Attitudes Of Health Care Providers Research Articles

Healthcare providers' attitudes and associated factors on palliative care referral: A qualitative systematic review and meta-aggregation.

Early referral to palliative care has been viewed as providing opportunity for accomplishing end-of-life care goals of life closure, comfortable dying and effective grieving. However, previous studies have shown that palliative care referrals are being made too late. Healthcare providers play important role in helping terminally ill patients to early access and being referred to palliative care. It is necessary to understand healthcare providers' attitudes on palliative care referral and associated factors regarding referrals. This review aimed to identify and synthesise healthcare providers' attitudes and associated factors on palliative care referrals systematically. A systematic review of qualitative evidence and meta-aggregation was conducted and guided according to PRISMA guideline. PubMed, CINAHL, PsycINFO, EMBASE, Web of Science and Cochrane databases from inception to 24 October 2022. Database searches yielded 5856 references. Twenty-two studies met eligibility criteria and of moderate to high methodological quality were included. Studies occurred in USA, UK, Australia and France with 716 healthcare providers participants were included. A total of 378 codings were finally extracted and integrated into 41 categories, forming three synthesised findings: (1) Healthcare providers' attitudes towards palliative care referrals, (2) the influence of subjective norms on palliative care referral behaviour and (3) perceived behavioural control on palliative care referral behaviour. This review demonstrates a series of factors that affect the palliative care referrals, including the attitudes of healthcare providers, the participation of patients and families, the support of colleagues and supervisors, inter-professional collaboration, the availability of hospice resource, disease trajectory and socio-economic factors. Further research that addresses these factors and design relevant trainings on improving healthcare providers' attitudes, enhancing patient and family engagement, strengthening support networks and optimising resource allocation may aid to meet increasing demands of patients. This review not only guides healthcare providers in making better decisions about patient referrals by identifying and addressing barriers but also aids in the development of effective interventions that facilitate the early initiation of referrals. No patient or public contribution.

When addressing resources is not enough: lessons learned from a respectful maternal and neonatal care provider training intervention evaluation in Kenya and Tanzania

BackgroundRespectful Maternal and Neonatal Care (RMNC) maintains and respects a pregnant person’s dignity, privacy, informed choice, and confidentiality free from harm and mistreatment. It strives for a positive pregnancy and post-pregnancy care experiences for pregnant people and their families, avoiding any form of obstetric violence. Though RMNC is now widely accepted as a priority in obstetric care, there is a gap in resources and support tools for healthcare wproviders to clearly understand the issue and change long-established practices such as non-humanized caesarean sections. MSI Reproductive Choices (MSI) manages 31 maternities across 7 countries with a zero-tolerance approach towards disrespectful maternity care and obstetric violence. MSI developed and implemented a hybrid training package, which includes an online module and 1-day in-person workshop that allows healthcare providers to explore their beliefs and attitudes towards RMNC. It leverages methodologies used in Values-Clarification-Attitudes-Transformation (VCAT) workshops and behaviour change approaches.MethodsThe impact of this training intervention was measured from the healthcare providers’ and patients’ perspectives. Patient experience of (dis)respectful care was collected from a cross-sectional survey of antenatal and postnatal patients attending MSI maternities in Kenya and Tanzania before and following the RMNC training intervention. Healthcare providers completed pre- and post-workshop surveys at day 1, 90 and 180 to measure any changes in their knowledge, attitudes and perception of intended behaviours regarding RMNC.ResultsThe results demonstrate that healthcare provider knowledge, attitudes and perceived RMNC practices can be improved with this training interventions. Patients also reported a more positive experience of their maternity care following the training.ConclusionRMNC is a patient-centred care priority in all MSI maternities. The training bridges the gap in resources currently available to support changes in healthcare wproviders’ attitudes and behaviours towards provision of RMNC. Ensuring health system infrastructure supports compassionate obstetric care represents only the first step towards ensuring RMNC. The results from the evaluation of this RMNC provider training intervention demonstrates how healthcare provider knowledge and attitudes may represent a bottleneck to ensuring RMNC that can be overcome using VCAT and behaviour change approaches.

