of caring for children and adolescents diagnosed with cancer, over a lengthy period, exert significant strain on the health and well-being of family caregivers. The capacity of family caregivers to surmount and cope with the various strains they experience due to the diagnosis and treatment trajectory is essential to the quality of life of the child and adolescent who has been diagnosed with cancer. However, the experiences of family caregivers have been under-explored. This study explored the strains, resources, and coping strategies of family caregivers of children and adolescents diagnosed with cancer in Ghana. METHODS: Guided by a descriptive phenomenological design, 20 semi-structured interviews with family caregivers were conducted at a tertiary health facility that provides paediatric oncology services. The study was conducted between June and October 2022. The interviews were transcribed verbatim, translated and coded using NVivo software. An inductive thematic analysis approach using Vaismoradi et al.'s thematic analysis framework was followed in analysing the data. RESULTS: The study revealed that family caregivers of children diagnosed with cancer experienced three main strains: somatic strains (poor sleep quality, loss of appetite, and unintended weight loss), economic strains (financial burden and loss of economic livelihood), and psychosocial strains (isolation from social activities and network, frustration and helplessness, and balancing multiple family needs). The following themes emerged as coping resources: family cohesiveness, community support, and support from health care providers. Coping strategies that emerged included trusting in God and being self-motivated. CONCLUSION: The study concludes that family caregivers experience somatic, economic, and psychosocial strains. However, they can leverage available resources (family cohesiveness, community support, and support from healthcare providers) to cope with these strains. There is a need to educate and sensitize family caregivers about the potential strains that they are likely to experience prior to the assumption of care roles. Also, the formal inclusion of non-governmental organizations and religious bodies will ensure that family caregivers receive sufficient community support to cope with the strains of caregiving.

The motivational factors and the perceived effects of attaining higher education among post-diploma graduate nurses and midwives in Kumasi, Ghana: A cross-sectional study.

BACKGROUND: Globally, there has been increased demand for higher education in nursing and midwifery to support evidence-based practice. It is believed that higher education in nursing leads to improved quality of care. The motivation for pursuing higher education, the choice of institution for learning and the effects of higher education programs have not been given much attention in research literature in Ghanaq OBJECTIVE: To assess the motivating factors, reasons for the choice of institution and the perceived effects of attaining higher educational qualifications among post-diploma graduate nurses and midwives. STUDY DESIGN: Descriptive cross-sectional study. SETTING: Kumasi. PARTICIPANTS: Convenience and snowball sampling were used to select 523 nurses and midwives who had pursued higher education after their Diploma in Nursing or Midwifery education. METHOD: A researcher-developed questionnaire was used to collect data on motivation, choice of institution and perceived effects of higher education by nurses and midwives. Data were analyzed through descriptive statistics, Pearson correlation and linear regression at 0.05 significance level. RESULTS: The greatest motivation for higher education by nurses/midwives was to improve clinical judgment. Academic quality and reputation of the institution were the main reasons for the choice of institution (n = 458, 92.7 %). There were weak but positive significant correlations between the perceived effects of higher nursing and midwifery education and pressure from the workplace (r = 0.204, p < .001), and increasing new demands from clients (r = 0.284, p < .001). Increasing demands from clients (ß = 0.203, p < .001) and improving social status (ß = 0.264, p < .001) were the motivating factors that influenced the perceived effects of higher nursing and midwifery education. CONCLUSION: The desire for improved professionalism and increased expertise are the reasons nurses and midwives seek higher education. Health managers should support nurses and midwives to attain higher education to improve the quality of care.

Factors influencing the free maternal health care policy under the national health insurance scheme's provision for skilled delivery services in Ghana: a narrative literature review.

BACKGROUND: Skilled Birth Attendance (SBA) is important in achieving the Sustainable Development Goals (SDGs) targets 3.1, 3.2 and 3.3.1. Ghana has made steady progress in SBA, yet, unsupervised deliveries still occur. The introduction of the Free Maternal Health Care Policy under the National Health Insurance Scheme (FMHCP under the NHIS) has improved the uptake of SBA but with some implementation challenges. This narrative review sought to explore the factors influencing the FMHCP under the NHIS provision for skilled delivery services in Ghana. METHODS: Electronic searches were conducted of databases including PubMed, Popline, Science direct, BioMed Central, Scopus and Google scholar for peer reviewed articles as well as grey articles from other relevant sources, published between 2003 and 2021 on factors influencing FMHCP/NHIS provision for skilled delivery services in Ghana. Keywords used in the literature search were in various combinations for the different databases. The articles were screened to determine the inclusion and exclusion criteria and quality was assessed using a published critical appraisal checklist. A total of 516 articles were retrieved for initial screening based on their titles, of which 61 of them, were further screened by reading their abstracts and full text. Of this number, 22 peer-reviewed and 4 grey articles were selected for the final review based on their relevance. RESULTS: The study revealed that the FMHCP under the NHIS does not cover the full costs associated with skilled delivery and low socioeconomic status of households affects SBA. Also, funding and sustainability, hinders the quality-of-service delivery offered by the policy. CONCLUSION: For Ghana to achieve the SDGs above and further improve SBA, the cost associated with skilled delivery should be fully covered by the NHIS. Also, the government and the key stakeholders involved in the policy implementation, must put in place measures that will enhance the operation and the financial sustainability of the policy.

