Access To Health Services Research Articles

Assessing the experiences of teenage mothers in accessing healthcare in Rwanda

Teen mothers are more susceptible to the negative consequences of pregnancy, due to system-wide and socio-cultural barriers to accessing needed services, posing higher pregnancy complications and health risks to the babies and mothers. Understanding their lived experience can inform context-specific health programs and interventions that address their needs and improve the health outcomes. Twenty-three women who had delivered her first child before the age of 18 years were interviewed using semi-structured interview guide. The transcripts were coded, categorized and summarized into four major themes: 1) Many pregnant teen girls were disadvantaged by the system from accessing the healthcare services, 2) Although being judged, many found the health care services positive and important, 3) Faced financial difficulty in accessing health services, despite most medical services are covered by community based health insurance, 4) Health care services focuses mostly on the medical health of pregnancy, the social and psychological needs were mostly not available. The study highlighted the gap in providing mental health services, financial support to the teen mothers as part of a comprehensive health services. Some of them consulted health services for the first time with and did not return for follow up if perceived the services was bad. More sensitive and targeted materials and ANC services can be offered to this unique group of clients. More acceptance training to the health care providers and the public is needed. For health facilities, there is a need to also check their psychological wellbeing when seeking ANC services. Online or mobile phone-based mental health interventions may provide some solutions to the issue. Government should re-evaluate the health insurance system to avoid unintentional exclusion of this group of population. Policy to facilitate men to take responsibilities on teen pregnancy issue is needed.

Health care needs and barriers to care among the transgender population: a study from western Rajasthan

BackgroundTransgender people comprise an estimated 0.3–0.5% (25 million) of the global population. The public health agenda focuses on understanding and improving the health and well-being of gender minorities. Transgender (TG) persons often have complex healthcare needs and suffer significant health disparities in multiple arenas. The international literature suggests that this community is at a higher risk of depression, and other mental health problems, including HIV. Many transgender people experience gender dysphoria and seek specific medical needs such as sex reassignment surgeries, implants, hormonal therapies, etc., but are unable to access these services due to financial or social reasons. The objective of this study was to assess the healthcare needs and associated barriers experienced by transgender people in Western Rajasthan. Methodology: A qualitative study was carried out in which multilevel stakeholder interviews were conducted using interview and focus group discussion guides. Data was analyzed using the qualitative thematic analysis technique. Results: Findings reveal that transgender people have expressed their need to access health services for general health needs, including but not limited to mental health, non-communicable diseases, and infectious diseases. Barriers to healthcare services were identified on 3 levels: health system, social and personal. Health system barriers include policy, accessibility, affordability, and acceptability issues. Social factors such as inadequate housing, education, and job opportunities also play an important role in affecting the individual’s health-seeking behavior. The knowledge of healthcare providers in this context was also limited in context of health insurance schemes, package of services available for transgenders and the importance of gender sensitive healthcare. Conclusion: Transgender people expressed the need for mental health services, programs targeting nutritional improvement, gender-affirmation procedures besides regular screening of non-communicable diseases as operational for males and females. Levels of barriers have been identified at various levels ranging from absence of targeted policies to individual behavior.

Analysis of the Governance System of National Health Insurance Referral Patients at the Outpatient Polyclinic of Dian Harapanjayapura Hospital, Papua