"I'll take them another day": A qualitative study exploring the socio-behavioral complexities of childhood vaccination in urban poor settlements.

Despite improvement over recent decades, childhood vaccination uptake remains a concern across countries. The World Health Organization observed that over 25 million children missed out on one or more vaccines in 2021, with urban poor and other marginalized groups being the most affected. Given the higher risk of disease transmission and vaccine-preventable diseases (VPD) outbreaks across densely populated urban slums, identifying effective interventions to improve childhood vaccination in this vulnerable population is crucial. This study explored the behavioral and social factors influencing childhood vaccination uptake in urban informal settlements in Nairobi, Kenya. A grounded theory approach was employed to develop a theoretical account of the socio-behavioral determinants of childhood vaccination. Five focus group discussions (FGDs) were conducted with purposively sampled caregivers of children under five years of age residing in informal settlements. The Theory of Planned Behavior guided the structuring of the FGD questions. An iterative process was used to analyze and identify emerging themes. Thirty-nine caregivers (median age 29 years) participated in the FGDs. From the analysis, four main thematic categories were derived. These included attitude factors such as perceived vaccine benefits, cultural beliefs, and emotional factors including parental love. Additionally, subjective norms, like fear of social judgment, and perceived behavioral control factors, such as self-control and gender-based influences, were identified. Furthermore, a number of practical factors, including the cost of vaccines and healthcare providers attitude, also affected the uptake of vaccination. Various social, behavioral, cultural, and contextual factors influence caregiver vaccination decisions in urban poor settings. Community-derived and context-specific approaches that address the complex interaction between socio-behavioral and other contextual factors need to be tested and applied to improve the timely uptake of childhood vaccinations among marginalized populations.

Experiences and attitudes of task-shifting and task-sharing of physicians, nurses, and nursing assistants in hospitals: a qualitative systematic review protocol.

The objective of this review is to explore the experiences and attitudes of physicians, nurses, and nursing assistants regarding task-shifting and task-sharing in hospitals. Despite multiple health care professionals performing overlapping tasks, the need for effective task-shifting and task-sharing remains a concern. Understanding task-shifting and task-sharing experiences, as well as the attitudes of health care providers in hospitals, is essential for providing safe and patient-appropriate care with limited human resources. Qualitative studies that examine the experiences and attitudes of physicians, nurses, and nursing assistants in hospitals regarding task-shifting and task-sharing will be included. The review will include physicians, advanced practice nurses who are nurse practitioners or clinical nurse specialists, registered nurses, and nursing assistants. Midwives, pharmacists, occupational therapists, physical therapists, and students will be excluded. PubMed, MEDLINE, CINAHL, PsycINFO, Cochrane Database, and Web of Science will be searched as part of a 3-step search strategy. We will search for unpublished research and gray literature using Google Scholar and ProQuest Dissertations and Theses. Studies published in English or Japanese from the time each database was established to the present will be considered for inclusion. The methodological quality of all studies will be evaluated by screening against the inclusion criteria and by at least 2 critical evaluations using the standardized JBI checklist. Synthesized results will be pooled by meta-aggregation and published as a ConQual Summary of Findings. PROSPERO CRD42023409612.

Assessment of the Knowledge, Attitude, and Perception of Healthcare Providers Regarding Halal Pharmaceuticals

