Shaping future deprescribing priorities: outcomes of a World Café stakeholder workshop

Pregnant women and mothers who use substances often face significant barriers to accessing and engaging with substance use services. A scoping review was conducted in 2019 to understand how stigma impacts access to, retention in and outcomes of harm reduction and child welfare services for pregnant women and mothers who use substances. The forty‐two (n = 42) articles were analysed using the Action Framework for Building an Inclusive Health System developed by Canada's Chief Public Health Officer to articulate the ways in which stigma and related health system barriers are experienced at the individual, interpersonal, institutional and population levels. Many articles highlighted barriers across multiple levels, 19 of which cited barriers at the individual level (i.e., fear and mistrust of child welfare services), 18 at the interpersonal level (i.e., familial and relational influence on accessing substance use treatment), 30 at the institutional level (i.e., high organisational expectations on women) and 17 at the population level (i.e., negative stereotypes and racism). Our findings highlight the interconnectedness of stigma and related barriers and the ways in which stigma at the institutional and population levels pervasively influence individual and interpersonal experiences of stigma. Despite a wealth of literature on barriers to treatment and support for pregnant women and mothers who use substances, there has been minimal focus on how systems can address these formidable barriers. This review highlights the ways in which the barriers are connected and identifies opportunities for service providers and policymakers to better support pregnant women and mothers who use substances.

Media reports abound of harm that can occur to the individual when using social media, from financial, emotional to psychological. To date, research around online harm and mitigation has tended to focus on specific risks such as phishing scams and identity theft. Some studies have explored the influence of factors such as age, cognitive ability, education, personality and risk propensity; while others have examined the effects of the type of attack, e.g. investment scam, on scam compliance. However, few studies, if any, have explored the individual’s approach to the holistic notion of potential risk and harm that might occur through social media use, particularly scams, given that one seldom knows what sort of, when and where such an attack may occur. This study aims to address this gap in the research. Informed by, amongst others, Protection Motivation Theory (Rogers, 1975), Reactance Theory (Brehm, 1966) and Self-Determination Theory (Deci & Ryan, 1985), exploratory interviews were conducted with a purposive sample of 25 individuals to ascertain (1) their knowledge and/or experience of scams and consequent harm in social media use and (2) their mitigation responses. Findings indicate a range of scam knowledge and experience. Financial damage occurred most frequently, and often significant emotional harm. A variety of tactics was embraced by the interviewees in order to mitigate the potential harm of social media use. These ranged from becoming expert in certain types of attacks, to adopting a head-in-the-sand approach. Various demographic, personality and contextual factors seemed to contribute to vulnerability and favoured mitigating tactics. Suggestions are provided as to how to provide holistic guidance to users and the role of banks, social media and regulatory/advisory bodies. Areas of future research are also indicated.

Objectives: We used a social ecological model to examine vulnerability and resilience among older adults during the COVID-19 pandemic. Methods: We analyzed two open-ended questions included in a survey of 235 respondents, 51–95 years old (M = 71.35; SD = 7.39; 74% female), which asked about COVID-19-related difficulties and positive experiences during the past week. We identified three different levels for difficulties and positives at the personal, interpersonal, and/or societal levels. Results: Fewer than half of the respondents reported on difficulties (41%) and positives (40%) just at the personal level. In terms of crossing levels, people were most likely to report events spanning the personal and interpersonal levels (14% and 18%, respectively). A few individuals reported difficulties and positives at the societal level. Discussion: Older individuals were acutely aware of challenges and positives existing at all three levels, and contributed to resources at the interpersonal and community levels.