Attitudes of health care professionals towards interprofessional teamwork in Ashanti Region, Ghana.

BACKGROUND: Interprofessional collaboration ensures that high-quality health care is provided leading to improved health outcomes and provider satisfaction. Assessing the attitudes of health care professionals towards teamwork in Ghana is novel. OBJECTIVE: To examine the attitudes of health care professionals towards interprofessional teamwork and assess specific attributes influencing these attitudes in the Ashanti region, prior to implementing an in-service interprofessional HIV training programme. METHODS: A cross-sectional pre-training online survey using a modified Attitudes Toward Health Care Teams Scale was conducted among health care practitioners undergoing a two-day interactive interprofessional HIV training in Kumasi and Agogo from November 2019 to January 2020. Trainees were diverse health professional cadres selected from five hospitals in the Ashanti region of Ghana. Data was summarised using the mean and standard deviation for continuous variables, and frequencies and percentages for categorical variables. An exploratory factor analysis was conducted to categorise the 14 items of the modified attitudes scale. The Wilcoxon rank-sum (Mann-Whitney) and Kruskal-Wallis tests were used to test the mean attitude difference among the demographic characteristics. Statistical significance was set at p < 0.05. RESULTS: Altogether, 302 health professionals completed the survey. The ages ranged from 20-58 years, mean age 27.96 years (standard deviation 5.90 years). Up to 95% of the trainees agreed with the 14 statements on the modified attitudes scale. Three factors were identified; "quality of care", "team efficiency", and "time constraint" with Cronbach's alpha measures of 0.73, 0.50, and 0.45 respectively. The overall mean attitude score was 58.15 ± 6.28 (95% CI, 57.42-58.88). Attitude of health care professionals towards interdisciplinary teams for patient care varied significantly by age (p = 0.014), health profession cadre (p = 0.005), facility (p = 0.037), and professional experience (p = 0.034). CONCLUSION: Strengthening in-service interprofessional training for health practitioners especially early career professionals in the Ashanti region would be valuable.

Lessons learnt from a scientific peer-review training programme designed to support research capacity and professional development in a global community.

High-quality peer-reviewer training open to researchers across the globe has the potential to improve the published literature, however, this type of training is not widely available. In this paper, we describe an online peer-reviewer training programme, highlight its effectiveness in building peer review and writing skills, and discuss challenges and lessons learnt. This training programme, open to researchers across the globe, acquaints participants with challenges to and inequities in publishing and educates them about writing effective peer reviews. A focal point is how to provide specific and respectful feedback to help authors get accepted for peer review at an academic journal. Forty-nine participants from or residing in six continents completed the training. All programme evaluation respondents agreed that the orientation helped them gain a better understanding of their role as a peer reviewer at Pre-Publication Support Service. Most agreed that the training was helpful in improving their peer-review skills, and that the training was helpful in improving their writing skills. Participants wanted more networking and collaboration opportunities with other peer reviewers, inclusion of a qualitatively researched example paper and improved communication about the required time commitment. Our online programme with multiple time options was geographically inclusive but internet connectivity was challenging for some participants. Peer-reviewer training programmes can help researchers build their peer review and writing skills and enhance participants' understanding of disparities in publishing. Integrating a geographically diverse group of researchers has the potential to enrich the discussions and learning in such a programme.

Prevalence and risk factors of hypertension among public servants in Ejisu-Juaben municipality, Ghana.