The National Health Insurance (JKN) program, which has been running since January 1, 2014, has been widely benefited by most of the community. This program makes it easy for the public to access health services. However, the implementation of JKN for nine years often faces problems and challenges, one of which is governance. Many parties involved in this JKN program include BPJS Kesehatan as the organizer, the Ministry of Health as a regulator, Health Facilities (hospitals) as service providers and Professional Associations. This research is a qualitative research with a type of program review (governance system). The data collection process is carried out by conducting observations, interviews, analysis and documentation. Data analysis is in the form of an explanation of the situation being studied, while the presentation is in the form of a story explanation. This is in accordance with descriptive research which is the study of observations on the object of research to obtain an overview and actual circumstances. This research has been conducted at Dian Harapan Jayapura Hospital in Papua in February 2024. Based on the results of the study, it was found that inputs, processes and outputs related to the governance of National Health Insurance referral patients at the Outpatient Polyclinic of Dian Harapan Jayapura Hospital Papua were based on an assessment of human resources, facilities and infrastructure, Standard Operational Procedures, constraints and problem solving processes. The results of the study based on the influence of Human Resources show that training related to BPJS has not been carried out evenly for all personnel, including the evaluation of services has not been carried out regularly. The Assessment of Facilities and Infrastructure is considered to have been fulfilled only due to disturbances in the queue machine, the V-Claim application and Scan Finger interference. The assessment of SPO is considered to be available and understood, but there has been no routine evaluation to assess the progress of SPO implementation. The assessment of the obstacles that are often experienced is the disruption of the V-Claim Application and the queue system is still offline because the patient has not used the Mobile JKN Application so that the patient comes early in the morning to take the queue number. In terms of handling problems in stages starting from internal, if necessary, coordination between units or coordination with management with higher authority will be carried out. The conclusion in this study is that Human Resources have a great influence on services, in terms of the number that has been fulfilled, it is still necessary to evaluate the progress of services such as obstacles to delays in the doctor's practice schedule to be corrected according to the agreement so as not to affect service satisfaction. Regarding Facilities and Infrastructure, it is still considered good, it only needs to be added to facilitate online registration by increasing the benefits of the Mobile JKN Application, including the Queue Display facility at the Polyclinic. The applicable Standard Operational Procedures have been implemented, but there has not been a routine evaluation of the implementation of the SPO has been carried out appropriately or still requires additional SPOs to support services. Regarding obstacles and the solution of obstacles, it is considered good. Each officer is already independent in handling problems.

Mental health service use among mothers and other birthing parents during the COVID-19 pandemic in Ontario, Canada

BackgroundParents have reported increased symptoms of depression and anxiety during the COVID-19 pandemic. This study evaluated changes in mental health and addiction (MHA)-related health service use among mothers and other birthing parents during the COVID-19 pandemic. MethodsWe conducted a repeated cross-sectional study using health administrative data in Ontario, Canada. The population included all mothers and birthing parents (≥1 child aged 1–18, no children <1 to exclude postpartum parents) between January 2016 and December 2021. We compared rates of MHA-related outpatient physician visits, hospitalizations, and emergency department (ED) visits during COVID-19 (March 2020–December 2021) to pre-COVID-19 (pre-March 2020). ResultsMHA-related outpatient visit rates increased by 17 % (rate ratio (RR) 1.17, 95 % CI 1.16–1.18) during COVID-19. Monthly utilization rates remained higher than expected across the COVID-19 period. MHA-related ED visit rates remained lower than expected during COVID-19, while MHA-related hospitalization rates returned to expected levels by August 2020. The largest relative increases in MHA-related outpatient visits during COVID-19 were in mothers and other birthing parents living in higher income (RR 1.20, 95 % CI 1.19–1.22) or urban areas (RR 1.20, 95 % CI 1.18–1.21), with children aged 1–3 years (RR 1.23, 95 % CI 1.20–1.25) and with no history of MHA-related health service use (RR 1.20, 95 % CI 1.19–1.21). LimitationsThis study only captured physician-delivered MHA-related health service use. ConclusionsThe COVID-19 pandemic was associated with an increase in MHA-related outpatient visits among mothers and other birthing parents. These findings point to the need for improvements in mental health service access.

Riesgo climático en los servicios de Salud Local en Ecuador

This work analyzes the interaction between climate risk, caused by extreme events resulting from the El Niño-Southern Oscillation (ENSO) phenomenon and/or Climate Change, and its impact on local health services in Ecuador. The analysis focuses on Ecuador’s growing vulnerability to the effects of climate change, which exacerbates challenges in the delivery of health services, particularly in the context of severe climate events. The main objective is to analyze the relationship between the number of hectares affected by climate events and the availability and effectiveness of local health services, considering community resilience and health coverage as moderating variables. The methodology uses a linear regression analysis using data from 221 Ecuadorian municipalities, covering variables such as climate risk, health services, community resilience, health coverage, and demographic and socioeconomic factors. The results indicate a significant influence of climate risk on the effectiveness of health services, moderated by community resilience and health coverage. It is observed that areas with greater preparation and health coverage show a better capacity to respond to extreme weather events. Finally, it is important to integrate climate risk management into health services planning, suggesting that greater community resilience and broad health coverage are essential to mitigate the negative impacts of climate change on public health.

