Access To Health Services Research Articles

Guardians of health: School nurses and their leadership roles in the fight against the COVID-19 pandemic in education<sup></sup>

This study investigated school health nurses’ critical role and importance in managing infectious diseases during the COVID-19 pandemic. The pandemic has had negative impacts on schools and educational institutions. In light of these impacts, the assistance of school health nurses in overcoming difficulties in accessing health services for students and their families was examined globally. The study aimed to explore the status of school nursing practices in various countries in response to the challenges posed by the COVID-19 pandemic, assess the situation in Turkey, and examine how these nurses contribute to health management in educational settings. To identify pertinent literature, relevant publications were reviewed using key terms such as ‘school nursing,’ ‘infectious disease management,’ ‘COVID-19,’ ‘safe school,’ and ‘public health’. The search focused on studies analysing the role of school health nurses during the pandemic. Sources included academic databases, public health reports, and public health organisation publications. Due to the lack of precise data on the employment of school health nurses in Turkey, specific information on their role during the pandemic could not be found. However, the relevant literature was comprehensively reviewed, and the study analysed global publications highlighting the critical role of school nurses in managing infectious diseases in educational settings. The study highlights that school health nurses play significant roles in preventing and controlling communicable diseases and contribute notably to health education for students and staff during the pandemic. School health nurses protect children and adolescents’ physical, psychological, and spiritual well-being. Findings suggest that structural changes in health and education systems are needed to enhance the effectiveness of school nurses. This study underscores the critical importance of school health nurses in pandemic management and public health protection. Strengthening their role is vital for preventing the spread of infectious diseases in schools and ensuring the well-being of students. Recommendations include increasing the employment of school health nurses, improving their professional development, and integrating their expertise into pandemic management strategies.

Family relationships and environmental factors of children in social vulnerability

This study sought to analyze the dynamics of family relationships and environmental factors in children in situations of social vulnerability and violence served by an educational institution. This is a descriptive-exploratory study, with eight families served by a non-governmental institution located in a municipality in the Southern Region of Brazil. Semi-structured interviews were applied to fathers, mothers and/or guardians for the analysis of the Comprehensive Assessment Synthesis Instruments (ISAC). The results showed averages close to 3.0 (from 1 to 5) in ISAC, which conceives situations in which there are strengths, but also vulnerabilities in families, especially socioeconomic factors. It was also identified difficulty in accessing health services, education, employment and adequate food. Therefore, health promotion actions should be encouraged, seeking to develop a culture of peace, reduce vulnerabilities and strengthen support networks.

Stigma, Discrimination and Other Social-Structural Factors Associated with Barriers to Counselling or Therapy among Women Living with HIV Who have Experienced Violence in Metro Vancouver, Canada.

Women living with HIV face high social and structural inequities that place them at heightened risk for gender-based violence and mental health conditions, alongside health services access inequities, with almost no research done to better understand access to mental health services. This study therefore examined social and structural factors associated with barriers to counselling or therapy amongst women living with HIV who experienced lifetime physical and/or sexual violence in Metro Vancouver, Canada. Bivariate and multivariable logistic regression using generalized estimating equations (GEE) were used and adjusted odds ratios (AOR) and 95% Confidence Intervals ([95%CIs] are reported). From Sept/15-Aug/21, 1695 observations were collected among 279 participants. In multivariable analysis, with all variables measured in the last six months, experiencing any barriers to counselling or therapy was significantly associated with having thoughts or attempts of suicide (AOR:1.64 [1.02-2.66]), lacking coverage for health care (AOR:1.60 [1.17-2.18]), and everyday discrimination (AOR:1.02 [1.00-1.04]) and anticipated (AOR:1.57 [1.04-2.36]), enacted (AOR:1.48 [1.02-2.16]) or internalized (AOR:1.53 [1.07-2.20]) HIV stigma. Access to interdisciplinary mental health care services should be improved. Social and structural interventions to reduce HIV stigma and discrimination are urgently needed.

