"It's about how you take in things with your brain" - young people's perspectives on mental health and help seeking: an interview study.

INTRODUCTION: Poor mental health in young people has become a growing problem globally over the past decades. However, young people have also been shown to underutilize available healthcare resources. The World Health Organisation (WHO) has formulated guidelines for youth-friendly health services (YFHSs) to increase youth participation in healthcare. Still, little is known about how young people using these services perceive mental health, indicating a knowledge gap concerning the subjective evaluation of their mental health. AIM: To investigate how young people visiting youth health clinics (YHC) perceive the concept of mental health and factors they view as central to maintaining mental health. METHODS: In total 21 interviews were carried out, 16 in 2018, and 5 in 2023 to assure no changes in findings after the COVID-19 pandemic. Subjects were recruited during visits to youth health clinics (YHCs) in mid-Sweden and were aged 15-23 years. Recruitment strived to achieve heterogeneity in the sample concerning gender, sexual orientation, gender identity and age. Interviews were transcribed and analysed using qualitative content analysis. FINDINGS: Findings of the analysis revealed two themes, "Mental health is helped and hindered by the surroundings" and "Mental health is difficult to understand and difficult to achieve". The participants described their health as highly dependent on their social surroundings, and that these are important to maintaining health but may also affect health negatively. They described mixed experiences of the health care services and mentioned prerequisites for seeking care for mental health problems such as accessibility and respect for their integrity, including the right to turn down offered treatment. The informants also viewed mental health as an ongoing undertaking that one must work for, and that it is sometimes difficult to know what constitutes mental health. They also expressed a need from healthcare services to enquire about their health, and to show an active interest in how they are doing. CONCLUSIONS: Findings underline the need of young people's individual needs to be met in the healthcare system and their vulnerability to their social surroundings. Health status assessments in young people should consider social and individual factors to fully capture mental health.

Identification of health-related problems in youth: a mixed methods feasibility study evaluating the Youth Health Report System.

BACKGROUND: Because poor health in youth risk affecting their entry in adulthood, improved methods for their early identification are needed. Health and welfare technology is widely accepted by youth populations, presenting a potential method for identifying their health problems. However, healthcare technology must be evidence-based. Specifically, feasibility studies contribute valuable information prior to more complex effects-based research. The current study assessed the process, resource, management, and scientific feasibility of the Youth Health Report System prototype, developed within a youth health clinic context in advance of an intervention study. METHODS: This mixed-methods feasibility study was conducted in a clinical setting. The process, resource, management, and scientific feasibility of the Youth Health Report System were investigated, as recommended in the literature. Participants were youth aged 16-23 years old, attending a youth health clinic, and healthcare professionals from three clinics. The youth participants used their smart phones to respond to Youth Health Report System health questions and healthcare professionals used their computer to access the results and for registration system entries. Qualitative data were collected from interviews with healthcare professionals, which were described with thematic analysis. Youth participants' quantitative Youth Health Report System data were analyzed for descriptive statistics. RESULTS: Feasibility analysis of qualitative data from interviews with 11 healthcare professionals resulted in three themes: We expected it could be hard; Information and routines helped but time was an issue; and The electronic case report form was valuable in the health assessment. Qualitative data were collected from the Youth Health Report System. A total of 54 youth participants completed the evaluation questionnaire, and healthcare professionals retrieved information from, and made post-appointment system entries. Quantitative results revealed few missing items and acceptable data variability. An assessment template of merged qualitative and quantitative data guided a consensus discussion among the researchers, resulting in acceptable feasibility. CONCLUSIONS: The process-, resource-, management-, and scientific feasibility aspects were acceptable, with some modifications, strengthening the potential for a successful Youth Health Report System intervention study.

Implementing a Food Prescription Program during COVID-19: Benefits and Barriers.