Institutional Violence Perpetrated against Transgender Individuals in Health Services: A Systematic Review of Qualitative Studies.

This review aims to analyze the evidence related to violence perpetrated against transgender individuals in health services based on their narratives. This is a systematic literature review of qualitative studies. A search was carried out in the Scopus, Web of Science, Latin American and Caribbean Literature in Health Sciences (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, and MEDLINE databases using the descriptors "transgender people", "violence", and "health services". The eligibility criteria included original qualitative articles addressing the research question, with fully available text, reporting violence specifically by health workers, involving trans individuals aged 18 and above, and published in Portuguese, English, or Spanish. In addition, studies were included that reported experiences of violence suffered by the trans population, through their narratives, in health services. A total of 3477 studies were found, of which 25 were included for analysis. The results highlighted situations such as refusal of service; resistance to the use of social names and pronouns; barriers to accessing health services; discrimination and stigma; insensitivity of health workers; lack of specialized care and professional preparedness; and a system focused on binarism. The analysis of the studies listed in this review highlights the multiple facets of institutional violence faced by the transgender population in health services. It is evident that the forms of violence often interlink and reinforce each other, creating a hostile environment for the transgender population in health services. Thus, there is an urgent need to create strategies that ensure access to dignified and respectful care for all individuals, regardless of their gender identity.

Differential impacts of the COVID-19 pandemic on mental health service access among Medicaid-enrolled individuals.

The COVID-19 public health emergency (PHE) caused significant disruptions in the delivery of care, with in-person visits decreasing and telehealth use increasing. We investigated the impact of these changes on mental health services for Medicaid-enrolled adults and youth in Washington State. Among enrollees with existing mental health conditions, the first year of the PHE was associated with a surge in specialty outpatient mental health visits (13% higher for adults and 7% higher for youth), returning to pre-PHE levels in the second year. Conversely, youth with new mental health needs experienced a decline in specialty outpatient visit rates by ∼15% and 37% in the first and second years of the PHE, respectively. These findings indicate that while mental health service use was maintained or improved for established patients, these patterns did not extend to Medicaid-enrolled youth with new mental health needs, potentially due to barriers such as difficulty in finding providers and establishing new patient-provider relationships remotely. To bridge this gap, there is a need for a multi-faceted approach that includes improving service accessibility, enhancing provider availability, and optimizing initial care encounters, whether in-person or virtual, to better support new patients.

Spatial and Socioeconomic Patterns of Mental Health and Healthcare Utilization in Cologne, Germany.

Children and adolescents are significantly tied to their family's socioeconomic position and living environment. Neighbourhood and the living environment have been identified as potential risk factors for mental disorders in this age group. The aim of the study was to investigate the distribution of mental and behavioural disorders (prevalence) and the provision of mental health services for children and adolescents aged 0-19 years in the city of Cologne. In particular, the study aimed to examine the association of these factors with area deprivation and the availability of mental health services covered by statutory health insurance. Finally, possible spatial variations in these aspects were analysed. Claims data of children and adolescents aged 0 to 19 years included in four statutory health insurance of the year 2021 were analysed. A deprivation index using data on the level of the ZIP code area was calculated. Analyses were carried out descriptively, using ordinary least squares (OLS) and geographically weighted regression (GWR). The prevalence of mental and behavioural disorders in children and adolescents varied across ZIP code areas, with higher rates in the northern, southern, and eastern parts of the city. The results indicated that the use of services by male children and adolescents with a prevalent diagnosis of mental and behavioural disorders was higher in areas with a higher density of healthcare providers. However, prevalence was on the whole lower in areas with a higher density of healthcare providers. In addition, the density of health care providers was higher in the city centre with comparatively lower deprivation. These results indicate inadequate access to care for children and young people outside the city centre. However, due to the heterogeneity of the population in these areas, this study provides only preliminary insights. Data with a finer geographic resolution are needed for further research in order to analyse the association further.