OBJECTIVES: We determined the prevalence and risk factors of hypertension among public servants of Ejisu Juaben municipality. RESULTS: The overall prevalence of hypertension was 29.3% (95%CI:22.5-36.1%) and only 8.6% of the participants were aware of their hypertensive status. Respondents who were > 40 years were twice as likely to develop hypertension compared to those who were ≤ 40 years [adjusted odds ratio (AOR) = 2.37, 95% confidence interval (CI) 1.05-5.32]. Those who were married were 2.54 times more likely to be hypertensive compared with those unmarried [AOR = 2.54, 95%CI: 1.06-6.08]. Compared to health workers, Judicial and Security service workers were almost five times more likely to be hypertensive [AOR = 4.77, 95%CI: 1.20-18.96]. Being overweight [AOR = 2.25, 95%CI: 1.06-6.41] and obese [AOR = 4.80, 95%CI: 1.82-12.91] was associated with increased odds of hypertension. The prevalence of hypertension among the participants in this study is high. Employee wellness programs are needed at workplaces and the Ghana Health Service must adopt targeted intervention programs such as regular screening for non-communicable diseases and promotion of physical activities at the workplace.

Charge midwives' awareness of and their role in promoting respectful maternity care at a tertiary health facility in Ghana: A qualitative study.

BACKGROUND: Evidence suggests that the implementation of respectful maternity care (RMC) interventions is one of the surest and most effective means of minimising mistreatment during intrapartum care services. However, to ensure the successful implementation of RMC interventions, maternity care providers would have to be aware of RMC, its relevance, and their role in promoting RMC. We explored the awareness and role of charge midwives in promoting RMC at a tertiary health facility in Ghana. METHODS: The study adopted an exploratory descriptive qualitative study design. We conducted nine interviews with charge midwives. All audio data were transcribed verbatim and exported to NVivo-12 for data management and analyses. RESULTS: The study revealed that charge midwives are aware of RMC. Specifically, ward-in-charges perceived RMC as consisting of showing dignity, respect, and privacy, as well as providing women-centred care. Our findings showed that the roles of ward-in-charges included training midwives on RMC and leading by example, showing empathy and establishing friendly relationships with clients, receiving and addressing clients' concerns, and monitoring and supervising midwives. CONCLUSION: We conclude that charge midwives have an important role to play in promoting RMC, which transcends simply providing maternity care. Policymakers and healthcare managers should ensure that charge midwives receive adequate and regular training on RMC. This training should be comprehensive, covering aspects such as effective communication, privacy and confidentiality, informed consent, and women-centred care. The study also underscores a need for policymakers and health facility managers to prioritise the provision of resources and support for the implementation of RMC policies and guidelines in all healthcare facilities. This will ensure that healthcare providers have the necessary tools and resources to provide RMC to clients.

"She is My Work": Caregiving for Older Adults With Hypertension and Diabetes Mellitus.

To explore the lived experiences of informal caregivers of older adults with hypertension and/or diabetes mellitus in Kumasi, Ghana. A qualitative research approach was used to conduct the study using informal caregivers of older adults with hypertension and/or diabetes mellitus at a teaching hospital in Ghana. In all, 20 participants were purposively sampled, interviewed, and data were analyzed using thematic analysis. Three main themes emerged: "Experience with care demands," "Coping with care demands," and "Motivation for caregiving." Older adults with hypertension and/or diabetes mellitus had needs that placed a burden on informal caregivers' work life, health, and social life. Informal caregivers of older adults with hypertension and/or diabetes mellitus are under strain. Caregiving is a difficult task, requiring a lot of time, effort, attention, and devotion. Nurses should plan the care of older adults with hypertension and/or diabetes mellitus in collaboration with their informal caregivers.

Perspectives of healthcare workers on the challenges with obstetric referrals in rural communities in Ghana: a descriptive phenomenology study.

OBJECTIVE: We explored and document healthcare workers' (HCWs') perspectives on the challenges encountered during obstetric referrals. DESIGN: The study adopted a qualitative research approach and a descriptive phenomenology design. HCWs permanently working in 16 rural healthcare facilities in the Sene East and West Districts composed of the target population for this study. Using a purposive sampling technique, participants were recruited and enrolled in in-depth individual interviews (n=25) and focused group discussions (n=12). Data were analysed thematically using QSR NVivo V.12. SETTING: Sixteen rural healthcare facilities in the Sene East and West Districts, Ghana. PARTICIPANTS: Healthcare workers. RESULTS: Areas related to patient as well as institutional level issues challenged the referral processes. At the patients' level, financial constraints, fears associated with referral and patients' non-compliance with referrals were identified as challenges that delayed the referral process. With regard to institutional challenges, the following emerged: referral transportation challenges, poor attitudes of service providers, low staff strength and healthcare bureaucracies. CONCLUSION: We conclude that in order for obstetric referrals in rural Ghana to be effective and timely, there is the need to raise more awareness about the need for patients to comply with referral directives, through health education messages and campaigns. Given our findings on the delays associated with long deliberations, the study recommends the training of more cadre of healthcare providers to facilitate obstetric referral processes. Such an intervention would help to improve the current low staff strength. Also, there is a need to improve ambulatory services in rural communities to counteract the challenges that poor transportation system poses on obstetric referrals.