Get out of life on the edge: The role of urban public health services on migrants’ social integration in China

AbstractPublic health services for migrants are not only related to their health status, but also crucial to their social integration in the host cities. Using data from the 2017 China Migrants Dynamic Survey, we examine the impacts of urban public health services on migrants’ social integration. We find a positive correlation between the accessibility of public health services among migrants and their social integration. Research on the mechanisms reveals that obtaining public health services contribute to social integration by improving migrants’ health status, fostering the alignment of hygiene practices with those of local residents and promoting family migration. Heterogeneity analysis shows that the positive impact of public health services on social integration is notably pronounced among migrants engaged in informal employment, lacking social security, holding rural hukou and having a relatively brief duration of residence in the host cities. This paper presents valuable insights into migrants’ social integration which is a critical issue for policymakers. By improving the accessibility of public health services, migrants will better integrate into host cities. The findings may be instructive for promoting urbanization in China and other countries.

Abstract B172: Evidence of behavioral research before and during cancer care in Sub-Saharan Africa: A scoping review

Abstract Introduction: Understanding the behavioral aspects of cancer care in Sub-Saharan Africa (SSA) is crucial for developing effective interventions and improving outcomes, particularly during the peri-treatment phase. Synthesizing knowledge sets the stage for prioritizing cancer-focused research in SSA. Therefore, this scoping review aims to synthesize current knowledge on cancer behavioral research during the peri-treatment phase in SSA, focusing on the behavioral and psychosocial aspects of care. Method: Comprehensive literature searches were conducted across multiple databases and grey literature sources. Studies were selected if they included participants > 18 years old undergoing peri-treatment care, randomized controlled trials, or qualitative/quantitative methodologies focused on behavioral oncology. Only full-text articles published in English were included. Data from the selected studies were systematically extracted and organized. Results: A total of 1,897 cancer patients were included across 18 out of the 24 articles analyzed, with participants aged 8-80 years old. The studies mainly included participants recently diagnosed with cancer or undergoing treatment, covering various cancer types, including prostate, cervical, gastric, liver, and colon cancer, from stage I-III. Only three of the 24 studies referenced theoretical frameworks. Each study identified behavioral factors and outcomes among their sample population. Key findings across the studies underscored significant psychological distress manifested through a spectrum of emotional and psychosocial challenges, including poor social and psychological well-being, depression, anxiety, insomnia, and agoraphobia. Cultural influences, cost considerations, and non-interference of symptoms with day-to-day activities delayed healthcare seeking, especially among women. Despite these challenges, instances of psychological resilience were noted, driven by perceived social support, religiosity, hope, and optimism. The review highlighted the complex interplay between cultural norms, stigma, and health behaviors, with stigma often rooted in cultural beliefs. Spiritual beliefs and practices were central to many participants’ cancer journey, shaping their views on illness, treatment, and recovery. Key factors affecting cancer care include healthcare accessibility, financial limitations, social support networks, healthcare provider attitudes, family involvement in treatment decisions, and emotional support. Conclusion: The findings from this scoping review reveal significant psychological distress and barriers to care among cancer patients in SSA, highlighting the urgent need for comprehensive, culturally sensitive interventions that addresses emotional, social, and cultural dimensions. This approach should integrate accessible mental health services, enhance social support networks, and promote culturally appropriate educational programs to reduce stigma and encourage timely healthcare-seeking. Citation Format: Opeyemi O. Bolajoko, Danneta S. Hooks, Motolani Adedipe, Jessica Saintibert, OluwaSeyi Toye, Clifton Sheri, Folakemi T Odedina. Evidence of behavioral research before and during cancer care in Sub-Saharan Africa: A scoping review [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B172.

Study of Anxiety Among Older People in Kazakhstan and Factors Affecting This Indicator