Background The intersection of religious beliefs and medical practices significantly impacts medication usage and patient adherence to treatment regimens. Emerging within this discourse is the concept of halal pharmaceuticals, emphasizing the alignment of therapeutic drugs with religious beliefs. Despite its importance, there is limited awareness among healthcare providers (HCPs) regarding their ingredients, standards, and manufacturing processes, particularly in the Middle East region. Thus, this study aimed to investigate the knowledge, attitudes, and perceptions (KAP) of HCPs concerning Halal pharmaceuticals, which are crucial for addressing the growing concerns among patients and consumers. Methods A cross-sectional survey involved diverse HCPs (physicians, pharmacists, and nurses) in Jordan. The survey encompassed demographic data, knowledge about Halal pharmaceuticals, attitudes, and perceptions. Descriptive statistics and inferential analyses were performed to examine the associations between demographic variables and KAP scores. Results A total of 381 HCPs participated in the study. While HCPs generally had a high level of knowledge, gaps existed, particularly concerning pharmaceutical composition and Halal alternatives. Attitudes and perceptions were mostly positive or neutral, though variations occurred among professions. Pharmacists exhibited significantly higher knowledge scores compared to physicians and nurses. Information sources included academic institutions, peers, religious and educational books, and online resources. Factors, such as age, marital status, religion, education type, insurance type, working place, and years of experience significantly influenced the KAP scores of participants. Conclusion Tailored educational interventions are critical for addressing knowledge gaps, fostering positive attitudes, and ensuring culturally sensitive healthcare related to Halal pharmaceuticals. Leveraging diverse information sources and tailoring education based on demographics can enhance understanding. Improved knowledge, attitudes, and perceptions enable HCPs to meet the needs of diverse patient populations and provide safe, Halal-compliant medications. Additionally, further research into the perspectives and willingness of patients to pay for Halal pharmaceuticals is essential to ensuring equitable access to pharmaceutical care services.

A Qualitative Study of Caregivers of Children Living with HIV/AIDS in Ghana: Diagnosis History, Health-seeking Behaviour, and Care Expectations

Caregivers of Children Living with HIV/AIDS experience severe burdens in Africa amidst unmet needs while seeking care from hospitals. This study aimed to explore the diagnosis history, health-seeking behaviour, and care provided by hospitals and whether the services meet caregivers’ expectations. We used a qualitative approach and conducted individual in-depth interviews among purposively sampled caregivers of children living with HIV/AIDS from three hospitals. We achieved data sufficiency after interviewing nine participants. Audio-recorded interviews were transcribed verbatim and thematically analyzed manually through Collaizi’s steps. Four themes developed including; history of pregnancy and poor HIV testing, effective care for caregivers and CLWH, attitude of healthcare providers, and unmet expectations of care. Healthcare providers showed positive attitudes towards caregivers and provided services (counselling, dispensing Anti-retrovirals, health monitoring, and coordination of clinical care). Expectations bordered on financial support (for food, education, health care), and treatment for opportunistic infections. Findings indicate gaps in HIV voluntary testing for pregnant women, enrollment in Prevention of Mother to Child Transmission (PMTCT), and unmet needs. It is imperative to improve coverage of testing for pregnant women and efforts made to meet their needs. Financial support, provision of food security, and assistance for caregivers are essential for care.

Examination of medical student and physician attitudes towards suicide reveals need for required training.

The attitudes of healthcare providers towards suicidal patients are known to influence their motivation to treat patients during a suicidal crisis. Patients who attempted suicide are more likely to have recently visited a primary care provider who is not necessarily sufficiently trained in managing a suicidal patient rather than a mental health provider who is trained to do so. For those reasons, documenting medical students and physicians' attitudes towards suicide can help in the development of effective intervention training to prepare them to manage these types of patients. In this mini review, attitudes towards suicidal patients, the effectiveness of training on changing their attitudes are discussed. In summary, primary care providers are recognized as a top area where improvements can prevent suicides; providing proper suicide prevention training can effectively improve attitudes and quality of care for suicidal patients.

IJCM_217A: Literacy for health: Bridging the gap between female literacy and health seeking behaviour

Background: The private sector has maintained its dominance in the healthcare industry despite numerous government measures to improve public services. Public sector is still not a choice for treatment, various reasons being large distance from residence, poor quality of care, shortage of drugs, poor attitude of health care provider. Enumeration of the factors that defines pattern of the utilization of health services become utmost important. Hence, this study is being conducted to understand the factors behind the utilization of government health services. Objectives: i)To find the prevalence of Reproductive Tract Infections, among married women of reproductive age group, seeking treatment among rural and peri-urban areas of Aligarh. ii) To find the determinants of utilization of reproductive health services among married women in Aligarh. Methods: This cross-sectional study was conducted between 2020-2021 Data was collected through a pretested, semi-structured questionnaire through simple random sampling from 500 married women of reproductive age group, in the field areas registered under Department of Community Medicine, JNMCH A.M.U. Data was analysed using IBM SPSS 20.0. Proportion, frequencies, chi square were used to interpret the data. Results: Among total females interviewed 201 (40.2%) were found to have symptoms of Reproductive Tract Infections, out of them 165, (74.1%) sought treatment. Among 165 females who started treatment, 62.4 % of females seeking treatment were literate.69% females who delayed treatment were illiterate. Self-motivation for treatment was seen among 60.2 % of literate females. Area of residence, social class and female’s role in decision making also determined the treatment seeking behaviour. Conclusion: In our study female literacy has been found as major factor influencing the health seeking behaviour. Factors like place of residence, socio economic status, female role in decision making were significant. There is no denying the significant health benefits of supporting women’s education. Education has a crucial role in family planning, from the earliest stages to caring for one’s own health and newborn children.

