Objective:Existing research points to how increasing male engagement in public health interventions without addressing gender inequities can perpetuate power imbalances in a relationship which may lead to increased stress and anxiety for women. The aim of this study was to identify profiles of couples who attended a violence prevention intervention based on their attitudes toward gender norms and power sharing within a couple, determine if these profiles have different women’s mental health outcome and examine whether male engagement moderates this relationship.Methods:Using data from a cluster randomized controlled trial conducted in North Kivu, Democratic Republic of Congo, we conducted a latent profile analysis to categorize different profiles amongst couples in the intervention (n=202) and conduct logistic regression to examine the study aims.Results:The latent profile analysis identified three profiles of couples: (1) discordant dyads, (2) concordant high gender equity dyads, and (3) concordant average dyads. There were no differences in women’s depression symptoms at the end of the intervention amongst the three profiles. Male engagement, measured through attendance data, did not moderate the relationship between the couple’s relationship profile and women’s mental health.Conclusion:Small sample size, measurement sensitivity, and potential response bias to the scales assessing gender norms, power dynamics and mental well-being might have led to the null results we see. Yet, future studies should further explore the potential for differences in mental health outcomes and the impact of interventions on these outcomes based on intercouple dynamics in understanding and expression of power and gender norms.

Background: Healthcare delivery models can have significant influence on patient-centred communication due to their influence on the thinking and behaviour of health workers about what constitute sickness and healthcare. While the extant knowledge shows many efforts at transforming Nigeria’s health sector towards sustainability, there are no clear facts on improvements in clinical communication, especially, the adoption of the biopsychosocial model (BPSM) for patient-centred communication (PCC) in the country. Aim: Researchers investigated the adoption of the BPSM for PCC in General Hospitals in Benue State. Methodology: Researchers adopted the pragmatic approach and convergent mixed methods design involving personal survey for 372 patients and in-depth interview for 67 clinicians from 21 of the 23 General Hospitals in the State. Results: Findings show that the BPSM has not been adequately adopted in clinical interactions, consequently, clinical communication is not patient-centred enough. Data analysis using the PCC model shows reasonable evidence of application of the BPSM in some areas, however, the contents of clinical communication largely fall short of the psychosocial and patient involvement characteristics. Inadequate adoption of the BPSM is linked to poor patient satisfaction with the usefulness of clinical interactions for patients’ psychosocial needs and home management of their conditions. Findings indicate a prevalence of systemic issues in the General Hospitals in Benue State interfering with the adoption of the BPSM for PCC. Researchers suggest a purposeful policy direction to enshrine the modern global philosophy of healthcare both in medical practice and education; a strong political will, and a commitment to proper staffing for enhancing the full integration of the BPSM, improving the PCC and clinical communication experience for both patients and clinicians.

Introduction: Immigrant older adults in Canada face unique post-migration challenges and barriers that place them at significant risk of social isolation. Evidence-based interventions exist that address the determinants of social isolation, but it is unclear whether these are acceptable to immigrant older adults in Canada. Acceptability is known to influence the uptake and engagement of and adherence to interventions. This paper presents a protocol for a proposed study that will examine the acceptability of selected evidence-based interventions and explore modifications that may be required to enhance their cultural appropriateness. Methods: A mixed-method – concurrent quantitative and qualitative – design will be used. Immigrant older adults from nine Canadian cities will be recruited if they are 60 years of age or older, self-identify as belonging to the Arabic, Mandarin, and Punjabi-speaking immigrant communities, live in the community, and be able to provide informed consent. The total sample size will be 600 to 800. Participants will be informed of each intervention; asked to rate its acceptability using 5 items adapted from the Treatment Acceptability and Preference instrument; and invited to participate in a semi-structured interview to explore their perspectives on cultural appropriateness and possible modifications needed to enhance the acceptability of each intervention. Descriptive statistics will be used to analyze acceptability ratings. Interviews will be audio-recorded with consent, translated into English when needed and transcribed, and content analyzed. Interventions with rating scores > 2 and qualitative comments indicating their fit with participants’ beliefs and values will be considered acceptable. Results: The project is in its initial stage of data collection. Conclusions: Results will help clarify which of the selected interventions are acceptable and what modifications they may require before evaluating them for their effectiveness in reducing social isolation, and fostering social connectedness among Arabic, Mandarin, and Punjabi-speaking immigrant older adults in Canada.