Introduction: Type 2 diabetes (T2D) disproportionately impacts minority populations. The National Institute of Minority Health and Health Disparities (NIMHD) Research Framework identifies drivers of health disparities across multiple levels and domains. This study synthesized evidence on the behavioral drivers of T2D disparities among minority populations in the US and categorized them across individual, interpersonal, community, and societal levels. Methods: Relevant articles were retrieved from PubMed, CINAHL, PsycINFO, and Scopus. Eligible studies, defined as studies published between 2017 and 2023 that report glycemic measures or differences in T2D prevalence or related outcomes for US minority populations were abstracted and summarized descriptively. Results: Of the 108 included studies, 28 (26%) addressed behavioral drivers or strategies for addressing T2D disparities, the majority of which were at the individual level 20 (71%), 7(25%) at the community level, and 1(4%) at the interpersonal level. Individual-level drivers included physical activity, dietary practices, dysfunctional eating, sleep quality and duration, health-seeking behavior, and coping strategies such as anxiety, stress, depression, or distress. The interpersonal-level factors were emotional and maternal abuse. The identified community-level interventions to improve T2D outcomes included lifestyle interventions, self-management education, and interventions aimed at improving resilience. No identified behavioral factors at the societal level. Conclusions: This review identified a persistent focus on individual-level behavioral drivers of T2D disparities. Given the clear evidence that disparities in T2D are the result of upstream factors, more studies are needed at the interpersonal, community, and societal levels to inform comprehensive interventions and policies aimed at reducing T2D disparities. Disclosure E.O. Owolabi: None. M. Diaz: None. M. Braxton: None. T. Godfrey: None. M. Singh: None. A.M. Rascon: None. G.Q. Shaibi: None.

Initiating antiretroviral therapy (ART) in Indonesia poses major challenges, with limited studies on specific ART initiation barriers and facilitators. Using a socioecological approach, we explored, through semi-structured interviews, the perspectives of 67 participants: 17 people with HIV not (yet) on ART, 30 people with HIV on treatment, and 20 HIV service providers (HSPs). Fears emerged as pervasive barriers to initiation encompassing, at the intrapersonal level, (irrational) fears of negative medical and non-medical consequences. At the health system level, fears were linked to concerns about bureaucracy and insufficient universal coverage. On a societal level, fears stemmed from prevalent myths, misinformation on social media, and the impact of COVID-19. Interestingly, fear also served as a facilitator to initiation. At the intrapersonal level, initiation was driven by a fear of deteriorating health or death due to AIDS-related conditions. At the interpersonal level, buddies and HSPs leveraged to motivate initiation. At the societal level, accurate yet fear-inducing information on social media stimulated initiation. Perspectives differed between people with HIV and HSP, with people with HIV emphasizing barriers on intrapersonal to health system levels, while HSP focused mostly on intrapersonal and interpersonal barriers, albeit recognizing the crucial role of health systems.