Healthcare Providers’ knowledge, attitudes and practice in relation to drug hypersensitivity reactions at King Abdulaziz Medical City in Riyadh

BackgroundDrug hypersensitivity reactions (DHRs) are immune-mediated responses triggered by exposure to a drug. DHRs are responsible for serious adverse drug reactions (ADRs) and are considered the fifth leading cause of death. This study aims to assess and evaluate the knowledge, practice, and attitudes of healthcare providers (HCPs) towards DHRs. MethodsA cross-sectional survey was conducted at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. Healthcare providers, including pharmacists, physicians, and nurses, were recruited using a convenience sampling method to complete the survey. The survey comprised three domains: knowledge (14 items), attitudes (5 items), and practices (6 items), utilizing a standardized self-administered questionnaire. ResultsThe survey was completed by 373 healthcare providers. The respondents were predominantly female (72.1 %) with a mean age of 33.8 ± 7.8 years. Of the respondents, 64 % were nurses, 25 % pharmacists, and 11.3 % physicians. Educational levels varied, with 53 % holding a bachelor's degree, 22 % an associate degree, and 25 % a master's degree or higher. The median knowledge score was 48. Female healthcare providers, those with advanced levels of education, and physicians had higher knowledge scores compared to male and nurse participants (p < 0.05). One-third of the respondents (33 %) were satisfied with their knowledge of DHRs, and 42 % believed HCPs should receive more advanced training in DHR management. Less than a quarter of HCPs reported inquiring about patients' histories of hypersensitivity reactions. ConclusionsThe study revealed that healthcare workers had a relatively low level of knowledge about drug hypersensitivity reactions and lacked a consensus on DHR management. While displaying a positive attitude towards DHRs, they often did not translate this attitude into consistent clinical practice.

The Attitude of Healthcare Providers and the General Population on the Concept of Do-Not-Resuscitate (DNR) Order in End-Stage Patients

Background: The do-not-resuscitate (DNR) order in end-stage patients constitutes a critical medical decision, directing healthcare providers to withhold cardiopulmonary resuscitation (CPR) in the event of cardiopulmonary arrest upon the patient's request. Objectives: This study aims to analyze the attitudes of healthcare providers and the general population toward the concept of DNR orders in end-stage patients. Methods: Conducted from September 2021 to May 2022, this cross-sectional study aimed to gauge the attitudes of healthcare providers and the general population toward DNR orders in end-stage patients using a questionnaire assessing attitudes toward DNR. The research population included healthcare providers—physicians and nurses—from healthcare centers affiliated with Iran University of Medical Sciences, selected through convenience sampling, and the general population comprising individuals frequenting parks near these healthcare centers within the relevant municipal districts. Results: Among the 164 participating healthcare providers, 139 (84.8%) were female. Participants' ages ranged from 21 to 57 years, with an average age of 36.78 ± 7.79 years. The study found that healthcare providers had a significantly higher average attitude score toward DNR (29.85 ± 9.46) compared to the general population (27.08 ± 9.78). Healthcare providers with adequate financial status exhibited a more positive attitude toward DNR in end-stage patients compared to those with excellent or poor economic status (P = 0.001). Additionally, the relative frequency of individuals experiencing a poor prognosis of disease was significantly lower among healthcare personnel than the general population (P = 0.018). Healthcare providers without family members or friends in their end-stage of life demonstrated a more favorable attitude toward DNR for these patients (P = 0.001). Conclusions: The study revealed that healthcare providers exhibited a significantly more positive attitude toward DNR compared to the general population. Furthermore, healthcare providers experienced a lower relative frequency of individuals facing a poor prognosis of disease compared to the general population. However, the relative frequency of experiencing family members or friends in the end stage did not significantly differ between healthcare providers and the general population. Healthcare providers with less than 2 years or more than 20 years of experience in the medical field demonstrated a more positive attitude toward DNR.