Background: Zambia has embarked on the devolution of various health functions to the subnational levels at provincial and district level. Objectives: (i) To examine the decentralisation process in Zambia using the lens of the Constitution, enabling pieces of legislation, the relevant policy frameworks and (ii) To examine the decentralisation implementation process using the change management process. Methodology: This was an observational study involving both qualitative and quantitative methods using purposive selection of participants from the District Health Offices, Health facilities and the Local authorities. Interviews and focus group discussions were used to collect the data over a period covering January and February 2024 in three sites namely Mazabuka, Lusaka and Chongwe Districts of Zambia. Key Findings: Inadequate legal and policy framework, operationalization of the decentralisation policy, the acceleration of the implementation before the legal framework, as well as other change management processes and procedures were identified as key challenges. Conclusion: While there are adequate constitutional provisions, inadequacies in policy and legal frameworks, implementation capacity in councils, community participation, change management process as well as the collaborative framework to facilitate smooth and effective implementation of decentralizing some health functions to the Local Authorities.

Background: One of the paramount hurdles to Nigeria's development in maternity-care service is the emigration of midwives to developed countries. However, midwives’ perspectives on the effects of the emigration of their colleagues’ to developed countries have yet to be investigated. This study examined the impact of midwives’ emigration on maternity care services and associated challenges in Nigeria. Methods: This study adopted a cross-sectional survey of 121 midwives and nurses at Adeoyo Maternity Teaching Hospital (AMTH), Ibadan Nigeria. Data were collected using a self-structured questionnaire. Results: 98.3% reported negative maternal health outcomes, 98.3% indicated midwives’ burnout, 93.4% reveal midwives’ low morale. Logistic regression analysis identified that the strongest challenge faced by care providers was lack of staff support (OR = 4.05, p = 0.001). Conclusion: The nursing implications of midwife emigration are far-reaching, affecting both maternity care service and remaining midwives. The increased workload reduces the quality of care and poses a high risk to maternal and neonatal outcomes. Addressing these challenges requires a multi-faceted approach, including workforce development, policy reforms, retention strategies. Despite ongoing challenges, maternity-care services can be strengthened through implementation of these strategies.

Cross-border migration has implications for immigrant experiences of the host country’s health care system and health care provisions. Female genital mutilation/cutting (FGM/C) is a traditional practice performed on young girls between infancy and age 15. While illegal in Canada, proxy estimates of females aged 0 to 49 years at risk of FGM/C in the country range from 95,000 to 161,000, based on internationally accepted estimation methodologies. Two of the top source continents for immigrants in Canada – Asia and Africa – demonstrate high prevalence of FGM/C, raising concerns about implications for the health outcomes of female immigrants who are at risk of having undergone the practice and the need for awareness among health care professionals and other stakeholders. To date, little is known about the health outcomes for females at risk of having undergone FGM/C and who are living in Canada. Using Canadian linked administrative data, the Longitudinal Immigration Database (1980-2013) and Discharge Abstract Database (2004-2005 to 2013-2014), regression analyses were conducted to compare causes of hospitalizations for female immigrants born in countries identified at risk for FGM/C and female immigrants from non-FGM/C practicing countries. The results suggest female immigrants from FGM/C-practicing countries appear to be at higher-risk for obstetric-related conditions requiring acute-care hospitalization.

Background: Persons with intellectual and developmental disabilities (IDD) face interlocking inequities in access to healthcare services. Nurses require education and training in specific competencies to address their needs. This cross-sectional study explored the experiences and perspectives of youth with IDD on nursing care in the times of COVID-19 restrictions across 4 provinces in Canada. Methods: Nine youth (16-29 years) completed a virtual survey: without assistance of caregiver parent (n=3), supported by a parent (n=3), and represented by parent proxy (n=3). Close-ended Likert-type questions assessed health, mental health, and Quality of Care and Support (QOCS). Open-ended questions addressed Person-and-Family-centred Care (PFCC), communication and behaviour management. At the analytical stage the qualitative and quantitative data were integrated applying concurrent mixed-methods principles. Results: Emerging themes include: 1) Limited access to quality of care (e.g., dismissive attitude, safety concerns, insufficient respite funding, unaffordable care, shortage of nurses prepared in developmental disability, complicated program enrolment process, insufficient knowledge on IDD rights and services, competency and professionalism); 2) Person-and-Family-Centered Care (e.g., experiences of PFCC, not a Person-Centered care; 3) Communication is key to quality nursing care; and 4) Inadequate emotional support (e.g., respect and value youths’ wishes, nurses need emotional support too). Conclusion: Barriers to quality nursing care for youth with IDD include lack of communication skills, emotional support, and Person-and-Family-Centered Care. Nursing care tailored to the needs of persons with IDD is crucial for their health and wellbeing and requires structural changes at the macro (enhanced funding for program/services), meso (education, curricula, training), and individual levels (awareness).