Aim/Purpose: The purpose of this study was to understand the personal narratives of Filipino adolescents about the Fear of Missing Out (FOMO), and how it affects their overall life situations. By delving into their experiences, this research aimed to uncover the unique ways that FOMO shapes their emotions, behaviors, and social interactions, providing a deeper insight into their daily struggles and coping mechanisms. Introduction/Background: The study encapsulated the Fear of Missing Out (FOMO), a common experience among active social media users, especially young people. Social media is a platform where contents are filtered, and only happy and joyful moments are seen. Because of the frequent posting of happy moments and successes on social media, many people perceive others' lives as perfect and feel pitiful about their own lives. People feel that they are not included or that their lives are lacking compared to others. Studies have found that FOMO has a negative impact on self-esteem and mental well-being, and excessive use of social media makes it worse, as it can create negative feelings of envy towards what individuals perceive from social media. Methodology: A qualitative research design that used narrative analysis was chosen to examine how Filipino youth experience Fear of Missing Out (FOMO) in relation to social media use and offline interactions. The study was conducted in the City of Cagayan de Oro, located in the northern part of Mindanao. The researchers selected eight (8) Filipino youths aged 13 to 18 who had experienced FOMO. To obtain the necessary data, a semi-structured interview guide created by the researchers was used as the main research instrument. Since some participants were minors, a consent form was prepared to inform parents of the purpose and method of the study to address ethical considerations. Upon obtaining consent, the researchers set up an interview schedule with each participant. The participants were also asked to fill out an assent form. The researchers utilized open-ended questions to allow participants to reveal their experiences of FOMO. The researchers made audio recordings of the interviews to ensure data accuracy and reliability. The recordings were then transcribed to facilitate analysis. In terms of data analysis, the researchers utilized three levels of narrative analysis: personal, positional, and societal. On a personal level, participants' individual experiences and how they personally experienced FOMO were explored. At the positional level, differences in the social positions of the narrator and the listener were examined. The societal level looked at society's broader view of FOMO, and how it is affected by social factors. The data analysis was divided into three parts: beginning, middle, and end. The beginning focused on the individual or personal impact of FOMO. The middle part examined the influence of social networks and relationships with others, especially the role of social belongingness. The final section focused on the broader impact of social media on FOMO, specifically the value of online visibility and social media as a source of personal satisfaction and confidence. Findings: The results showed that due to social media, Filipino adolescents experienced FOMO which affected their self-worth, emotional well-being, and sense of belonging. The frequency of social media use affected adolescents significantly. Many relied on likes and reactions for validation, feeling inadequate when they received little engagement, while social comparisons intensified feelings of exclusion and self-doubt. Peer pressure pushed them to maintain an idealized online presence, often conflicting with their true selves and creating a struggle between social belonging and personal values. Additionally, what individuals perceived on social media affected their self-perception, conflicting with their overall well-being. Some participants recognized the need to detach their self-worth from social media, focusing instead on real-life experiences, personal growth, and meaningful relationships. The findings revealed that social media contributes significantly to feelings of inadequacy and anxiety, with adolescents often comparing themselves to others' curated online personas. Despite temporary validation through online engagement, many participants reported a cycle of dependence on social media to avoid missing out. In contrast, in-person interactions offered a sense of belonging and relief from exclusion. Contribution/Impact on Society: The study highlighted the psychological and social impacts of FOMO, and calls for interventions such as digital literacy programs and peer support groups to help adolescents healthily navigate these challenges. Recommendations: It is recommended that educators, parents, and mental health professionals help reduce the feeling of FOMO among adolescents by promoting social media literacy, encouraging open discussions, and providing coping strategies to build self-esteem and resilience against FOMO. Research Limitation: Due to the cultural context, the FOMO discussion may have unique characteristics that would not occur elsewhere. Future Research: Future research should explore the nuances of FOMO in different cultural contexts to provide a broader understanding of its impact and how to develop more effective interventions. Additionally, exploring the role of parental guidance and educational interventions in mitigating FOMO could provide valuable insights into preventive measures.

Femicide is a grave violation of fundamental human rights, such as the right to life, liberty, and personal security, as well as a formidable hin­drance to social and economic progress. By definition, femicide is the premed­itated killing of a female person due to their gender. This phenomenon is the result of a multitude of risk factors at the individual, interpersonal, communi­ty, and societal levels. The magnitude of what has been dubbed the “shadow pandemic” is evidenced by the mounting violence inflicted on women. This re­search seeks to analyze the role of social media marketing in bringing aware­ness to the issue of femicide, namely, its effect on public opinion, the degree to which it increases awareness of the rising femicide rate, and the reactions of social media users when confronted with individual cases. To achieve this, a phenomenological study with a Likert scale was conducted, involving 100 participants in North Macedonia aged between 18 and 60. The findings in­dicate that the majority of respondents do not believe that social media pro­vides an impetus for people to take action against femicide and their concern­ing note is witnessing online harassment or bullying related to femicide or vi­olence against women on social media. Empowering the potential of creat­ing a safe and supportive environment for discussing and addressing issues of femicide and violence against women in the social media space.

Based on two years' ethnographic research on doctor-patient relations in urban China, this paper examines the causes of patients' mistrust of physicians. I identify the major factors at the societal, institutional, and interpersonal levels that lead to patients' mistrust of physicians. First, I set the context by describing the extent of mistrust at the societal level. Then, I investigate the institutional sources of mistrust. I argue that the financing mechanism of public hospitals and physicians' income structures are the most crucial factors in inducing patients' mistrust. Hospitals' heavy reliance on self-finance has basically caused public hospitals to run like private hospitals, resulting in blatant conflicts of interest between hospitals and patients. Related to this is physicians' reliance on bonuses and commissions as part of their regular incomes, which has inevitably resulted in overtreatment and, hence, mistrust from the patients. At the interpersonal level, I describe how individual physicians' attitudes toward and interaction with patients may also affect patients' sense of trust or mistrust in physicians. In conclusion, I discuss the ethical implications of the mistrust problem, and suggest changes at the institutional and interpersonal levels to mitigate the problem.