Food prescription programs (Food Rx) have the potential to improve management of diet-related chronic diseases or underlying conditions such as type 2 diabetes (T2D), hypertension, and high body mass index (BMI) among food-insecure patients. The purpose of this study was to examine the effectiveness of a Food Rx program implemented in two community-based clinics in Florida. Data were collected through researcher-administered surveys (food insecurity, demographics, and socio-economic variables) and biometric data (HbA1c, blood pressure, and BMI). Key results include the following: (1) Hispanic patients are more likely to utilize the program than their Black and White counterparts (p < 0.001); (2) older patients (≥50 years) have a higher food redemption rate when compared to younger patients (36-49.9 years); (3) food redemption rate is negatively associated with food security scores indicating improvements in food security status over time (r2 = -0.184, p = 0.036); (4) diabetic patients with higher baseline HbA1c (>9%) have significant reductions in glycated hemoglobin (p = 0.011) over time as compared to patients with lower baseline values (<7%); and (5) patients enrolled in the program for at least 6 months have a significant reduction in systolic blood pressure (p = 0.051). Changes in BMI were not significantly associated with redemption rates. This study is significant as it offers insights into the potential benefits and challenges of implementing Food Rx programs to address diet-related chronic diseases among underserved populations.

HIV Care Profiling and Delivery Status in the Mobile Health Clinics of eThekwini District in KwaZulu Natal, South Africa: A Descriptive Evaluation Study.

Mobile health clinics (MHCs) serve as an alternative HIV care delivery method for the HIV-burdened eThekwini district. This study aimed to describe and profile the HIV care services provided by the MHCs through process evaluation. A descriptive cross-sectional quantitative evaluation study was performed on 137 MHCs using total population sampling. An online data collection method using a validated 50-item researcher-developed instrument was administered to professional nurses who are MHC team leaders, following ethical approval from the local university and departments of health. Descriptive statistics were used to analyze the data. The results described that HIV care services are offered in open spaces (43%), community buildings (37%), solid built buildings called health posts (15%), vehicles (9%), and tents (2%) with no electricity (77%), water (55%), and sanitation (64%). Adults (97%) are the main recipients of HIV care in MHCs (90%) offering antiretroviral therapy (95%). Staff, monitoring, and retaining care challenges were noted, with good linkage (91%) and referral pathways (n = 123.90%). In conclusion, the standardization and prioritization of HIV care with specific contextual practice guidelines are vital.

Application of a Digital Mental Health Clinic in Secondary Schools: Functionality and Effectiveness Evaluation.

BACKGROUND: Adolescents experience relatively more stress than other populations as they are facing rapid physical changes and adapting to complex social environments. However, access for this population to professional service providers is limited. Therefore, there is an increasing need for access to mental health services and new mental health care resources tailored to adolescents. OBJECTIVE: The aim of this study was to evaluate the functionality and effectiveness of a school digital mental health clinic (DMHC) created by a Chinese psychiatric hospital and provided to secondary school students for a trial. METHODS: The trial period of the DMHC was from January to July 2021 at three secondary schools in Taizhou City, China. Under a collaborative agreement between the local educational bureau and provider, use of the DMHC was free to all students, teachers, and staff of the schools. The functionality of the DMHC was compared with existing digital health interventions introduced in the literature and its effectiveness was quantitatively analyzed in terms of the volume of received counseling calls, number of calls per 100 students, length and time of calls, and reasons for the calls. The mini course video views were analyzed by topics and viewing time. RESULTS: The design functions of the DMHC are well aligned with required factors defined in the literature. The first advantage of this DMHC is its high accessibility to students in the three schools. All functions of the DMHC are free to use by students, thereby eliminating the economic barriers to seeking and receiving care. Students can receive virtual counseling during or after regular working hours. Acceptability of the DHMC was further ensured by the full support from a national top-tier mental health facility. Any audio or video call from a student user would connect them to a live, qualified professional (ie, a psychiatrist or psychologist). Options are provided to view and listen to resources for stress relief or tips to help address mental health needs. The major reasons for the counseling calls included difficulties in learning, interpersonal relationships, and emotional distress. The three topics with the highest level of interest for the mini course videos were emotional assistance, personal growth, and family member relationships. The DMHC served as an effective tool for crisis prevention and intervention during nonworking hours as most of the live calls and mini video viewing occurred after school or over the weekend. Furthermore, the DMHC helped three students at high risk for suicide and self-injury through live-call intervention. CONCLUSIONS: The DMHC is an effective complementary solution to improve access to professional mental health care facilities, especially during nonworking hours, thereby helping adolescents meet their mental health needs. Extension of the DMHC into more schools and other settings is recommended.

Adolescent Friendly Health Clinics (AFHCS) in India and their compliance with government benchmarks: A scoping review.