Knowledge, attitudes, and associated factors towards HIV pre-exposure prophylaxis among health care providers

The knowledge and attitudes of health care providers were limited as reviewed in many studies. Attitudes and knowledge about pre-exposure prophylaxis among healthcare providers have not been investigated in Ethiopia even though pre-exposure prophylaxis is a novel healthcare topic. The aim was to assess knowledge, attitudes, and associated factors towards pre-exposure prophylaxis among healthcare providers in Gojjam health facilities, North West Ethiopia, 2022. An institutional-based cross-sectional study was conducted from June 1–30 among 410 healthcare providers in public health facilities in the East Gojjam zone. A simple random sampling technique was used to recruit the required study participants. The statistical program EPI Data version 4.6 was used to enter the data, and statistical packages for Social science version 25 was used for analysis. Variables with a p-value less than 0.25 in the bivariable analysis were included in the multivariable logistic regression analysis. Statistical significance was determined with a p-value less than 0.05. The good knowledge and the favorable attitude of healthcare providers toward HIV pre-exposure prophylaxis were 55.7% (50.6–60.2%) and 60.2% (55.0–65.0%) respectively. male participant (AOR 1.67; 95% CI (1.01–2.55), service year ≥ 10 years (AOR 2.52; 95% CI (1.23–5.17), favorable attitudes (AOR 1.92; 95%CI (1.25–2.95), and providers good sexual behavior (AOR 1.85; 95%CI (1.21–2.82) were significantly associated with the good knowledge, and training (AOR 2.15; 95% CI (1.23–3.76), reading the guideline (AOR 1.66; 95% CI (1.02–2.70), and good knowledge (AOR 1.78; 95% CI (1.16–2.75) was significantly associated with the favorable attitudes. In general, the finding of this study shows that the knowledge and attitudes of healthcare providers were low. Since this is a new initiative their knowledge is lower than their attitudes. Male, service year 10 years, and good provider sexual behavior were factors significantly associated with good knowledge. Training, reading the guidelines, and good knowledge were factors significantly associated with a favorable attitudes. As a result, healthcare facilities intervention programs and strategies better target these factors to improve the knowledge and attitudes of healthcare providers. Preparing training programs to enhance knowledge and attitudes towards PrEP is recommended.

Cross-Cultural Validation of the Healthcare Provider's Practices, Attitudes, Self-Confidence, and Knowledge Regarding Bullying Questionnaire.

How can we know the reality of the context of bullying in the field of primary health care? The aim of this study is to obtain a validated and reliable tool that allows measurement of the involvement of primary care professionals in addressing bullying through a systematic content validation process. A cross-cultural validation of the Healthcare Provider's Practices, Attitudes, Self-Confidence, and Knowledge Regarding Bullying Questionnaire was conducted for the Spanish perspective. This involved linguistic adaptation through translation-back-translation, content validity index (CVI) analysis, construct validity using confirmatory factor analysis (CFA), and internal consistency (Cronbach's α). The total CVI was 0.95, with individual item scores ≥ 0.78. CFA revealed a good fit for the three subscales, with discrimination indices (item-total correlation within the dimension) > 0.30. Cronbach's α for each dimension indicated a high level of reliability, with values of 0.735 for attitudes, 0.940 for self-confidence, and 0.895 for knowledge. The questionnaire is valid and reliable for evaluating the knowledge, attitudes, and self-confidence of primary care professionals in Spain regarding bullying. Its validity and reliability guarantee its potential use in other health settings and may lead to better training of professionals and school biopsychosocial health.