Experiences of patient advocacy among nurses working in a resource constrained emergency department in Ghana.

BACKGROUND: Patient advocacy at the emergency department is stressful and cumbersome as a result of the increasing patient-to-nurse ratio and high patient turnovers. It is also unclear what patient advocacy entails and the experiences of patient advocacy in a resource-constrained emergency department. This is significant because advocacy underpins the care provided in the emergency department. AIM: The primary aim of this study is to explore the experiences and underpinning factors that influence patient advocacy among nurses working in a resource constrained emergency department. METHODS: A descriptive qualitative study was conducted among 15 purposively sampled ED nurses working at a resource-constrained secondary-level hospital facility. Study participants were individually interviewed via a recorded telephone conversation, after which the interviews were transcribed verbatim and inductively analyzed using the content analysis approach. The study participants described patient advocacy, situations in which they advocated for patients, the factors that motivated them and the challenges they encountered practicing patient advocacy. RESULTS: Three major themes generated from the study included: "stories of advocacy", "motivating" factors and "challenging" factors. ED nurses understood patient advocacy and also advocated for patients in various instances. There were factors such as personal upbringing, professional training and religious training that motivated them and they were challenged by negative inter-professional experiences, patient and relatives' attitudes and healthcare system factors. CONCLUSION: Participants understood patient advocacy and incorporated it into daily nursing care. Unsuccessful advocacy causes disappointment and frustrations. There were no documented guidelines on patient advocacy.

Lived experiences and coping strategies of persons seeking infertility treatment in the Kumasi metropolis: a descriptive phenomenological study.

BACKGROUND: Women seeking fertility treatment face myriad challenges that they must adapt and adjust to daily. This aimed at exploring the experiences and coping strategies of such persons in the Kumasi. Metropolis. METHODS: A qualitative approach was employed and a purposive sampling technique was used to select 19 participants. A semi-structured interview was used to collect data. The data collected were analyzed using Colaizzi's method of data analysis. RESULTS: Persons living with infertility had emotional experiences of anxiety, stress, and depression. Socially, participants experienced isolation, stigma, societal pressure, and marital problems due to their inability to conceive. The key coping strategies adopted were spiritual (faith-based) and social support. Though formal child adoption can be an option, no participant preferred it as a coping strategy. Some participants also reported using herbal medicine before going to the fertility centre upon realizing that the approach was not helping in achieving their desired outcome. CONCLUSION: Infertility is a source of suffering for most women diagnosed with it, resulting in significant negative experiences in their matrimonial homes, families, friends, and the community at large. Most participants rely on spiritual and social support as their immediate and basic coping strategies. Future research could evaluate the treatment and coping strategies and also determine the outcomes of other forms of treatment for infertility.

Easing the transition from nurse clinician to nurse educator in Ghana: Exploring novice nurse educators' perspectives.

AIM: To explore novice nurse educators' perspectives on easing the transition from nurse clinician to nurse educator in Ghana. DESIGN: A descriptive qualitative study. METHODS: In total, 12 novice nurse educators (NNEs) were recruited from three health training institutions in the Upper East Region of Ghana. Between June and August 2020, individual in-depth interviews were conducted using a semi-structured interview guide. The audio-recorded interviews were transcribed verbatim and analysed manually using thematic analysis. RESULTS: Four themes emerged: mentoring, orientation to educator role, pedagogical preparation and postgraduate studies. To ease the transition, NNEs stressed on developing individual mentoring programmes to mentor novices before they start to teach. They endorsed the development of college-specific orientation programmes to orientate novices before they assume full teaching roles. Participants also urged nurse clinicians to obtain pedagogical preparation and postgraduate degree before moving into academia or immediately after being employed.

Health system barriers influencing timely breast cancer diagnosis and treatment among women in low and middle-income Asian countries: evidence from a mixed-methods systematic review.