<b>Aim:</b> The purpose of this research was to study of anxiety among older people in Kazakhstan and factors affecting this indicator.<br /> <b>Methods:</b> A cross-sectional survey was conducted with 221 randomly selected elderly people from different regions of Kazakhstan. The survey covered questions of socio-demographic type and also used the GAD-7 (Generalized Anxiety Disorder-7).<br /> <b>Results:</b> The majority of participants showed low levels of anxiety on the test. Nevertheless, a significant proportion of older adults experienced mild and moderate anxiety, accounting for 33% and 23.1%, respectively. The analysis showed that age (OR = 0,852, 95% CI: 0,779-0,931, p < 0,001), gender (OR = 8,167, 95% CI: 3,232-20,642, p < 0,001), level of education (OR=9,928, CI 95%: 3,760 - 26,212, p < 0,001) and living conditions (OR=0,167, 95% CI: 0,060-0,467, p = 0,001) have a statistically significant impact on the anxiety level of this population group.<br /> <b>Conclusion:</b><b> </b>The results of the analysis confirm the importance of developing and implementing a set of measures aimed at improving the quality of life of older people, taking into account the individual characteristics and needs of each person. The following measures can be suggested to improve the quality of life of older persons: organize social activity and community involvement programs through clubs and activities; establish accessible health and social service centers where older persons can receive qualified care; use technology, such as mobile applications and smart devices, to facilitate daily life, including telemedicine and home-based services.

Pelayanan BPJS Peserta pada Jaminan Kesehatan di BPJS Kesehatan Kantor Padang Lawas Utara

Quality health services are a right for every individual, including participants of the Health Social Security Administering Agency (BPJS). This study aims to analyze the services provided to BPJS Health participants in the North Padang Lawas area, with a focus on North Padang Lawas Health BPJS. The research method used is a descriptive approach with qualitative methods, direct observation, interviews with participants and officers, as well as analysis of secondary data related to service performance. The research results show that although BPJS Health has provided wider access to health services for the community, there are several challenges faced by participants in the North Padang Lawas area. Some of these are limited health facilities, especially in rural areas, long waiting times to receive services, and sometimes inadequate availability of medicines. The quality of service is also a major concern, where there are complaints regarding the attitude and responsiveness of officers and the availability of adequate medical personnel. In this context, increasing training for officers and improving health infrastructure in this region are very necessary to improve services to BPJS Health participants. This research contributes to the understanding of the quality of health services in the North Padang Lawas area, as well as providing a basis for BPJS Health and local governments to make necessary improvements to increase the quality and accessibility of health services for the community.

The potential of a rights-based approach to refugee-focused mental health policy in Aotearoa New Zealand

ABSTRACT In accordance with international human rights commitments, individuals with a refugee background have the right to mental health services that are available, accessible, acceptable, and of good quality. However, refugee-background individuals living in Aotearoa New Zealand experience a myriad of barriers at the individual, community, and policy level that impede access to appropriate mental health services. This commentary puts forward the argument that the incorporation of a human rights-based approach to mental healthcare service at a policy level is essential for reducing barriers to care and increasing the accessibility of mental health services. The article provides key recommendations for reforming the current New Zealand Refugee Resettlement Strategy (NZRRS) to include rights-based indicators for children and youth, to monitor accessibility relative to geographic location, to disaggregate data, to extend the 12-month monitoring period and to extend monitoring beyond one mental health visit. Further research is needed to understand how best to implement these recommendations and develop insight into how Aotearoa New Zealand can more effectively uphold the rights of refugee-background individuals with the ultimate goal of developing a mental health system that is more inclusive and responsive to their needs.

Perception of community reintegration among individuals with spinal cord injury in northwest Nigeria: a qualitative description

Purpose To explore the meaning of community reintegration and strategies for promoting community reintegration based on the lived experiences of individuals with spinal cord injury in northwest Nigeria. Material and Methods Using a qualitative description, we purposively recruited people with spinal cord injury residing in Kano, Nigeria. Eight focus groups were conducted to gather relevant information about the meaning and strategies for community reintegration, based on the lived experiences of the participants. Results A total of 64 people aged 18-60 years completed the study. Most of the participants had lived with spinal cord injury for more than five years. The individuals perceived community reintegration as a multi-dimensional concept reflected by five major themes namely: living life as usual, gainful engagement, a basket of opportunities, courage and support, and acceptance of destiny. Furthermore, the participants considered education and awareness about spinal cord injury, supportive and enabling environment, equal opportunities, care and moral support, and accessible health and rehabilitation services as critical for promoting community reintegration. Conclusion Community reintegration is a multidimensional process, and its promotion in northwest Nigeria requires a multisectoral approach.