Background: Adolescent Friendly Health Clinics (AFHCs) are one of the critical pillars of India's Adolescent Health Programme-Rashtriya Kishor Swasthya Karyakram that seeks to enable all adolescents to realize their full potential by making informed decisions concerning their health and by accessing the services. Thus, a review was conceptualised to assess the compliance of AFHCs with the benchmark proposed by the Government under Rashtriya Kishor Swasthya Karyakram. Methods: Three databases (PubMed, Scopus and Google Scholar) were searched for articles published between 2014 and December 2022. A snowball search strategy was also used to retrieve all published articles. Based on the search strategy eight studies were included. Results: AFHCs are not fully compliant with all the benchmarks proposed by the government of India. Evidence from the primary studies showed that the benchmarks need attention as privacy was lacking (six out of seven studies), unavailability of Information Education and Communication material (four out of five), signages (two out of four), referrals (one out of two), and judgemental attitude of health care providers (one out of 3). Conclusions: There is a pressing need to focus on the fulfilment of these gaps to make the clinics adolescent-friendly. This might increase the utilisation of available services in AFHCs by adolescents and will improve their health. The improved health will catalyse achieving the Sustainable Development Goals indicators that are associated with nutrition, reproductive health, sexual and intimate partner violence, child marriage, education, and employment.

A campus-based community clinic and food-shelf join efforts to reduce food insecurity using a One Health approach toward building a vibrant living system.

This report describes a One Health approach to address food insecurity among two distinct campus populations-college students and patients at a campus-based community health clinic serving Latine adults. The multidisciplinary collaboration includes college staff, faculty, and students, and the founders, both women-centered institutions. Organic community gardens located on and near campus property, pollinated by campus-based beehives, contribute local organic produce to a campus-based food shelf increasing food security and nutritional health for both populations. The One Health system modeled in this report is a step toward building a vibrant community and demonstrates how others can be a part of the larger One Health movement.

Development and usability evaluation of an electronic health report form to assess health in young people: a mixed-methods approach.

BACKGROUND: Electronic Patient-Reported Outcomes (ePROs) have potential to improve health outcomes and healthcare. The development of health-technology applications, such as ePROs, should include the potential users and be theoretically grounded. Swedish Youth Health Clinics (YHCs) offer primarily sexual and psychological healthcare for young people aged 12 to 25 years old. Young people in healthcare settings are considered a vulnerable group. The development of a collection of Patient-Reported Outcomes (PROs) in an Electronic Health Report Form (eHRF) for identifying health and health-related problems in young people, was preceded by a qualitative interview study, exploring young people's views on using an eHRF at YHCs and which questions about health an eHRF should contain. The aim of the current study was to develop and evaluate the usability of an eHRF prototype for identifying health and health-related problems in young people visiting YHCs. METHODS: This study used a participatory design. During the development, an expert panel consisting of eight researchers and one Information Technology worker, participated. A wide literature search was performed to find PROs to construct an eHRF prototype to cover health areas. A mixed methods usability evaluation included 14 participants (young people, healthcare professionals, and an expert panel). RESULTS: The development resulted in an eHRF prototype, containing ten reliable and valid health questionnaires addressing mental-, physical-, and sexual health and social support, a self-efficacy question, and background questions, in total 74 items. The interviews in the usability evaluation resulted in three categories describing the usability of the eHRF: 'Captures the overall health of young people but needs clarification', 'Fun, easy, and optional and will keep young people's interest', and 'Potential contribution to improve the health consultation'. The quantitative results support the usability of the eHRF for YHCs. CONCLUSIONS: The participatory approach contributed to development of the eHRF prototype to cover health areas adapted for the target population. The usability evaluation showed that the eHRF was usable and had the potential for self-reflection and contributions to cooperation between young people and healthcare professionals during the health consultation.

Health Care Utilization among Homeless-Experienced Adults Who Were Seen by a Mobile Addiction Health Clinic in Boston, Massachusetts: A Quasi-Experimental Study.