Knowledge, attitude, and practice of healthcare providers on chronic refractory cough: A cross-sectional study

ObjectivePrevious studies from outside China showed that the knowledge, attitudes, and practice (KAP) of chronic refractory cough (CRC) was moderate among physicians. This study examined the KAP toward CRC in Chinese healthcare providers. MethodsThis single-center cross-sectional study was conducted at The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, from July 2022 to January 2023 and enrolled healthcare providers. The demographic characteristics and KAP scores were collected using a questionnaire (Cronbach's α = 0.934) developed based on CRC guidelines. ResultsThe study included 539 healthcare providers. The mean knowledge score was 8.27 ± 2.37 (maximum of 14, 59.07%), indicating poor knowledge. The highest rates of inaccuracies pertained to knowledge about the definition of chronic cough, empirical treatment methods, and potential risks of different treatments, suggesting a need for unified training in all aspects of CRC for medical staff. The mean attitude score was 49.74 ± 63.63 (maximum of 60, 82.90%), indicating favorable attitudes. Most healthcare providers believed that CRC affects normal work and life and that it would be necessary to provide more help to patients from the perspectives of drug treatment and psychological counseling. The mean practice score was 23.20 ± 6.28 (maximum of 35, 66.29%), indicating poor practice. ConclusionThis study suggests that healthcare providers in Yancheng have poor knowledge, favorable attitudes, and poor practice of CRC. This study provides points that should be targeted in future training and continuing education activities.

Knowledge and Attitude of Healthcare Providers Regarding Palliative Care and Related Factors: An Online Cross-Sectional Study.

Palliative care alleviates pain and enhances the quality of life of patients with life-threatening illnesses. Training programs are required to provide patients with proper care and advance their health because the expertise of healthcare personnel in palliative care is inadequate. We aimed to assess healthcare professionals' knowledge of palliative carebecause palliative care programs are infrequently used in Syria. An online cross-sectional study was conducted between July 24, 2022, and August 28, 2022, to assess palliative care knowledge and applications among Syrian healthcare workers. The study questionnaire was designed in accordance with a previous study, and the inclusion criteria included Syrian healthcare workers, physicians, and nurses, as well as medical and nursing students. The first section of the questionnaire included sociodemographic information, while the second, third, and fourth sections assessed healthcare workers' experiences, knowledge, and attitudes toward palliative care, respectively. Of the 602 participants, 66.2% of the sample study were females. The majority of the respondents (72.9%) were medical students, with 18.8%residents and 8.3%nurses or nursing students. The majority of the participants (84%) correctly answered the question about pain treatment goals, while only a small percentage (5.3%) correctly answered the question about whether long-term opioid use was addictive. There were no statistically significant differences in the overall knowledge levels across demographic areas, genders, or specialties. Only 14 participants were considered knowledgeable about palliative care. Regarding attitudes toward palliative care, the three responses that received the greatest degree of agreement were "Pain relievers should be given as needed to terminally ill patients" (89.7%)and "Patients have the right to determine their own degree of psychosocial intervention" (81%). Residents in urban and rural areas scored markedly different in their attitudes. Students in their fifth year were 8.06 times more likely to have a positive attitude when compared to those in their first year. Our findings show that Syrian healthcare providers lack knowledge of palliative care. It is important to integrate palliative care into Syria's healthcare system to enhance the quality of life of patients who are approaching the end of their lives and to provide care for those who require it.

Assessing Medical Ethics Knowledge and Practice Among Healthcare Professionals in Al Majma'ah, Saudi Arabia.