Preferences for sexual health services among middle-aged and older adults in the UK: a discrete choice experiment

ObjectivesSexual health is an integral part of well-being. However, the sexual health needs and desires of middle-aged and older adults have been largely disregarded. Therefore, this study aimed to understand...

Racial and ethnic differences in the receipt of continuous positive airway pressure treatment for obstructive sleep apnea

ObjectiveTo examine the pattern of health services access and utilization that may contribute to racial/ethnic disparities in receiving continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA). MethodsThis cross-sectional study used a national sample from the All of Us Research Program, which included over 80 % of participants from underrepresented populations in biomedical research. Study participants included adults aged 18 years and older diagnosed with OSA (N = 8518). Diagnosis of OSA and CPAP treatment were ascertained by diagnostic and procedural codes from the electronic health records. Sociodemographic characteristics and health service utilization factors were identified using self-reported survey data. ResultsWith this national survey, the overall diagnosed prevalence of OSA was 8.8 %, with rates of 8.12 % in non-Hispanic (NH) Black adults, 5.99 % in Hispanic adults, and 10.35 % in NH White adults. When comparing to NH White adults, Hispanic adults were less likely to receive CPAP treatment for OSA after adjusting for socioeconomic and demographic characteristics, access to and utilization of health services, and comorbidities such as obesity and having multiple chronic conditions (OR = 0.73, 95 % CI = 0.59,0.90), p < 0.01. ConclusionsThe rates of CPAP treatment among OSA patients are not consistent across racial and ethnic groups. Unequal access to health services based on residence may contribute to these differences. Interventions that target disparities in OSA diagnosis, access to treatment, and barriers in insurance coverage could potentially help reduce racial and ethnic differences in OSA diagnosis and management.

RELEASE: Preliminary results from a novel data-linkage study into mental health and substance use service utilisation by people released from Scottish prisons

ObjectivesPeople released from prison are at increased risk of dying by suicide, drug overdose, and illnesses related to drugs and alcohol. International literature demonstrates patterns in health service access that imply service accessibility may be insufficient to meet the mental health and substance use needs of this population. This study aims to compare the use of health services for mental health and substance use between people released from Scottish prisons and the general population, using national Scottish data for the first time. ApproachRetrospective observational cohort study, comparing all individuals released from Scottish Prison in 2015 (n=8,917), and a random general population sample (n=42,455), matched on age, sex, postcode and Scottish Index of Multiple Deprivation (SIMD) deciles. Scottish Prison Service data were linked with community prescriptions, death registrations, inpatient admissions to general and psychiatric hospitals, outpatient contacts, and emergency care. ResultsDescriptive summaries of the demographic characteristics of the cohort and bivariate comparisons of service use across different services will be presented, alongside planned approaches using Poisson regression models of service contacts. ConclusionsThis study advances our understanding of the feasibility of conducting research using national linked data from health and justice services and provides insight into differences in access to mental health and substance use support. ImplicationsThis research expands applications of public health approaches and administrative data research in Scotland. It provides crucial evidence to inform interventions that optimise access to appropriate services, to improve the lives of people released from Scottish prisons and to reduce inequalities.

Differences in need for and access to eye health services between older people with and without disability: A cross-sectional survey in four districts of northern Uganda.

Eye health and disability are both common among older people, and it is important to understand how disability relates to visual health status and access to services. While people with disabilities face barriers to accessing health services, few studies have measured participants' functional status in domains other than vision and little evidence exists on how disability impacts eye health services access. This paper describes how visual impairment and access to eye health services differ between people aged 50 years and above with and without disability in Karamoja, Uganda, and explores the factors driving that difference. This was a cross-sectional survey among individuals aged 50 years and above. A standardised eye health survey was conducted, with additional questions on personal and health characteristics. Ophthalmologists conducted a vision examination, and recorded participants' self-reported functional difficulties using the Washington Group Short Set Enhanced. Descriptive analyses were conducted using Stata, and multivariate models constructed to explore relationships. 21.7% of respondents self-reported some sort of functional difficulty. Twenty-five percent of individuals with a non-visual functional difficulty are also blind, and a further 29% experience a lower level of VI. In a multivariate model, blindness was associated with self-reported difficulties seeing, but not any other type of difficulty. Blindness was also associated with age, not being married, and living in a smaller household. Access to cataract surgery was associated with non-visual functional difficulties, male gender, and having a regular household income. This study confirms that in the study area, disability and visual impairment are common among people aged 50 years and above, access to eye health services is low, and self-reported functional difficulties are not associated with lower access to services.