* Abbreviations: COVID-19 — : coronavirus disease of 2019 LGBTQ — : lesbian, gay, bisexual, transgender, queer, and/or questioning Vulnerable pediatric populations (including youth who are lesbian, gay, bisexual, transgender, queer, and/or questioning [LGBTQ]; homeless; maltreated; in foster care; and struggling with substance use disorders) warrant particular consideration during the coronavirus disease of 2019 (COVID-19) pandemic. It is likely that stay-at-home orders, combined with increased economic instability and family pressures, will increase their risks for harm and, in some cases, may make it untenable (and potentially dangerous) for them to shelter in place. Simultaneously, safety nets that protect youth (child protective services, medical and mental health providers, and educators) have fewer staff available or are inaccessible because of the COVID-19 crisis. These conditions highlight how morbidity and mortality in vulnerable pediatric populations will likely extend beyond the pandemic itself. For some children and youth, home can be isolating and, in some cases, dangerous. Adverse childhood experiences, including physical abuse, sexual abuse, and neglect, are common, with an estimated 678 000 children and adolescents experiencing maltreatment in 2018, and young children are at highest risk for serious harm.1 These risks increase for specific populations. Indeed, LGBTQ and gender nonconforming youth (up to 16% of all youth) are at far higher risk of experiencing physical and sexual abuse, with the level of gender nonconformity predictive of … Address correspondence to Rachel I. Silliman Cohen, MD, Child Abuse Research Education and Service Institute, School of Osteopathic Medicine, Rowan University, 42 E Laurel Rd, Stratford, NJ 08084. E-mail: sillimancohen{at}rowan.edu

New media technology and social media impact all employees directly and indirectly, becoming a ubiquitous element of the workplace. Members of organizations feel the impact on an individual, group, organizational, and even societal level. Young people especially are heavily influenced by new digital media channels, including social media platforms, which later on impact their communication as they enter the workforce in large numbers. Moreover, their ability to work together, collaborate and coordinate among themselves relies on synchronous and asynchronous communication that happens over digital devices, mainly spurred by various contemporary working arrangements (remote work, hybrid work, coworking, working on mobile technology, and similar). This makes using social networks and other digital media platforms and tools imperative for successfully completing work-related tasks and objectives (Ligurgo, et al., 019). Therefore, enhancing (social) media ccompetencies in the workplace is essential and shapes new ways of working and communicating on different organizational levels. This paper will attempt to answer what the social media literacy competencies needed by young employees to communicate better in a professional work environment are. Answering this question will be addressed from the perspective of a social media literacy (SML) model rather than from the technical aspect. As a data collection method, the authors conducted semi-structured interviews with office workers, whereas the results of these interviews were analyzed with the employment of grounded theory. Investment and collaboration for a comprehensive social media literacy education are vital for organizations to start addressing the phenomenon in the workplace and educate the employees on how social media and communication via this platform can better the overall work climate, communication, and well-being.

Rationale: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among individuals with chronic obstructive pulmonary disease (COPD). Black women with COPD are at elevated risk of CVD-related mortality compared with White women. CVD risk factors are undertreated in Black men and women. However, barriers to CVD prevention from the perspective of Black individuals living with COPD have not been previously identified. Objectives: To identify barriers and facilitators for CVD prevention among Black individuals living with COPD. Methods: We conducted semistructured interviews with Black participants living with COPD and attending clinics at two urban hospitals. Participants were included if they had physician-confirmed COPD diagnoses and presence of CVD or CVD risk factors. Interviews were conducted until thematic saturation was reached, with additional interviews conducted to confirm saturation. Data were analyzed using thematic analysis, iteratively revising and updating the codebook by consensus of the study team. Codes were grouped into categories, subthemes, and themes. Themes were organized using the social ecological framework into individual, interpersonal, health system, and societal levels. Results: We interviewed 30 participants of mean age 67.8 ± 8.3 years; 17 (57%) were Black women and 13 (43%) were Black men. Individual-level themes were that living with COPD and resultant multimorbidity affects CVD prevention (theme 1) and that self-efficacy and advocacy affect care received (theme 2). At the interpersonal level, supportive relationships facilitate improved access to CVD prevention (theme 3). System-level themes were that health systems are not designed to support patients with COPD and CVD (theme 4) and that health systems do not deliver effective patient education (theme 5). At the societal level, structural barriers and racism prevent access to care and adoption of a healthy lifestyle (theme 6). Conclusions: We identified barriers to CVD prevention at all levels of the socioecological framework for Black individuals living with COPD. To maximize their impact, future interventions to prevent CVD among individuals with COPD can use these findings to target barriers at multiple levels.