BACKGROUND: Globally, breast cancer is the most common cancer type and the leading cause of cancer mortality among women in developing countries. A high prevalence of late breast cancer diagnosis and treatment has been reported predominantly in Low- and Middle-Income Countries (LMICs), including those in Asia. Thus, this study utilized a mixed-methods systematic review to synthesize the health system barriers influencing timely breast cancer diagnosis and treatment among women in Asian countries. METHODS: We systematically searched five electronic databases for studies published in English from 2012 to 2022 on health system barriers that influence timely breast cancer diagnosis and treatment among women in Asian countries. The review was conducted per the methodology for systematic reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, while health system barriers were extracted and classified based on the World Health Organization (WHO)'s Health Systems Framework. The mixed-methods appraisal tool was used to assess the methodological quality of the included studies. RESULTS: Twenty-six studies were included in this review. Fifteen studies were quantitative, nine studies were qualitative, and two studies used a mixed-methods approach. These studies were conducted across ten countries in Asia. This review identified health systems barriers that influence timely breast cancer diagnosis and treatment. The factors were categorized under the following: (1) delivery of health services (2) health workforce (3) financing for health (4) health information system and (5) essential medicines and technology. Delivery of health care (low quality of health care) was the most occurring barrier followed by the health workforce (unavailability of physicians), whilst health information systems were identified as the least barrier. CONCLUSION: This study concluded that health system factors such as geographical accessibility to treatment, misdiagnosis, and long waiting times at health facilities were major barriers to early breast cancer diagnosis and treatment among Asian women in LMICs. Eliminating these barriers will require deliberate health system strengthening, such as improving training for the health workforce and establishing more healthcare facilities.

"Some believe those who say they can cure it" perceived barriers to antiretroviral therapy for children living with HIV/AIDS: Qualitative exploration of caregivers experiences in tamale metropolis.

BACKGROUND: HIV/AIDS is now a chronic disease, as adherence to anti-retrovirals impacts positively on the quality as well as expectancy of life. However, there exist multifaceted barriers to treatments for which children are most disadvantaged. Since Ghana subscribed to the "treat all" policy less percentage (25.5%) of children (2-14 years) living with HIV/AIDS have been enrolled on the antiretroviral program compared to other categories of the population by 2019. At present no study has explored these barriers to children living with HIV/AIDS enrollment and adherence. This study aims to explore the perceived barriers of caregivers of children living with HIV/AIDS in the Tamale Metropolis. METHODS: We used descriptive phenomenology to explore the phenomena. Caregivers were purposively selected and interviewed till information became repetitive at the ninth (9th) caregiver. A semi-structured interview guide was used to collect data through face-to-face in-depth interviews which were audio recorded. The interviews lasted an average of 47 minutes. Audio interviews were transcribed verbatim (English) and translated back-to-back (Daghani) before analysis was done manually according to Collaizi's seven-step approach. We used the Guba and Lincoln guidelines to ensure the rigour of the study and its findings. Results are presented in themes and supported with quotes. RESULTS: Six themes emerged from the analysis of the caregivers' transcripts; (1) denial of HIV/AID diagnosis, (2) stock-outs and privacy at the clinic, (3) busy schedule and poor support, (4) ignorance and alternative herbal cure, (5) stigma and discrimination, (6) transportation and distance. CONCLUSION: Perceived barriers are multi-dimensional and encountered by all PLWHA, especially children. These barriers could derail the gains of HIV/AIDS interventions among children. Adherence counselling among caregivers alongside campaigns among faith and herbal healers are of grave concern to reduce myths of cure.

Promoting respectful maternity care: challenges and prospects from the perspectives of midwives at a tertiary health facility in Ghana.

BACKGROUND: Evidence shows that women in Ghana experience disrespectful care (slapping, pinching, being shouted at, etc.) from midwives during childbirth. Hence, evidence-based research is needed to advance the adoption of respectful maternity care (RMC) by midwives. We therefore sought to explore and document midwives' perspectives concerning challenges faced and prospects available for promoting RMC in a tertiary health facility. METHODS: We employed an exploratory descriptive qualitative study design. In total, we conducted 12 interviews with midwives educated on RMC. All audio data were transcribed verbatim and exported to NVivo-12 for data management and analyses. We relied on the Consolidated Criteria for Reporting Qualitative Research guideline in reporting this study. RESULTS: The findings were broadly categorised into three themes: emotional support, dignified care and respectful communication which is consistent with the WHO's quality of care framework. For each theme, the current actions that were undertaken to promote RMC, the challenges and recommendations to improve RMC promotion were captured. Overall, the current actions that promoted RMC included provision of sacral massages and reassurance, ensuring confidentiality and consented care, and referring clients who cannot pay to the social welfare unit. The challenges to providing RMC were logistical constraints for ensuring privacy, free movement of clients, and alternative birthing positions. Poor attitudes from some midwives, workload and language barrier were other challenges that emerged. The midwives recommended the appointment of more midwives, as well as the provision of logistics to support alternative birthing positions and privacy. Also, they recommended the implementation of continuous training and capacity building. CONCLUSION: We conclude that in order for midwives to deliver RMC services that include emotional support, dignified care, and respectful communication, the government and hospital administration must make the required adjustments to resolve existing challenges while improving the current supporting activities.