Barriers to Childhood Immunisation and Local Strategies in Four Districts in South Africa: A Qualitative Study.

Introduction: In South Africa over the past 20 years, immunisation has saved countless lives as well as prevented illnesses and disabilities. Despite this, vaccine-preventable illnesses remain a danger. The demand for and uptake of immunisation services are shaped by a variety of factors that can either act as barriers or facilitators to immunisation uptake. The aim of this project was to identify the supply and demand barriers and develop local strategies to improve childhood immunisation in four zero-dose districts in South Africa. Materials and Methods: This study used a mixed-method approach. In each of these four districts, 15 in-depth key informant interviews with health workers and local health managers and four focus group discussions (10 participants per focus group discussion) with community members and caregivers were held over a three-month period. Transcribed interviews were thematically analysed using qualitative analysis software (Nvivo®) into 10 factors as identified as important in influencing immunisation demand and uptake in previous studies. A further four were identified during the data analysis process. Results: Despite the varying role of factors affecting demand and uptake of immunisation services, three consistent findings stand out as major barriers across all districts. The first is interaction with healthcare staff. This clearly highlights the crucial role that the interactions between patients and staff play in shaping perceptions and behaviours related to immunisation services. The second is the overall experience of care at healthcare facilities. This emphasises the role that patient experience of services plays in perceptions and behaviours related to immunisation services. The third is family dynamics. This highlights the important role family dynamics play in shaping individuals' decisions regarding immunisation uptake as well as the impact it has on the ability of people to access health services. Discussion: The role played by the different factors in the demand and uptake of immunisation services varied across the four districts examined in this study. Each of the districts presents a unique landscape where different factors have varying degrees of importance in affecting the utilisation of immunisation services. In some districts, certain factors are major barriers, clearly hindering the demand and uptake of immunisation services, while in others, these same factors might be a relatively minor barrier. This discrepancy highlights the unique nature of healthcare challenges across the districts and the need for tailored strategy recommendations to address them effectively.

Experiences of central child health services teams regarding a special governmental investment in child health services

BackgroundHistorically marked by a high infant mortality rate, Sweden’s healthcare reforms have successively led to a robust, decentralized universal child health system covering over 97% of the population 0–5 years. However, inequities in health have become an increasing problem and the public health law explicitly states that health inequities should be reduced, resulting in various government initiatives. This study examines the experiences of Central Child Health Services (CCHS) teams during the implementation of the Child Health Services Accessibility Agreement between the State and the regions starting in 2017. The agreement aimed to enhance child health service accessibility, especially in socio-economically disadvantaged areas, but broadly stated guidelines and the short-term nature of funding have raised questions about its effectiveness. The aim of this study was to understand the experiences of CCHC teams in implementing the Child Health Services Accessibility Agreement, focusing on investment decisions, implementation efforts, as well as facilitators and barriers to using the funds effectively.MethodsCCHC teams were purposefully sampled and invited via email for interviews, with follow-ups for non-respondents. Conducted from January to October 2023, the interviews were held digitally and recorded with individuals familiar with the agreement’s implementation within these teams. Both authors analyzed the transcripts thematically, applying Braun and Clarke’s framework. Participants represented a cross-section of Sweden’s varied healthcare regions.ResultsThree main themes emerged from the thematic analysis: “Easy come, easy go,” highlighting funding uncertainties; “What are we supposed to do?” expressing dilemmas over project prioritization and partner collaboration; and “Building castles on sand,” focusing on the challenges of staff retention and foundational program stability. Respective subthemes addressed issues like fund allocation timing, strategic decision-making, and the practical difficulties of implementing extended home visiting programs, particularly in collaboration with social services.ConclusionsThis study uncovered the challenges faced in implementing the Child Health Services Accessibility Agreement across different regions in Sweden. These obstacles underline the need for precise guidelines regarding the use of funds, stable financing for long-term project sustainability, and strong foundational support to ensure effective interprofessional collaboration and infrastructure development for equitable service delivery in child health services.