Evidence points to the worsening of sexual health problems in adolescents due to the lack of sexual education in the family and at school. Sexual education programs with an approach to empowerment, emphasizing gender, rights and their active participation are more effective. This study aims to understand what a school program on sexuality education should be like from the perspective of Brazilian high school adolescents. Qualitative participatory research was operationalized through a Freirean Thematic Investigation, conducted in a public school within a low-income community in the Northeastern region of Brazil. Forty-two high school adolescents, aged between 15 and 18 years, participated throughout the year 2022. The data collected through participant observation and focus groups were analyzed using the Method of Interpreting Meanings. The consequences caused by the scarcity of sexuality education, the lack of dialogue, and the fragility of intergenerational relationships are highlighted. It is reflected that sexuality education is a possible path to transforming reality if initiated in the family environment and continuously extended to the school, with the active participation of adolescents, covering a broad range of contextualized, practical, stimulating topics with gradual complexity, promoted in a relaxed setting, and small groups. A proposal for Critical and Emancipatory Sexuality Education was outlined as an educational action developed by integrating Freirean references, Comprehensive Sexuality Education, and the collective construction of adolescents. A dialogical process of awareness is proposed, to experience safe sexuality in the defense and guarantee of citizenship with a commitment to changing reality towards humanization.

Background. Patient- or person-centred care (PCC) has become a core competency that healthcare professionals must develop to deliver high-quality care. PCC enhances positive patient perceptions of care, promoting patient safety and overall health outcomes. Yet, little is known about PCC from nurses who become patients. Aim. To map nurse patients’ experiences and perceptions of PCC and how their illness experiences influence nursing practice after recovery. Methods. A scoping review methodology was implemented. Scopus, PubMed, Ovid Medline, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for relevant literature using a comprehensive list of keywords, including nurse patient, nurse-as-patient, person-centred care, person-focused care, hospital, experiences, etc. Thematic analysis was conducted on extracted data, and the results were reported narratively. Results. Thirty-seven (37) studies were included in this review. Four broad themes: experiences of PCC, care practices that promote PCC, the influence of illness experience on nursing practices, and nurse patients’ unique contextual issues were developed, which revealed that nurse patients experienced heightened fear, anxiety, denial, uncertainty, and discomfort when diagnosed with life-threatening illnesses due to their knowledge of the healthcare system. While navigating treatment, most nurse patients experience care that aligns with PCC dimensions (respecting patient dignity, treating patients as persons, providing adequate information, and effective communication). Others received care that deviated from PCC principles, including waiting for long periods to access treatment services, being stereotyped, not being provided enough information, and being less engaged in their care. Furthermore, nurse patients faced unique challenges, including role ambiguity and confidentiality and privacy concerns. Nonetheless, they promoted PCC in their nursing practice after recovery by advocating for patients, serving on healthcare boards, influencing policy change, and becoming peer educators. Conclusion. Research from different nurse patients is needed to deepen our understanding of PCC and how nurse patients’ illness experiences drive quality care and patient safety.

Introduction: For transgender and gender-diverse (TGD) persons, encounters with healthcare providers can be harmful and can compromise medical outcomes. This harm, which is not always overt and direct in these interpersonal relations, can be conceptualized as microaggressions. Aim: This study explored TGD persons’ accounts of microaggressions in healthcare settings. Methods: Unstructured interviews were conducted with TGD participants who had experienced harm in healthcare settings in South Africa. Deductive analysis was used. Findings: Ten of the 12 taxonomy’s themes were present. Offensive terminology, prominent amongst the themes, was directed at persons with (trans) feminine expression or nonbinary presentations. Conclusions: We propose ‘Conflation of Trans Identification With Sexual Orientation’ be added to the taxonomy to make one of the categories less overinclusive and improve on the taxonomy’s contextual transferability.