Background: Mobile health clinics improve access to care for marginalized individuals who are disengaged from the healthcare system. This study evaluated the association between a mobile addiction health clinic and health care utilization among people experiencing homelessness. Methods: Using Medicaid claims data, we evaluated adults who were seen by a mobile addiction health clinic in Boston, Massachusetts from 1/16/18-1/15/19 relative to a propensity score matched control cohort. We evaluated both cohorts from four years before to one year after the index visit date with the mobile clinic. The primary outcome was the number of outpatient visits; secondary outcomes were the number of hospitalizations and emergency department (ED) visits. We used Poisson regression to compare changes in outcomes from before to after the index date in a quasi-experimental design. Results: 138 adults were seen by the mobile clinic during the observation period; 29.7% were female, 16.7% were Black, 8.0% Hispanic, 68.1% White, and the mean age was 40.4 years. The mean number of mobile clinic encounters was 3.1. The yearly mean number of outpatient visits increased from 11.5 to 12.1 (p = 0.43; pdiff-in-diff = 0.15), the number of hospitalizations increased from 2.2 to 3.0 (p = 0.04; pdiff-in-diff = 0.87), and the number of ED visits increased from 5.4 to 6.5 (p = 0.04; pdiff-in-diff = 0.40). Conclusions: The mobile addiction health clinic was not associated with statistically significant changes in health care utilization in the first year. Further research in larger samples using a broader set of outcomes is needed to quantify the benefits of this innovative care delivery model.

Is Time Spent on Prior Authorizations Associated With Approval?

Advanced practice providers increasingly assume responsibility for prior authorizations (PAs). We hypothesized that the time burden of PAs will be correlated with increased approval. We collected several variables (ie, type, method, time spent, use of peer to peer, and outcome) for all PAs completed by a departmental nurse practitioner in 1 region. Chi-square tests and 2 sample t tests were used to assess significance. There was no significant association between the method of request, the number of attempts, and the time spent to approved PA. Further research is needed to determine ways to decrease the time and opportunity cost associated with PAs.

Senior Health Clinic for 75-year-old home-dwelling Finns - study design, clinic protocol and non-response analysis.

BACKGROUND: In the Finnish policy on older people preventive activities, which maintain functional capacity and independent living, are emphasized. The Turku Senior Health Clinic, aimed at maintaining independent coping of all home-dwelling 75-year-old citizens in the city of Turku, was founded in the beginning of 2020. The aim of this paper is to describe design and protocol of the Turku Senior Health Clinic Study (TSHeC) and provide results of the non-response analysis. METHODS: The non-response analysis used data from 1296 participants (71% of those eligible) and 164 non-participants of the study. Sociodemographic, health status, psychosocial and physical functional ability indicators were included in the analysis. Participants and non-participants were also compared in respect to their neighborhood socioeconomic disadvantage. Differences between participants and non-participants were tested using the Chi squared or Fisher´s exact test for categorical variables and t-test for continuous variable. RESULTS: The proportions of women (43% vs. 61%) and of those with only satisfying, poor or very poor self-rated financial status (38% vs. 49%) were significantly lower in non-participants than in participants. Comparison of the non-participants and participants in respect to their neighborhood socioeconomic disadvantage showed no differences. The prevalence of hypertension (66% vs. 54%), chronic lung disease (20% vs. 11%), and kidney failure (6% vs. 3%) were higher among non-participants compared to participants. Feelings of loneliness were less frequent among non-participants (14%) compared to participants (32%). The proportions of those using assistive mobility devices (18% vs. 8%) as well as those having previous falls (12% vs. 5%) were higher in non-participants than in participants. CONCLUSIONS: The participation rate of TSHeC was high. No neighborhood differences in participation were found. Health status and physical functioning of non-participants seemed to be slightly worse than those of the participants, and more women than men participated. These differences may weaken the generalizability of the findings of the study. The differences have to be taken into account when recommendation for the content and implementation of preventive nurse-managed health clinic in primary health care in Finland is going to be given. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05634239; registration date; 1st of December 2022. Retrospectively registered.

Introducing Norwegian parents to the Circle of Security Parenting program during the postpartum period: A qualitative descriptive study.