Background The healthcare system is increasingly confronted with ethical challenges, necessitating a thorough exploration of healthcare providers' ethical knowledge and attitudes. This study aims to evaluate the ethical awareness and attitudes of healthcare providers in the Al Majma'ah region of the Kingdom of Saudi Arabia (KSA). Aim This research focuses on assessing the level of knowledge and practice regarding medical ethics among healthcare providers in a community hospital in Majmaah, KSA. Methods A comprehensive cross-sectional study was undertaken in the Majmaah governorate of Saudi Arabia. Data collection involved distributing a meticulously designed questionnaire to healthcare providers and faculty members affiliated with the College of Medicine. Subsequently, the acquired dataset underwent analysis utilizing SPSS software. Results A total of 183 participants were included in the study. The findings revealed that only 77 respondents (42.1%) considered ethical issues in their profession as extremely important. Moreover, 104 participants (56.8%) were aware of the existence of an ethics committee in their institution. A total of 113 respondents (61.7%) disagreed with the notion that ethical conduct is primarily important to avoid legal consequences, and 120 participants (65.6%) believed in the significance of in-service training on medical ethics for doctors. The study also highlighted that 100 participants (54.6%) believed that healthcare providers' opinions supersede patient preferences. However, a majority, 163 participants (89.1%), agreed that patients should be informed of any wrongdoing, contrasting with only 20 (10.9%) who disagreed. When asked about adhering to patients' wishes despite doctors' opinions, 112 (61.2%) responded affirmatively, while 71 (38.3%) disagreed. There was also a disparity in opinions regarding the necessity of obtaining consent, with 81 (44.3%) agreeing that consent is required not only for surgical procedures but also for medications or investigations. Furthermore, 137 participants (74.9%) recognized the importance of discussing ethical, social, and legal issues during clinical rounds alongside clinical aspects of patient care, while 46 (25.1%) disagreed. Conclusion Although medical ethics were introduced into the Saudi healthcare system more than a decade ago, this study underscores the ethical necessity of obtaining comprehensive informed consent prior to invasive and other medical procedures. It also highlights the significance of engaging patients in the decision-making process regarding their treatment. Well-informed patients typically exhibit higher satisfaction levels and are less inclined to pursue legal action.

THE DISPOSAL PRACTICES OF UNUSED AND EXPIRED PHARMACEUTICAL PRODUCTS AMONG NON-GOVERNMENTAL HEALTHCARE PROVIDERS IN NORTH EASTERN NIGERIA

The disposal practices of unused and expired medicines have become a worldwide challenge. Due to the state of insecurity in the North Eastern Nigeria, Non-Governmental Healthcare providers provide healthcare services and medication to populations in distress and are also positioned to possess unused and expired health products. The objective of the study was to evaluate the knowledge, attitude, and practices of Non-Governmental Healthcare providers working in Borno State Nigeria towards handling unused and expired pharmaceuticals. A cross-sectional research design using questionnaires was employed among all Non-Governmental Healthcare providers registered under the Borno State Agency for Coordination of Sustainable Development and Humanitarian Response (BACSDAHR) and all donor agencies implementing health programmes within the state. A total of 43 respondents participated in the study. About 86.0% showed good knowledge of the environmental impact of improper disposal, 95.5% showed a good attitude on disposal of unused and expired medicine, 62.8% exhibited good practices in the handling of unused and expired medicines. A significant association was found between the profession and the disposal practices of unused and expired medicines. Between 80% to 93% of respondents do not know of the availability of any medicine disposal guideline document in their organization. The staff of Non-Governmental Healthcare providers show good knowledge, good attitude as well as good practices on the disposal of unused and expired medicines. The profession of respondents significantly influenced their disposal practices.

Depression care integration in tuberculosis services: A feasibility assessment in Pakistan

AbstractBackgroundThe co‐occurrence of depression among tuberculosis (TB) patients is a critical issue, contributing to poor treatment outcomes, prolonged hospitalisations and increased healthcare expenses.ObjectiveThe objective of this study was to assess the feasibility of delivering a co‐designed depression care pathway within TB services in Pakistan.DesignMixed‐method study.Setting and ParticipantsRoutine depression screening for TB patients was conducted at three TB facilities in Peshawar, Pakistan, encompassing primary, secondary and tertiary care settings. All patients aged 18 or above (male and female) attending the three TB facilities between November 2021 and February 2022 were included in the study using the consecutive sampling technique.ResultsA total of 301 people with confirmed TB, within the past 4 weeks, visited the three TB care facilities; 191/301 patients were screened for depression. Approximately 35% of the 191 TB patients screened positive for depression, with varying severity levels. Qualitative findings highlighted the acceptability of integrated depression care, emphasising the importance of open communication and empathetic attitudes. Barriers to integration include stigma, logistical challenges, patient noncompliance and cost burdens. Facilitators included the empathetic attitude of healthcare providers and the availability of mental health services within the same facility.ConclusionThere is a high burden of depression in patients with TB, highlighting the pressing need for mental health support in this population. Acceptability of integrated care was evident, with factors such as co‐located mental health services, training healthcare providers and provider empathetic attitudes playing a crucial role. Further research is required to evaluate the effectiveness of the integrated TB‐depression screening systems towards improved health outcomes, implementation, scalability and impact on the broader healthcare system.Patient and Public ContributionTo create a more inclusive and comprehensive TB and depression care pathway, we gathered input from both service providers and service users (TB patients, their carers). Reflective meetings with community leaders, social activists and health professionals from various sectors were also conducted during pathway delivery to get their insights. Power, gender and age imbalances were addressed by encouraging participation of patients and carers across gender and age groups. This approach ensured that the perspectives of all stakeholders were considered in the development of the care pathway.