Spatiotemporal distribution and risk factors for patient and diagnostic delays among groups with tuberculous pleurisy: an analysis of 5-year surveillance data in eastern China.

To understand and analyze the factors relating to patient and diagnostic delays among groups with tuberculous pleurisy (TP), and its spatiotemporal distribution in Zhejiang Province. Data of all tuberculous pleurisy patients were collected from the existing Tuberculosis Information Management System. A time interval of > 2 weeks between first symptom onset and visit to the designated hospital was considered a patient delay, and a time interval of > 2 weeks between the first visit and a confirmed TP diagnosis was considered a diagnostic delay. Univariate and multivariate logistic regression analyses were used to explore factors influencing patient and diagnostic delays in patients with TP. Spatial autocorrelation and spatiotemporal scan analyses were used to identify hot spots and risk clusters, respectively. In total, 10,044 patients with TP were included. The median time and interquartile range for patients seeking medical care and diagnosis were 15 (7-30) and 1 (0-8) days, respectively. The results showed that people aged > 65 years, retirees, and residents of Jinhua, Lishui, and Quzhou were positively correlated with patient delay, whereas retreatment patients, houseworkers, unemployed people, and residents of Zhoushan or Ningbo were positively correlated with diagnostic delay. Additionally, high-risk clusters of patient delays were observed in the midwestern Zhejiang Province. The most likely clusters of TP diagnostic delays were found in southeast Zhejiang Province. In summary, patient delay of TP in Zhejiang province was shorter than for pulmonary tuberculosis in China, while the diagnostic delay had no difference. Age, city, occupation, and treatment history were related to both patient and diagnostic delays in TP. Interventions in central and western regions of Zhejiang Province should be initiated to improve the early detection of TP. Additionally, the allocation of health resources and accessibility of health services should be improved in the central and eastern regions of Zhejiang Province.

Affordability, Accessibility, and Quality of Maternal Health Care Services and Level of Satisfaction of Mothers in Rural Areas in China

Objective: This study aimed to understand the affordability, accessibility, and quality of maternal and child health services for postpartum mothers, and their impact on satisfaction. Methods: The study utilized the Anderson model and revised the Maternal Pregnancy and Perinatal Health Service Questionnaire. A survey was conducted among 289 mothers aged 20–49 in Feicheng City. Results: Regarding accessibility, most respondents (133) reported that travel time to healthcare services exceeded 60 minutes, while 99 respondents indicated a travel time of 16–30 minutes. The issue of affordability was highlighted, with 86.85% of participants perceiving maternal healthcare services as costly, indicating a significant financial burden. More than 50% of respondents were satisfied with two specific dimensions (P &lt; 0.05) regarding the quality of maternal healthcare services. Conclusion: The study found that accessibility, affordability, and quality significantly affect mothers’ satisfaction with maternal health services. Future research should focus on developing more suitable service pathways for rural mothers.

Determinants of dropout from the maternal continuum of care in Ethiopia, multilevel analysis of the 2016 demographic and health survey.

Over the past two decades (2000-2020), Ethiopia achieved significant reductions in maternal and neonatal mortality, with a 72% and 44%, respectively. However, low maternal health service utilization and dropout from the maternal continuum of care remain major health system challenges. This study aimed to investigate individual and community-level determinants of dropout from the maternal continuum of care. We used the recent, 2016 Ethiopian Demographic and Health Survey (EDHS) data. In the maternal continuum of care pathway, i) less than four antenatal care (ANC) attendance, ii) subsequent dropout from skilled birth attendance (SBA) after 4 or more ANC, and iii) dropout from postnatal care (PNC) after attendance of facility delivery were the outcomes for dropout. A Multilevel logistic regression analysis of individual and community level factors (e.g., place of residence, geographical regions) were included in the model. The variation in the outcomes were presented by odds ratio (OR), 95% confidence interval and intra-cluster correlation coefficient (ICC). In the maternal continuum of care pathway higher dropouts were observed from SBA to PNC (85%) and from 4+ ANC to SBA (43.4%). Poorest wealth quantile (AOR = 2.31, 95% [CI = 1.69,3.16]), having no health insurance coverage (AOR = 1.44, 95% [CI = 1.01,2.06]), and high community poverty (AOR = 1.28, 95% [CI = 1.01,1.63]) were associated with having < 4 ANC attendance. Perceived distance from health facility as a big problem (AOR = 1.45, [95% = CI, 1.12,1.88), lower community media exposure (AOR = 1.6, 95% [CI = 1.14,2.23]) and rural residency (AOR = 3.03, 95% [CI = 1.75,5.26]) increased the odds of dropout from SBA after 4+ ANC visits. The dropout from the maternal continuum of care was higher in Ethiopia and postnatal care were the most affected maternal care. Oromia and Somali regions were associated with dropouts from all levels of care. Policy strategies should prioritize geopolitical regions with higher dropout levels. In addition to improving access and quality of institutional health services, designing an alternative strategy for targeted outreach for ANC visits and postnatal checkups is recommended.

