BackgroundThe high incidence of Drug-Related Problems (DRPs), including medication adherence among patients with chronic diseases, especially during no direct monitoring by health workers, becomes a challenge to therapy success. Home Medication Review (HMR) is an alternative solution in primary healthcare services to avoid further complications.ObjectiveThis study aimed to analyze DRPs, their affecting factors, and DRP interventions for patients with chronic diseases in primary health centers (Puskesmas) through HMR.MethodsA quantitative, cross-sectional observational study using purposive sampling was conducted in several Puskesmas in Yogyakarta from February to May 2023. The collaborative HMR involved healthcare providers at each Puskesmas. DRPs were assessed based on observations and semi-structured interviews. The DRP classification followed PCNE V9.1, and medication adherence was measured using both pill counts and self-report via the MARS-10 questionnaire. Data were analyzed using SPSS 25.0 to perform logistic regression with a 95% confidence level.ResultsA total of 544 patients, comprising 269 adults and 275 older patients, were involved. Older patients experienced more DRPs than the adults (94.2% vs 84.8%). The most DRP experienced by both age groups was ineffective therapies, with the two most frequent causes being related to patient factors. Among the adults, hypertension comorbidity, number of medications, and BMI factors were associated with DRPs (p < 0.05). In contrast, no factors correlated with DRPs in the older patients. There was fair agreement between pill count and MARS-10 regarding medication adherence for both adults and older patients (kappa coefficients of 0.298 and 0.355, respectively).ConclusionPatients in primary health facilities with hypertension and using at least three medications have over a three-fold increased risk of experiencing DRPs. Healthcare providers, including pharmacists, nurses, and physicians, should collaborate to identify medication-related issues and provide personalized advice and management plans to enhance medication adherence. This study highlights the need for a standardized, structured HMR program, not merely as a patient home visit but also to better control chronic diseases.

BackgroundChildren with acute conditions that suddenly worsen need immediate care in the Emergency Room (ER). Family-Centered Care (FCC) is considered the best approach in pediatric nursing, but its implementation in the ER is still limited. This is due to various challenges that can increase child and family anxiety and decrease the quality of nursing care.ObjectiveThis study aimed to explore nurses’ perspectives on the constraints of the health service system in implementing FCC in child care in the ER.MethodsThe study used a qualitative descriptive design. Eleven nurses working in the ER at Mokopido Tolitoli Regional Hospital participated in the study, which were chosen through purposive sampling. Data were collected using semi-structured interviews conducted from July 11 to July 23, 2023. Data were analyzed manually using a thematic approach.ResultsThe thematic analysis revealed two main interrelated themes regarding barriers to FCC in the ER: human resource constraints and organizational constraints. Human resource constraints include limited nursing staff, varying educational levels, lack of training or outreach on FCC, lack of competency, and communication barriers. Meanwhile, organizational constraints include high ER workloads, limited nurse time, and a focus on emergency medical procedures rather than a holistic approach. These various barriers lead to suboptimal family involvement in the care of children in the ER.ConclusionThe implementation of FCC in the ER still faces major challenges. These findings highlight the need for a strategic approach and supportive policies to improve nurse capacity and foster a collaborative and responsive hospital environment for patients’ families.

BackgroundUncontrolled type 2 diabetes results in major complications that threaten patients’ life. Patients with uncontrolled type 2 diabetes often have inadequate health literacy, making them less motivated to perform self-management behaviors for glycemic control. Earlier health literacy interventions were effective in promoting self-management behaviors and reducing blood glucose, but evidence is lacking for those with uncontrolled type 2 diabetes.ObjectiveThis study aimed to investigate the effect of a health literacy program on self-management behaviors of patients with uncontrolled type 2 diabetes.MethodsThis two-group quasi-experimental study with pre-posttest design was done between September 2024 and June 2025. The participants were 64 patients with uncontrolled type 2 diabetes who lived in a community in a province in central Thailand selected using simple random sampling. The experimental group (n = 32) underwent the health literacy program with eight weekly sessions along with usual care while the control group (n = 32) was given usual care only. Data were collected using a Demographic Data Questionnaire, the Functional, Communicative and Critical Health Literacy Scale, the Self-Management Behavior Scale, and hemoglobin A1C (HbA1C) testing. Data analysis was performed with descriptive statistics, paired t-test and independent t-test.ResultsNo significant between-group differences were noted in baseline data. At post-test, the experimental group had a significantly higher mean score of overall health literacy (t = 3.720, Cohen’s d = 2.67), functional health literacy (t = 0.399, Cohen’s d = 2.43), communicative health literacy (t = 7.90, Cohen’s d = 1.76), and critical health literacy (t = 12.972, Cohen’s d = 3.14), and self-management behavior (t = 21.862, Cohen’s d = 2.84), and a significantly lower level of HbA1C (t = 3.436, Cohen’s d = -0.82) than before receiving the program and than the control group (all p <0.01).ConclusionThis study offers evidence for the program's efficacy in raising health literacy, which in turn improves self-management behavior and decreases HbA1C in patients with uncontrolled type 2 diabetes. Nurses can incorporate program activities in empowering patients for diabetes control by promoting their ability to seek and comprehend health information, communicate effectively during medical visits, and develop critical thinking abilities on diverse health determinants.Trial Registry NumberThai Clinical Trials Registry (TCTR20250624001)