Healthcare Barriers and Policy Implications for Non-Syrian Refugees Under International Protection in Türkiye

Türkiye hosts the largest number of refugees in the world, but research has mainly focused on Syrian refugees. This study fills this gap by exploring the experiences of non-Syrian refugees in accessing health services in Türkiye challenges they face. Using a qualitative methodology, 32 participants were selected, and data was collected through in-depth interviews. The analysis revealed three main themes: "health conditions of refugees," "difficulties in accessing health services" and "Professionals’ recommendations". The findings indicate that non-Syrian refugees face significant obstacles, including legal restrictions, financial constraints, language barriers, lack of knowledge of rights and discriminatory attitudes on the part of some health professionals. Access to mental health treatment was particularly difficult for non-Syrian refugees. This study has significant implications for policy makers and healthcare providers and identifies critical areas for intervention to improve access to essential healthcare services.

Changes in Rates of Special Considerations in Higher Education Applications Pre- and During the COVID-19 Pandemic in Victoria, Australia.

Since the onset of the COVID-19 pandemic, a significant rise in mental ill health has been observed globally in young people, particularly those in their final years of secondary school. Students' negative experiences coincide with a critical transitional period which can disrupt milestones in social and educational development. This study aimed to use innovative population-level data to map the impact of the pandemic on students entering higher education. Pre-pandemic (2019/2020) and pandemic (2020/2021) tertiary education application data were obtained from the Victorian Tertiary Admissions Centre. Prevalence of applications for special consideration related to mental ill health were compared between cohorts across various geographical areas and applicant demographic subgroups. Relative risk regression models were used to understand the role of different risk factors. Rates of mental health-related special consideration applications increased by 38% among all applications (pre-pandemic: 7.8%, n = 56 916; pandemic: 10.8%, n = 58 260). Highest increases were observed among students in areas with both extended and close-quarter lockdown experiences, and areas impacted by 2019/2020 black summer bushfires. The increases were higher among Year 12 students and students with other special consideration needs (e.g., physical condition, learning disability). Slightly higher increases were observed in areas with higher socio-economic status, which may potentially be related to inequality in mental health service access. As consequences of mental health difficulties and academic disruption in youth can be long lasting, it is critical to establish a mental health support framework both in and outside of higher education to facilitate young people's recovery from the pandemic.

Mental health service use and shortages among a cohort of women living with HIV in Canada

BackgroundThe prevalence of mental health conditions among women with HIV in Canada ranges between 29.5% and 57.4%, highlighting the need for accessible mental health care. We aimed to (1) describe the availability and use of mental health services among women with HIV and (2) identify characteristics associated with reporting that shortages of these services presented a problem in their care.MethodsBaseline data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study were analysed. Self-reported availability and use of mental health services were examined using descriptive statistics. Participants indicated whether a lack of mental health support was a problem in their care. Logistic regression models were constructed to determine associations between sociodemographic, clinical, and psychosocial characteristics and reported problematic shortages.ResultsOf 1422 women, 26.7% (n = 380) used mental health services in the last year, which most accessed through their HIV clinic. Thirty-eight percent (n = 541) reported that a shortage of mental health support was a problem in their care. Among this subset, 22.1% (n = 119) used services at their HIV clinic, 26.5% (n = 143) reported available services but did not use them, and 51.4% (n = 277) either indicated that these services were unavailable, did not know if such services were available, or were unengaged in HIV care. Factors associated with reporting problematic shortages included rural residence [adjusted odds ratio (aOR): 1.69, 95% confidence interval (CI): 1.03–2.77], higher education level (aOR: 1.43, 95% CI: 1.02–2.02), and higher HIV stigma score (aOR: 1.03, 95% CI: 1.02–1.03). Conversely, African/Caribbean/Black identity (aOR: 0.37, 95% CI: 0.26–0.54), history of recreational drug use (aOR: 0.56, 95% CI: 0.39–0.81), and Quebec residence (aOR: 0.69, 95% CI: 0.50–0.96) were associated with lower odds of reporting service shortages.ConclusionOur findings highlight the HIV clinic as the primary location of mental health service use. However, existing services may not be sufficient to reach all patients or meet specific needs. Furthermore, the low uptake among those reporting a shortage suggests a lack of connection to services or patient knowledge about their availability. Characteristics associated with reporting shortages reflect geographic and socioeconomic disparities that must be accounted for in future service design.