OBJECTIVE: Public health nurses in Norway provide a range of health promotion and primary prevention services to families in the postpartum period. The study objectives were to describe parents' experiences of: 1) being introduced to the Circle of Security Parenting program during a home visit and 2) participating in a parent group meeting. DESIGN: Qualitative descriptive study. SAMPLE: A purposeful sample of 24 caregivers (n = 15 mothers, n = 9 fathers) parenting an infant. MEASURES: In-depth, semi-structured interviews were conducted to document participants experiences. Content analysis was used to code and categorize the data. FINDINGS: Three main categories with seven subcategories reflected the parents' experiences: 1) Confidence-building home visit, 2) Awareness-raising parental group, 3) Dissemination of knowledge. CONCLUSIONS: The parents experienced the home visit as being on their family's terms and reassuring. The parental group session started a reflection process which made them aware of the importance of being present for their child, how to modify their communication and have a common understanding of childrearing. The parents thought the group was a great way to introduce the Circle of Security Parenting program and experienced it as a continuation of the information presented at the home visit. The introduction provided them with new knowledge.

Mobile Vaccine Clinics for Patients With Serious Mental Illness and Health Care Workers in Outpatient Mental Health Clinics.

OBJECTIVE: People with serious mental illness are particularly vulnerable to COVID-19 but face barriers to vaccinations. The authors describe the implementation of a mobile vaccine clinic at an outpatient mental health clinic for patients and health care workers to increase vaccination rates. METHODS: In late 2021, mobile vaccine clinics were held in collaboration with a local pharmacy to provide COVID-19 and influenza vaccines to patients and health care workers. Participants in one clinic were asked to fill out a questionnaire about their experience. RESULTS: Of 69 individuals who completed the questionnaire, 96% received the COVID-19 booster and 17% received the seasonal flu vaccine. Most patients and health care workers reported that the mobile vaccine clinic was easily accessible and preferable and that they would recommend it. Moreover, the mobile vaccine clinic was cost-effective. CONCLUSIONS: Mobile vaccine clinics can improve vaccine access for patients and health care workers in community mental health settings and can be cost-effective.

A qualitative assessment of provider satisfaction and experiences with a COVID-19 community mobile health clinic outreach model in underserved Baltimore neighborhoods.

Objective: Although previous studies have assessed provider perceptions about telehealth, no prior studies have qualitatively assessed the experiences and satisfaction of health-care providers with a community mobile health clinic model within underserved urban settings. Methods: This study draws on the views expressed by community health workers (n = 4), registered nurses (n = 2), Grace Medical Center outreach specialists (n = 2), and physician assistants staffing LifeBridge Health's virtual hospital (n = 3) to understand their satisfaction and experiences with a COVID-19 community mobile health clinic in underserved Baltimore neighborhoods. Thematic analysis of the interviews was used to extract themes and subthemes of our health-care providers' experiences with the community mobile health clinic model. Results: These individuals shared their experiences addressing social determinants of health, the perceived impact of community mobile health clinic, satisfaction with and limitations of the pilot project, as well as future implications for the community mobile health clinic model. Finally, ideas for how the model can fit into the existing healthcare delivery framework are suggested. Conclusion: The context surrounding the COVID-19 pandemic has provided a unique opportunity to critically address healthcare frameworks and models. The LifeBridge community mobile health clinic served as an initiative to truly bridge together community outreach and health access. Among the many themes, health-care providers on the team applauded the model for its potential to bring preventative health care to the patient with the goal of improving patient health outcomes.

Implementation and evaluation of a multilevel intervention to increase uptake of the human papillomavirus vaccine among rural adolescents.

PURPOSE: Geographic disparities exist in uptake of the human papillomavirus vaccine (HPV). In 2020, the National Immunization Survey-Teen reported that adolescents living in nonmetropolitan statistical areas (MSAs) had lower HPV vaccination coverage (≥ 1 dose) compared to adolescents living in MSA principal cities. This paper describes the implementation and evaluation of a multilevel pilot intervention study to increase uptake of the HPV vaccine among adolescent patients ages 11-17 of a rural health clinic. METHODS: This parent, primary care team, and clinic multilevel pilot intervention was guided by evidence-based approaches to increase HPV vaccinations, formative research, and input from the community. HPV vaccination initiation and completion rates were analyzed at baseline and 23 months follow-up. FINDINGS: The proportion of adolescent patients ages 11-17 who had initiated the HPV vaccine series was significantly greater at follow-up compared to baseline, (82.7% compared to 52.4%), χ2 (1, n = 498) = 49.2, P < .0001. The proportion of adolescent patients ages 11-17 who had completed the HPV vaccine series was also significantly greater at follow-up compared to baseline, (58.0% compared to 27.0%), χ2 (1, n = 498) = 50.8, P < .0001. CONCLUSIONS: The multilevel intervention significantly increased HPV initiation and completion rates among adolescent patients ages 11-17 at this rural health clinic. This study demonstrates the feasibility of utilizing a multilevel intervention to address low HPV vaccination rates among rural adolescents and the potential of employing this strategy for a large-scale randomizing-controlled trial.