BackgroundEmergency department nurses face substantial occupational stress due to frequent exposure to high-risk, unstable, and unpredictable clinical environments. However, research on nurses’ professional quality of life (ProQOL) has largely focused on other specialties, leaving ED nurses underrepresented. Addressing this gap is essential to improving professional well-being and job satisfaction.ObjectiveThis study aimed to examine the associations between family care, organizational support, psychological resilience, and ProQOL among emergency department nurses.MethodsA cross-sectional study was conducted from July 6 to July 31, 2024, involving 441 emergency department nurses from 18 tertiary hospitals in 16 cities in Anhui Province, China. Data were collected using anonymous paper-based questionnaires and analyzed using descriptive statistics, t-tests, one-way ANOVA, Kruskal–Wallis H tests, Pearson’s correlation analysis, and multiple linear regression.ResultsCompassion satisfaction differed significantly by sex (Z = -2.677, |d| = 0.231, p = 0.007), professional level (H = 17.675, η2 = 0.035, p < 0.001), and number of night shifts (H = 10.571, η2 = 0.022, p = 0.005). Burnout scores varied significantly by professional level (H = 8.861, η2 = 0.016, p = 0.012), number of night shifts (H = 8.357, η2 = 0.021, p = 0.015), and presence of chronic illness (Z = -2.029, |d| = 0.437, p = 0.042). Secondary traumatic stress differed significantly according to chronic illness history (Z = -2.232, |d| = 0.341, p = 0.026). Family care, organizational support, and psychological resilience were positively correlated with compassion satisfaction (r = 0.382, 0.549, and 0.562, respectively; all p < 0.001) and negatively correlated with burnout (r = -0.333, -0.405, and -0.497, respectively; all p < 0.001). Regression analyses indicated that family care, organizational support, and psychological resilience significantly predicted compassion satisfaction (adjusted R2 = 0.458), while burnout was significantly associated with intention to leave the ED, family care, organizational support, and psychological resilience (adjusted R2 = 0.358).ConclusionThe findings provide evidence that family care, organizational support, and psychological resilience are associated with the ProQOL of nurses working in emergency departments. In China, these results offer useful references for regions facing similar emergency care pressures (e.g., high workloads in tertiary hospitals, nurse shortages) to optimize nurse well-being interventions. They also provide a foundation for developing targeted strategies to enhance nurses’ professional well-being and job satisfaction.

BackgroundLeprosy remains a persistent public health challenge, especially in endemic areas, where its historical association with stigma continues to harm social participation and psychosocial well-being. Understanding how stigma affects social participation across different life areas is crucial for developing effective care and public health strategies.ObjectiveTo examine the association between stigma and social participation across different domains among people affected by leprosy.MethodsA cross-sectional, quantitative study was conducted in 2019 with 97 individuals affected by leprosy followed at eight municipal reference units in Recife, Pernambuco, Brazil. Sociodemographic, environmental, and clinical data were collected using structured instruments and medical records. Stigma was assessed using the Explanatory Model Interview Catalogue (EMIC), and social participation was evaluated using the Participation Scale (PS). Data were analyzed using descriptive statistics, Spearman’s correlation, chi-square tests for linear trend, and effect size estimation using Cramér’s V. Statistical significance was set at p <0.05.ResultsA total of 53.6% of participants presented some degree of restriction in social participation. The mean stigma score was 16.63 (SD = 8.53), and the mean participation score was 16.58 (SD = 13.62). A statistically significant, low-magnitude correlation was observed between stigma and participation restriction scores (Spearman’s rho = 0.25; p = 0.016). Categorical analysis demonstrated a significant linear association between higher stigma tertiles and greater participation restriction (χ2 for trend, p = 0.022), with a low overall effect size (Cramér’s V = 0.20; 95% CI: 0.10–0.36). Moderate effect sizes were observed in specific participation domains, including religious and community activities (Cramér’s V = 0.24; p = 0.02), visiting other people in the community (Cramér’s V = 0.26; p = 0.01), and perceived respect within the community (Cramér’s V = 0.29; p = 0.04).ConclusionStigma was significantly associated with restricted social participation among people affected by leprosy. Although the overall association showed low magnitude, moderate and statistically significant associations were observed in key social domains. These findings support the inclusion of stigma and social participation assessments in routine leprosy care and highlight the need for integrated clinical, psychosocial, and community-based nursing and health interventions aimed at reducing stigma and promoting social inclusion.