Suicidal Thoughts and Behaviors Among US Adolescents: The Cumulative Effects of Polysubstance Use Behaviors

Background: The linkage between substance use and youth suicidality is less developed due to the predominant focus on certain types of substances (e.g., alcohol consumption, prescription opioid misuse). This study examines polysubstance use and its mutual impact on suicidal thoughts and behaviors among US adolescents. Methods: Data from 2019 Youth Risk Behavior Survey were utilized. Associations between the concurrent use of five substances (cigarette, e-cigarette, alcohol, marijuana, and prescription opioid) and suicidality (suicidal thoughts, suicide plans, and suicide attempts) were measured by logistic regression models. The combined effect of polysubstance use on suicidality was further assessed by structural equation modeling. Results: About two in five (42.1%) adolescents used at least one type of substances in the past month and one in seven (13.5%) used three or more types concurrently (polysubstance use). Adolescents with polysubstance use behaviors were three to five times more likely to experience suicidal thoughts (OR=3.8, p < 0.05), make a suicide plan (OR=3.5, p < 0.05), or attempt suicide (OR=4.6, p < 0.05) than non-users. In the final structural model, polysubstance use and suicidality were significantly correlated with each other (β=0.37, p < 0.05). Collectively, polysubstance use explained about 14% of variance in youth suicidality. Conclusions: Polysubstance use shows a significant impact on youth suicidality. School-based health centers and educational programs are recommended to reduce substance use and suicidal behaviors among adolescents. Accessible mental health services and targeted treatments are needed for polysubstance users to mitigate their risk of suicide.

El impacto del fraude en la competitividad de las instituciones prestadorasde servicios de salud «IPS» de Valledupar

Introduction: Fraud in the healthcare sector is a phenomenon that can have serious consequences, not only in economic terms but also in the quality and accessibility of health services. Objective: To analyze the incidence of fraud on the competitiveness of IPS in Valledupar. Methodology: The epistemic approach of the research was positivist. Regarding the type of study, it was descriptive with a non-experimental field study design. The population selected for this study consisted of officials from the IPS under study. Results: The results show that the IPS in Valledupar under study do not have mechanisms that can be implemented, meaning there is no effective approach to establishing robust internal controls designed to prevent fraudulent activities. Conclusions: Business fraud has been detected, which has had serious consequences not only for the companies and their shareholders but also for the employees, customers, and the economy of Valledupar, causing a loss of credibility in the health service providers

Perception of deaf patients about medical care

Deaf people are those who understand and interact with the world through visual language. Due to the linguistic and cultural differences that characterize the deaf population, this group still faces difficulties in accessing health services. For this reason, it was proposed to investigate communication difficulties in providing care to deaf patients. This is a qualitative study which was carried out at the Association of the Deaf of Maranhão (ASMA), in São Luís. The sample consisted of 10 women and 10 men, all over the age of 18. The information was collected through semi-structured interviews, with the help of Brazilian Sign Language (LIBRAS) interpreters. Data interpretation were performed based on thematic content analysis. Two thematic categories were identified: “communication” and “autonomy”. In the first, the interviewees pointed out the lack of knowledge of the doctors about the needs of the deaf community or about their language, LIBRAS. In an attempt to establish a dialogue, the patients reported the use of writing, gestures and orofacial reading during the consultations. These strategies, however, are insufficient, since the information cannot be well understood. The second evidenced the need for the presence of companions to mediate the dialogue, as the participants stated that they did not find LIBRAS interpreters in the health units, resulting in loss of autonomy and confidentiality of information. It is concluded that this scenario of adversity implies important consequences for the health of this population, as well as lower adherence to treatments and a decrease in the search for medical care.

Prediction of Hearing Help Seeking to Design a Recommendation Module of an mHealth Hearing App: Intensive Longitudinal Study of Feature Importance Assessment.