Brucellosis is a zoonotic disease with significant public health and economic effects on societies. In Uganda, brucellosis is endemic and a primary contributor in livestock productivity losses. This is more worrisome for populations in the cattle corridor with high reliance on cattle and milk for nutritional value and symbol in social relations and identity. The community's social construction may affect comprehension of brucellosis hence leading to exposure and increased vulnerability to transmission. Despite brucellosis' high prevalence in the cattle corridor, little attention has been paid to its social construction. Hence, this study explored the interplay between gender dynamics, vulnerability and social construction of brucellosis transmission, in consideration of the unique socio-cultural context that characterizes cattle corridor populations. Using an exploratory qualitative approach, the study was conducted in Nakasongola cattle corridor within three sub counties; Nabiswera, Nakitoma and Wabinyonyi using key informant interviews (KIIs) and focus group discussions (FGDs). Purposive sampling was used to identify participants for the four FGD [8-12] each from a subcounty though one was combined and 15 KIIs. Data were collected using face -to -face interviews with an interview guide that was structured using the Socio Ecological Model of Human Behaviour framework (SEMHB) constructs. Thematic analysis was conducted in NVivo 12 Pro incorporating both deductive (guided by the SEMHB) and inductive approaches (guided by the data). The study identified important themes under each SEMHB influence level (Individual, Interpersonal, Community and Societal level). The study indicates that social composition and role distribution are driven by social and cultural expectations and significantly contribute to exposure and vulnerability to infection in the cattle corridor. For instance, it is paramount that women undergoing marriage preparations to be fed on raw milk for a certain period prior to their ceremony to enhance beauty. Also, important to note that use of personal protection to assist births is viewed by the community as opposing cultural norms, creating a perception of detachment from the highly valued cattle. Another noteworthy finding is the level of knowledge on brucellosis in terms of symptoms, transmission route, prevention and treatment at the interpersonal level. Furthermore, findings show practices such as the consumption of raw milk and assisted births, as being rooted in the social cultural norms, hence critical for transmission of brucellosis. At the community and organizational levels, the findings indicate an inadequate level of knowledge sharing and reluctance towards preventive measures as structural factors for the transmission of brucellosis and are ingrained in family and power relations. The findings highlight that the social construction of brucellosis transmission is rooted in gender roles, social- cultural and power structures highlighting the influence of living process and spaces, at the different societal levels. Such complex dynamics play a critical role in determining individuals' susceptibility to infection as well as transmission potential of the disease-causing agent in cattle keeping communities. The gendered induced vulnerabilities related to the socio-cultural norms and familial roles, also play an important role in the exposure and spill over at the individual, interpersonal and community levels. The insufficient knowledge-sharing and reluctance to adopt preventive measures emerge as structural contributors to the persistence of brucellosis and other emerging zoonoses. These factors, intertwined with family dynamics and power relations, call for targeted interventions that address both individual behaviors and broader socio-cultural and institutional barriers to effective disease management and prevention. Conversely, policies that align with the community's social construction, gender and context are more likely to be feasible, adopted and sustained by the affected population.