BackgroundNursing students often experience high levels of stress during clinical training, particularly in maternal and child health (MCH) rotations, which may affect learning and well-being. Understanding stress levels, stressors, and coping strategies can inform the development of supportive and culturally appropriate educational approaches.ObjectiveTo assess perceived stress levels, identify clinical stressors, and examine coping strategies among nursing students during MCH clinical rotations in Saudi Arabia.MethodsA cross-sectional study was conducted in 2024 among 187 female nursing students enrolled in MCH clinical rotations. Data were collected using validated Arabic versions of the Perceived Stress Scale (PSS-10), the Nursing Student Clinical Stressor Scale (NSCSS), and the Brief COPE Inventory. Descriptive statistics and Spearman’s rho correlation analyses were performed using SPSS.ResultsMost students reported moderate perceived stress (75.4%), with a mean PSS-10 score of 20.5 ± 5.9. The highest stressor domains were MCH-specific challenges (9.13 ± 5.00), academic pressures (8.72 ± 3.95), and the clinical environment (7.65 ± 3.64). Religion (5.20 ± 2.06) and acceptance (4.79 ± 1.80) had the highest mean scores among coping strategies, while substance use was least reported (3.04 ± 1.40). Self-blame showed the strongest association with total clinical stressors (rho = 0.501, p <0.001).ConclusionFemale nursing students experienced moderate stress during MCH clinical rotations, largely related to clinical and academic demands. Coping strategies were predominantly emotion-focused, with self-blame showing a strong association with higher stress levels. These findings highlight the importance of culturally sensitive support strategies in nursing education.

BackgroundPrison health is increasingly recognized as part of community health, especially as the population of incarcerated women grows and presents unique health needs. Yet, evidence on how Thailand’s prison health system addresses gender sensitivity, particularly when viewed through the WHO’s Six Building Blocks framework, remains limited. This system-level knowledge gap restricts efforts to improve equitable care for women prisoners.ObjectiveThis study explored health service delivery for women prisoners in Northeastern Thailand from September 2022 to August 2024 through the WHO’s Six Building Blocks framework, identifying barriers, enablers, and policy implications for gender-sensitive prison healthcare.MethodsA qualitative descriptive design was employed. Data were collected through participatory and non-participatory observations, in-depth interviews, and document reviews with 35 informants, and analyzed using the WHO Health System Framework. Trustworthiness was ensured by triangulation, member checking, and prolonged engagement.ResultsThe healthcare system encompassed all six WHO building blocks: service delivery, health workforce, health information, access to medicines and technologies, financing, and governance. However, gaps persisted in gender-sensitive services such as gynecological and trauma-informed care, nurse workload, and budget allocation. Initiatives such as telemedicine and the Pansuk Project provided support but were insufficient to address women’s specific vulnerabilities.ConclusionWhile structural improvements have been achieved, strengthening gender-sensitive care is necessary. Nurses should integrate trauma-informed and gynecological competencies, supported by better shift management and telemedicine systems. Policy measures, including gender-responsive budgeting and inter-ministerial collaboration, are crucial to the sustainable integration of prison health into national public health.