Domains of Adherence and Non-Adherence to Anti-Hypertensive Medications in Hypertensive Patients from Kuala Lumpur: A Qualitative Study

@#Introduction: Previous medication adherence studies primarily focused on the domains of non-adherence in hypertension treatment and less attention has been given on domains that encourage adherence to anti-hypertensive medications. The current study is aimed to identify the domains of adherence and non-adherence to anti-hypertensive medications among hypertensive patients in Kuala Lumpur, Malaysia. Methods: Hypertensive patients from two public health clinics in Kuala Lumpur were invited for in-depth interviews until thematic saturation. Audio recordings from these interviews were transcribed verbatim. Transcripts were then analysed deductively with the guidance of the World Health Organization Medication Adherence Framework to extract the domains of adherence and non-adherence to anti-hypertensive medications. Results: Ten patients who were predominantly Malays and aged 34-73 years old participated the study. Patient-related (encompassing knowledge, attitude, belief and culture, lifestyle, personal barriers, self-efficacy, and cue to action), socioeconomic (encompassing social support), condition-related (encompassing nature of illness and presence of multiple co-morbidities), therapy-related (encompassing experience of receiving treatment, barrier in treatment, and side effects of treatment), and healthcare system (encompassing access to healthcare and healthcare center experience) domains were identified as central to the medication-taking behaviour of hypertensive patients. Conclusion: Sixteen codes of adherence and 22 codes of non-adherence to anti-hypertensive medications were identified, which were distributed across five domains (patient-related, socioeconomic, condition-related, therapy related, and healthcare system domains). These findings can help to inform future development of medication adherence questionnaires, individualised interventions for patients with adherence problems, and targeted health promotion programmes to reduce uncontrolled hypertension.

Ecological Study of Sick Building Syndrome among Healthcare Workers at Johor Primary Care Facilities.

INTRODUCTION: Persistent exposure to indoor hazards in a healthcare setting poses a risk of SBS. This study determines the prevalence of and risk factors for SBS among healthcare workers in health clinics. METHODS: A cross-sectional study was conducted across four health clinics from February 2022 to May 2022. As part of the study, self-administered questionnaires were completed to determine symptoms related to SBS. An indoor air quality (IAQ) assessment was conducted four times daily for fifteen minutes at five areas in each clinic (laboratory, lobby, emergency room, pharmacy, and examination room). RESULT: Most of the areas illustrated poor air movement (<0.15 m/s), except for the laboratory. The total bacterial count (TBC) was above the standard limit in both the lobby and emergency room (>500 CFU/m3). The prevalence of SBS was 24.84% (77) among the healthcare workers at the health clinics. A significant association with SBS was noted for those working in the examination room (COR = 2.86; 95% CI = 1.31; 6.27) and those experiencing high temperature sometimes (COR = 0.25; 95% CI = 0.11; 0.55), varying temperature sometimes (COR = 0.31; 95% CI = 0.003), stuffy air sometimes (COR = 0.17; 95% CI = 0.005; 0.64), dry air sometimes (COR = 0.20; 95% CI = 0.007; 0.64), and dust sometimes (COR = 0.25; 95% CI = 0.11; 0.60) and everyday (COR = 0.34; 95% CI = 0.14; 0.81). Only healthcare workers in the examination room (AOR = 3.17; 95% CI = 1.35; 7.41) were found to have a significant risk of SBS when controlling for other variables. CONCLUSION: SBS is prevalent among healthcare workers at health clinics.

Telehealth Care for Mothers and Infants to Improve the Continuum of Care: Protocol for a Quasi-Experimental Study.