Premature birth is the leading cause of neonatal morbidity and mortality. Understanding perceptions, beliefs and attitudes towards preterm births, and how these factors influence care provision at health facilities and at home is crucial for improving preterm newborns' health outcomes. We conducted an exploratory qualitative study at Batu and Meki communities in the East Shewa Zone of Oromia Region, Ethiopia. We conducted in-depth interviews (n=81) and focus group discussions (n=8) using semistructured guides. The study participants included women who had preterm births, family members, community members, healthcare workers and expert stakeholders. We audio-recorded, transcribed the interviews and coded the transcripts. We employed the socioecological model to present perceptions, beliefs and attitudes towards preterm birth at individual, interpersonal, organisational and societal levels. Giving birth to a preterm newborn is often associated with fear, stress, unhappiness, concern and worry. At the individual level, preterm newborns' mothers often feel guilt and self-blame. Families tend to keep preterm birth a secret due to perceptions of 'incompleteness'. At the interpersonal level, preterm newborns are often stigmatised and families are disappointed by mothers who give birth prematurely. However, some believe that preterm newborns are accepted within the community. At the organisational level, healthcare providers find the causes of preterm birth unpredictable, they do not consider preterm births prevalent, and consider some of them as abortion. There is also a common belief that preterm infants have a low survival rate, leading to the deprioritisation of their care. At the societal level, some believe preterm births are caused by divine will as punishment for sins committed by the mother, while others think they occur naturally. Preterm newborn's death is often not acknowledged as true loss and families are discouraged from grieving. Our study found that the beliefs, perceptions and attitudes surrounding preterm birth, held by families, communities, healthcare providers and society at large, influence the care that preterm newborn-mother dyads receive both at home and within health facilities. Addressing these requires a multifaceted approach targeted at deeply ingrained attitudes and perceptions.

It is assumed in Western society that women want to become mothers. This desire is situated within the ideology of the ‘perfect mother’. However, feminists have highlighted contradictions between this ideology and the reality of mothering. A trend towards later motherhood has recently been identified. Delayed motherhood has been associated with a number of advantages such as a sense of psychological readiness, however this may mask some of its negative aspects. The aim of the study reported here was to explore the transition to, and lived experience of, delayed motherhood. Five women who were over 30 prior to the birth of their first child were interviewed. A narrative analysis at the personal, interpersonal and societal levels was conducted. At the personal level, diverse stories which contained both problems in adapting to motherhood and also progressive aspects of positive experiences and integration of maternal identities were told. At the interpersonal level, the prominence of the ‘double‐edged’ tone conveyed maternal ambivalence. At the societal level, dominant ideologies of the ‘good mother’ and normative development were identified. Though the women actively constructed their stories and attempted to resist dominant representations, this analysis emphasises the need for more realistic portrayals of delayed motherhood. Copyright © 2006 John Wiley & Sons, Ltd.

BackgroundReproductive coercion is a significant public health issue in Australia which has mainly been conceptualised as a form of violence at the interpersonal level. This limited scope ignores the role of the gendered drivers of violence and fails to encompass a socio-ecological lens which is necessary to consider the multiple interacting layers that create the context in which reproductive coercion occurs. The aim of the scoping review was to explore how the reproductive coercion is defined by international research. Specifically, how is reproductive coercion defined at the social-cultural-systems-structural levels, and are the definitions of reproductive coercion inclusive of the conditions and contexts in which reproductive coercion occurs?MethodsA scoping review was undertaken to explore existing definitions of reproductive coercion. Searches were conducted on Embase, Cochrane Library, Informit Health Collection, and the EBSCOHost platform. Google was also searched for relevant grey literature. Articles were included if they were: theoretical research, reviews, empirical primary research, grey literature or books; published between January 2018 and May 2022; written in English; and focused on females aged 18–50 years. Data from eligible articles were deductively extracted and inductively thematically analysed to identify themes describing how reproductive coercion is defined.ResultsA total of 24 articles were included in the scoping review. Most research defined reproductive coercion at the interpersonal level with only eight articles partially considering and four articles fully considering the socio-cultural-systems-structural level. Thematic analysis identified four main themes in reproductive coercion definitions: Individual external exertion of control over a woman’s reproductive autonomy; Systems and structures; Social and cultural determinants; and Freedom from external forces to achieve reproductive autonomy.ConclusionsWe argue for and propose a more inclusive definition of reproductive coercion that considers the gendered nature of reproductive coercion, and is linked to power, oppression and inequality, which is and can be perpetrated and/or facilitated at the interpersonal, community, organisational, institutional, systems, and societal levels as well as by the state.