Mental Health Aftercare Availability for Juvenile Justice-Involved Youth in New York City.

The goal of our study was to describe the availability of community child and adolescent mental health services, trauma-informed care, and the geographic accessibility of these services for juvenile justice-involved (JJ) youth who received mental health services while in secure detention. Data collection occurred through direct contact with the child and adolescent outpatient clinics listed on the New York State Office of Mental Health website. Zip codes were collected from the juvenile secure detention census. Of the clinics contacted, 88.5 percent accepted JJ youth; however, 43.5 percent accepted them on a conditional basis. Only 62.1 percent offered trauma-informed care, including evidence-based interventions and unspecified care. Although 84.5 percent of the clinics that would accept this population reported currently accepting new patients, reported wait times were as high as six or more months. When JJ residents' home zip codes and those of the clinics were geographically mapped, there were few clinics in the zip codes where most residents lived. The clinics that accepted youth on a conditional basis often refused high-risk patients, essentially ruling out a large majority of this population. The geographical inaccessibility of these clinics limits their ability to provide care for this vulnerable population.

A qualitative study exploring the perinatal experiences of social stress among first- and second-generation immigrant parents in Quebec, Canada

BackgroundPerinatal psychological distress adversely impacts the well-being and social adjustment of parents and their children. Expectant parents who have migrated may be at higher risk for perinatal psychological distress due to various migration-specific stressors and healthcare service barriers. Limited studies have examined the perceived determinants of perinatal distress in immigrant parents, particularly men. This study explored first and second-generation immigrant parents’ lived experiences of social stressors and facilitators of perinatal psychological well-being.MethodsParticipants were recruited by convenience and purposive sampling as part of a larger study. Semi-structured interviews were conducted virtually with first and second-generation immigrant women and men in Quebec, Canada. An inductive thematic analysis was performed.ResultsSixteen women (age = 34.8 ± 3.7 years) and ten men (age = 35.1 ± 4.9 years) from various ethnic backgrounds participated in the study at 7.4 ± 0.73 and 7.5 ± 0.72 months postpartum, respectively. Three themes were identified: (1) cultural pressures (cultural differences in parenting, gender-related cultural pressures, health and baby-related practices), (2) health and social service access (social benefits and resources, and systemic barriers in health care), and (3) discrimination (physical appearance or parental-related discrimination, gender-related discrimination, ethnic-related discrimination). First-generation immigrant parents reported greater acculturative stress (i.e. mental health stigma, health care access) and ethnic discrimination concerns related to their distress. Among men, barriers include feeling as though the paternal role was devalued by society and not receiving consideration by health care.ConclusionsOur results highlight different social factors of perinatal well-being perceived by men and women from various ethnic and immigration backgrounds during the perinatal period. Perceived factors include macro-level factors, such as a country’s social climate, health and social policies and services, and social aspects of acculturative stress. Our findings suggest the need for continued efforts to challenge and eliminate discriminatory practices. Interventions and resources directed at first-generation immigrant parents should be bolstered. Understanding what parents perceive to facilitate or hinder their psychological well-being can help inform the development of tailored evidence-based programs and policies to better meet the mental health needs of Canadians and reduce gender disparities in the treatment of perinatal distress.