Mobile health (mHealth) solutions can improve the quality, accessibility, and equity of health services, fostering early rehabilitation. For individuals with hearing loss, mHealth apps might be designed to support the decision-making processes in auditory diagnostics and provide treatment recommendations to the user (eg, hearing aid need). For some individuals, such an mHealth app might be the first contact with a hearing diagnostic service and should motivate users with hearing loss to seek professional help in a targeted manner. However, personalizing treatment recommendations is only possible by knowing the individual's profile regarding the outcome of interest. This study aims to characterize individuals who are more or less prone to seeking professional help after the repeated use of an app-based hearing test. The goal was to derive relevant hearing-related traits and personality characteristics for personalized treatment recommendations for users of mHealth hearing solutions. In total, 185 (n=106, 57.3% female) nonaided older individuals (mean age 63.8, SD 6.6 y) with subjective hearing loss participated in a mobile study. We collected cross-sectional and longitudinal data on a comprehensive set of 83 hearing-related and psychological measures among those previously found to predict hearing help seeking. Readiness to seek help was assessed as the outcome variable at study end and after 2 months. Participants were classified into help seekers and nonseekers using several supervised machine learning algorithms (random forest, naïve Bayes, and support vector machine). The most relevant features for prediction were identified using feature importance analysis. The algorithms correctly predicted action to seek help at study end in 65.9% (122/185) to 70.3% (130/185) of cases, reaching 74.8% (98/131) classification accuracy at follow-up. Among the most important features for classification beyond hearing performance were the perceived consequences of hearing loss in daily life, attitude toward hearing aids, motivation to seek help, physical health, sensory sensitivity personality trait, neuroticism, and income. This study contributes to the identification of individual characteristics that predict help seeking in older individuals with self-reported hearing loss. Suggestions are made for their implementation in an individual-profiling algorithm and for deriving targeted recommendations in mHealth hearing apps.

Nurturing Black Male Mental Health Through the Black Church: A Conceptual Approach from a Social Work Perspective

ABSTRACT This article introduces a conceptual framework rooted in social work principles to support the mental well-being of Black males within the nurturing and supportive setting of the Black Church. It addresses how historical trauma, societal views of Black masculinity, and social determinants of health have made Black men more likely to experience mental health challenges. The framework combines vulnerability theory and social work theory to focus on Black men’s strengths and cultural sensitivities. It emphasizes the Black Church as a critical resource for promoting mental wellness and resilience. The approach includes implementing effective interventions to challenge stigma, improve the availability of mental health services, and encourage Black men to seek assistance. This article presents a holistic approach aimed at addressing mental health disparities experienced by Black males. It proposes using the strengths of the Black Church to promote resilience, facilitate healing, and encourage Black men to prioritize their mental well-being.

Chronic health conditions and disability are prevalent among community users of a digital mental health service: a scoping survey

Objectives: Digital interventions can offer accessible and scalable treatment for chronic conditions, though often focus separately on physical or mental health. People accessing digital health services may live with multiple conditions or experience overlapping symptoms. This study aimed to describe the breadth and characteristics of chronic health conditions and self-reported disability among routine users of a digital mental health service, and to examine related motivations to engage with digital mental health interventions. Methods: A cross-sectional survey of adults registered with a digital mental health service in the Australian community (THIS WAY UP) was conducted. Participant demography, chronic health conditions, self-reported disability and motivations for accessing digital treatment were collected and analyzed descriptively. Results: 366 participants responded (77% female, mean age 50 ± 15 years). 71.6% of participants (242/338) reported ≥1 chronic health condition and one-third reported multimorbidity (112/338, 33.1%). Chronic pain, musculoskeletal and connective tissue disorders were most common. 26.9% of respondents (90/334) reported a disability, most commonly physical disabilities. 95% of those with chronic conditions reported negative mental health effects and 46% reported heightened interest in digital mental health treatments because of their condition. Primary motivations for digital service use were receiving a recommendation from a health professional and service accessibility. Discussion: People who access digital mental health services in routine care report high rates of heterogenous chronic illness and related disability. There is interest in accessible digital treatments to support mental health at scale among people who live with varied chronic conditions and disabilities.

In the shadows of OCD: Jordanian patients' experiences during the COVID-19 quarantine.