BACKGROUND: Ensuring an appropriate continuum of care in maternal, newborn, and child health, as well as providing nutrition care, is challenging in remote areas. To make care accessible for mothers and infants, we developed a telehealth care system called Portable Health Clinic for Maternal, Newborn, and Child Health. OBJECTIVE: Our study will examine the telehealth care system's effectiveness in improving women's and infants' care uptake and detecting their health problems. METHODS: A quasi-experimental study will be conducted in rural Bangladesh. Villages will be allocated to the intervention and control areas. Pregnant women (≥16 gestational weeks) will participate together with their infants and will be followed up 1 year after delivery or birth. The intervention will include regular health checkups via the Portable Health Clinic telehealth care system, which is equipped with a series of sensors and an information system that can triage participants' health levels based on the results of their checkups. Women and infants will receive care 4 times during the antenatal period, thrice during the postnatal period, and twice during the motherhood and childhood periods. The outcomes will be participants' health checkup coverage, gestational and neonatal complication rates, complementary feeding rates, and health-seeking behaviors. We will use a multilevel logistic regression and a generalized estimating equation to evaluate the intervention's effectiveness. RESULTS: Recruitment began in June 2020. As of June 2022, we have consented 295 mothers in the study. Data collection is expected to conclude in June 2024. CONCLUSIONS: Our new trial will show the effectiveness and extent of using a telehealth care system to ensure an appropriate continuum of care in maternal, newborn, and child health (from the antenatal period to the motherhood and childhood periods) and improve women's and infants' health status. TRIAL REGISTRATION: ISRCTN Registry ISRCTN44966621; https://www.isrctn.com/ISRCTN44966621. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41586.

Mindfulness training for community-based psychotherapists: a feasibility study.

BACKGROUND: While mindfulness training's feasibility has been assessed in many health care settings, the feasibility of teaching mindfulness to psychotherapists of various orientations for both self- and patient-care has not been explored. The objectives of this feasibility assessment were to determine the degree to which clinic psychotherapists were willing to complete a skills-based mindfulness training program; evaluate the acceptability of integrating mindfulness interventions into an urban community mental health clinic; examine the training's influence on both personal mindfulness practice and integration into patient care; and explore the impact of a support group following the training. METHODS: Data on six aspects of feasibility were gathered through quantitative surveys, semi-structured qualitative interviews, and group observation and feedback, analyzed using grounded theory. RESULTS: Sixteen therapists and one administrator attended at least one session of this voluntary program and responded to the associated surveys. At 1-year post-training, 7 participants had attended one or more group support sessions, and 4 more than 50% of sessions. The following factors were identified as contributing to the training's success: significant interest on the part of clinic staff to receive the training; diversity of the teaching staff, buy-in from clinic administration, provision of meditation scripts, role-play exercises, the variety of practices taught, and case presentations. Therapists indicated that the training helped them create a personal mindfulness practice, and several proceeded to integrate mindfulness into client sessions. A bi-weekly support group organized after the training encompassed group practice, discussion, case presentations, and information about trauma-sensitive mindfulness. Clinicians identified the following challenges to integrating mindfulness into sessions: lack of scripts in client languages other than English, the unacceptability of mindfulness to some clients' religious beliefs, the lack of appropriateness for clients facing ongoing psychosocial crises, the lack of interest on the part of some clients, and the time constraints posed by brief therapy sessions. CONCLUSIONS: These findings indicate that such training may be feasible in community mental health settings given support from leadership and the presence of qualified facilitators within the organization. Adaptations to the training based on participant feedback can inform a larger scale trial that compares our protocol with another intervention in the treatment of a psychological disorder or condition identified by the participants as having responded favorably to the program.

Job Dissatisfaction and Its Predictors among Healthcare Workers of 'Type 2 Health Clinics' in North-Eastern Malaysia.

It is crucial to comprehend factors associated to job dissatisfaction among healthcare workers (HCWs) in Malaysia's primary health clinics, especially those working in 'Type 2 Health Clinics' which cater for populations of >50,000 and a daily average number of patients between 500 and 800. It is essential to ensure that effective strategies can be proposed to promote job satisfaction. A total of 314 HCWs from 'Type 2 Health Clinics' in north-eastern Malaysia consented to participate in this cross-sectional study, conducted between October 2020 and December 2021. The Job Satisfaction Survey was used to assess job dissatisfaction. The prevalence of job dissatisfaction was 35.7%. The significant factors associated with job dissatisfaction were younger age and those who were dissatisfied with their yearly performance mark. Targeted interventional activities for young HCWs and for those who are dissatisfied with their yearly performance mark are recommended to improve job satisfaction.