BackgroundExcessive gestational weight gain can adversely affect maternal and fetal health. Dietary behavior change can help control gestational weight gain and prevent adverse pregnancy outcomes.ObjectiveThis study aimed to examine the effect of the Capability-Opportunity-Motivation Behavior (COM-B) model of dietary behavior program on gestational weight gain.MethodsThis single-blind randomized controlled trial used a pre-posttest control group design and included 96 pregnant women from a northern province of Thailand. Participants were randomly assigned equally to the experimental and control groups (48 each) using permuted block randomization. The experimental group received a 14-session COM-B model of dietary behavior program, while the control group received usual care. Data were collected via questionnaires between November 2023 and October 2024, and were analyzed using SPSS version 26, employing descriptive and inferential statistical methods.ResultsAt 36 weeks’ gestation, pregnant women in the experimental group had a significantly lower mean difference in gestational weight gain based on the Institute of Medicine (IOM) recommendation compared with both their baseline at 20 weeks and the control group. After adjusting for maternal age and education, the experimental group continued to show significantly lower gestational weight gain than the control group. The adjusted intention-to-treat analysis indicated a mean difference of -2.227 kg (95% CI: -3.75 to -0.70; p = 0.005; partial η2 = 0.084), while the adjusted per-protocol analysis showed a mean difference of -2.648 kg (95% CI: -4.31 to -0.99; p = 0.002; partial η2 = 0.110). These results suggest that the COM-B model of dietary behavior program effectively limited gestational weight gain, independent of sociodemographic differences. Even modest reductions in gestational weight gain may contribute to lowering the risk of pregnancy complications such as gestational diabetes and preeclampsia. Dietary behavior change was monitored, but not a predefined secondary outcome.ConclusionThe COM-B model of dietary behavior program led to minimal but potentially clinically relevant reductions in gestational weight gain. The findings highlight the clinical relevance of nurse-led interventions, underscoring the need for nurse training to implement the program in routine antenatal care.Trial Registry NumberThai Clinical Trials Registry (TCTR20230907001)

BackgroundFather involvement in newborn care is increasingly recognized as a key determinant of infant health and family well-being. In Indonesia, paternal roles in neonatal care are often overlooked, and father-specific educational support remains limited. Understanding fathers’ lived experiences and learning needs is essential for developing effective, culturally appropriate interventions.ObjectiveThis study aimed to explore the experiences and educational needs of Indonesian fathers in newborn care.MethodsA qualitative descriptive study was conducted using a thematic analysis approach. Sixteen fathers of infants aged 0-12 months were recruited through purposive sampling in Jakarta and the surrounding areas. Data were collected in 2024 through in-depth semi-structured interviews and analyzed using Braun and Clarke’s six-step framework. Trustworthiness was ensured through audit trails, member checking, and peer debriefing.ResultsThree major themes emerged: (1) social media as the main source of information, (2) fathers’ practical involvement and learning needs in baby care, and (3) preference for visual and practical learning media. Fathers expressed strong motivation to be involved but faced challenges accessing reliable, father-focused educational content. Their learning preferences were shaped by practicality, time constraints, and the need for culturally relevant materials.ConclusionIndonesian fathers are eager to participate in newborn care but lack structured educational support tailored to their needs. Pediatric nurses play a critical role in developing father-inclusive, digital, and culturally responsive interventions that enhance paternal self-efficacy and caregiving competence. Future programs should integrate father-focused digital interventions, such as video-based tutorials and podcasts, into pediatric nursing practice to effectively bridge the educational gap.

BackgroundMaintaining regular physical activity (PA) is a critical challenge for patients undergoing cardiac rehabilitation (CR), as inadequate adherence can lead to adverse outcomes, including disease recurrence. Enhancing motivation is key to improving PA adherence. Motivational interviewing (MI) has been shown to overcome psychological barriers by building intrinsic motivation. However, there is a need to explore how to integrate MI techniques with digital technology to enhance intervention accessibility and leverage the strengths of both approaches.ObjectiveThis study aimed to evaluate the effects of a hybrid intervention model integrating phone-based motivational interviewing with mobile phone-based management on motivation and physical activity in patients undergoing CR.MethodsThis pilot randomized controlled trial was conducted in China between January and June 2024, involving 52 patients undergoing cardiac rehabilitation. The intervention group (n = 25) received usual care plus a 4-week phone-based motivational interviewing intervention, which included a face-to-face session, weekly phone MI sessions (OARS technique), and personalized support via WeChat. The control group (n = 27) received only usual cardiac rehabilitation guidance. Outcomes measured were steps/day (using a smart band) and motivation, assessed using the Behavioral Regulation in Exercise Questionnaire-2 (BREQ-2). Two-way repeated-measures ANOVA was used for data analysis.ResultsCompared with the control group, the intervention group showed a significant interaction effect of Group*Time on both steps/day (p <0.001, ηp2 = 0.706) and the BREQ-2 (RAI) (p <0.001, ηp2 = 0.349). The intervention group’s daily steps significantly increased from 3582.80 ± 649.59 to 9444.79 ± 1413.72 (p <0.001).ConclusionThis study indicates that a phone-based motivational interviewing intervention delivered by trained researchers can effectively increase physical activity levels and enhance autonomous motivation for PA in CR patients. This approach provides a scalable model for the routine care of cardiac rehabilitation patients, especially in resource-limited settings. For nursing practice, the findings highlight the importance of incorporating MI as a core skill and utilizing a hybrid, technology-supported care model to extend continuous professional support into patients’ homes.Trial Registry NumberChinese Clinical Trial Registry (ChiCTR2400079877)