INTRODUCTION: Pandemics, like COVID-19, can significantly harm the mental well-being and overall quality of life for individuals and their families. Those with pre-existing mental conditions, especially obsessive compulsive disorder (OCD), are more vulnerable to negative psychosocial effects since the fear of being infected or transmitting infection to others are some of the main characteristics of the illness. There is a need for a nuanced understanding of the personal, social and cultural experiences of people with OCD within their specific psychosocial context. To explore how Jordanian patients with OCD experienced their illness during COVID-19. A descriptive phenomenological design using semi-structured interviews with a purposive sample of 12 patients diagnosed with OCD and experiencing different types of OCD symptoms. Data were analysed thematically, and reported based on the critical appraisal skills programme (CASP) checklist for qualitative studies. Three main themes emerged: (1) Navigating Constraints: The Dual Pathways of Social Engagement and Avoidance (seeking solace through social interaction and embracing quarantine as an opportunity for social avoidance); (2) Estranging family attachments (enforcing proximity and struggling with intimacy); and (3) Shifting OCD landscapes (transforming existing obsessions and escaping to new compulsions). The interviews documented a complete lack of references to receiving professional mental health support throughout the pandemic. This study aligns with previous research indicating a surge in OCD severity during the pandemic, fuelled by distressing news and heightened hygiene measures. Notably, it underscores the strain on familial relationships, with some cases showing protective effects but many demonstrating worsening symptoms due to excessive family accommodation. The absence of professional mental health support during the pandemic raises questions about the quality and accessibility of mental health services in Jordan. The findings underscore the need for continued mental health support and intervention, particularly during times of heightened stress and isolation. Integrating e-mental health resources and cultural adaptation can play a vital role in providing accessible and effective support for individuals with OCD, including those in the Jordanian Arab culture. As we navigate future challenges, it is crucial to prioritize the well-being of individuals with OCD and ensure they have access to appropriate and tailored mental health services.

Barriers and facilitators to tuberculosis diagnosis in Lima, Peru: a mixed methods study

BackgroundTuberculosis (TB) infectiousness decreases significantly with only a few days of treatment, but delayed diagnosis often leads to late treatment initiation. We conducted a sequential explanatory mixed methods study to understand the barriers and facilitators to prompt diagnosis among people with TB.MethodsWe enrolled 100 adults who started TB treatment in the Carabayllo district of Lima, Peru, between November 2020 and February 2022 and administered a survey about their symptoms and healthcare encounters. We calculated total diagnostic delay as time from symptom onset to diagnosis. We conducted semi-structured interviews of 26 participants who had a range of delays investigating their experience navigating the health system. Interview transcripts were inductively coded for concepts related to diagnostic barriers and facilitators.ResultsOverall, 38% of participants sought care first from public facilities and 42% from the private sector. Only 14% reported being diagnosed with TB on their first visit, and participants visited a median of 3 (interquartile range [IQR] health facilities before diagnosis. The median total diagnostic delay was 9 weeks (interquartile range [IQR] 4–22), with a median of 4 weeks (IQR 0–9) before contact with the health system and of 3 weeks (IQR 0–9) after. Barriers to prompt diagnosis included participants attributing their symptoms to an alternative cause or having misconceptions about TB, and leading them to postpone seeking care. Once connected to care, variations in clinical management, health facility resource limitations, and lack of formal referral processes contributed to the need for multiple healthcare visits before obtaining a diagnosis. Facilitators to prompt diagnosis included knowing someone with TB, supportive friends and family, referral documents, and seeing a pulmonologist.ConclusionsMisinformation about TB among people with TB and providers, poor accessibility of health services, and the need for multiple encounters to obtain diagnostic tests were major factors leading to delays. Extending the hours of operation of public health facilities, improving community awareness and provider training, and creating a formal referral process between the public and private sectors should be priorities in the efforts to combat TB.

Where should we go - Estimating travel times for modelling accessibility to 24-hour emergency departments in Canada

Estimating travel time to 24-hour emergency services is an important component to modelling accessibility of health services, particularly for rural areas. However, methods used to estimate travel time vary significantly, are not representative of the residential population, and are not openly validated. This makes the assessment of travel-based accessibility metrics between studies incomparable. To address this issue and develop a standardized measurement of emergency service access, this study utilized small geographic units (Dissemination Areas – DA) and geographical boundaries representative of municipal equivalents (Census Subdivision – CSD). Estimated travel times between the centroid of an inhabited DA to each 24-hr emergency department was computed with population-weighted travel times generated for each CSD. This dataset provides a nationally consistent measurement of proximity to emergency services accounting for travel pathing and population distribution. This methodology can be extended to generate estimated shortest travel routes for other healthcare resources or develop actual travel routes based on individuals’ experiences with the healthcare system.