Introduction of a novel neonatal warming device in Malawi: an implementation science study.

Neonatal hypothermia significantly contributes to infant morbidity and mortality in low-resource settings like Malawi. Kangaroo mother care (KMC) is essential but faces challenges in providing continuous thermal support. The Dream Warmer is a neonatal warming device that was developed to complement KMC. We studied its implementation outside a research environment. Using an implementation science approach, we conducted a prospective interventional cohort study in two hospitals and four health centres in Malawi. Through audits and surveys, we assessed the effect of the Dream Warmer on neonatal hypothermia as well as healthcare provider (HCP) and parent attitudes regarding thermoregulation and related issues. The Dream Warmer raised no safety concerns and effectively treated hypothermia in 90% of uses. It was positively received by HCPs and parents, who reported it had a favourable effect on the care of small and sick newborns. Challenges identified included a scarcity of water and electricity, lack of availability of the device and HCPs forgetting to prepare it in advance of need or to use it when indicated. Feedback for future training was obtained. The Dream Warmer's strong safety and effectiveness performance is consistent with results from strict research studies. Training materials can be adapted to optimize integration into daily practice and provide educational content for parents. The Dream Warmer is a safe and effective device to treat neonatal hypothermia, particularly when KMC is insufficient. We gained an understanding of how to optimize implementation through robust HCP and family education to help combat hypothermia.

Setting up the first human milk bank in Uganda: a success story from Nsambya hospital.

The World Health Organization (WHO) strongly recommends the use of donor human milk (DHM) for low birth weight infants when mother's own milk is unavailable or insufficient. However, the use of DHM requires the availability of human milk banks (HMBs), the majority of which are in middle and high-income countries. Developing countries offer multiple opportunities and challenges regarding the establishment and operationalization of HMBs. This study describes the experience in setting up the HMB in Uganda at St. Francis Hospital Nsambya. The establishment of the first HMB in Uganda followed a step-wise approach using the PATH's Resource Toolkit for Establishing and Integrating Human Milk Banks. The steps included: performing a facility readiness assessment, implementing quality control measures, forming and training a committee for the Baby Friendly Hospital Initiative, establishing a monitoring and evaluation system, developing a communication strategy, engaging with the Ministry of Health, providing staff training by a Human Milk Bank consultant, and maintaining regular coordination by a dedicated technical team. A total of 170 donors have been screened and of these 140 have donated milk with a mean age of 26 years since the establishment of the bank in November 2021. A total of 108 admitted neonates have received the milk; majority (88%) are preterm infants with a mean gestational age of 34 weeks. A total of 90 liters have been collected and 76 distributed. The challenges in establishment of the Human Milk bank included: lack of guidelines on human milk banking, use of unpasteurized milk, lack of communication strategy, lack of clear model infrastructure and lactation training. We addressed the challenges: by drafting guidelines, set up a human milk bank and had training on use donor pasteurized milk, designed communication messages through videos and brochures, visited Pumwani hospital and remodeled the Human Milk Bank according to the model at Pumwani, all the health workers in the human milk bank had a training on Lactation. Assessing the experiences and attitudes of mothers, donors, healthcare providers, and hospital leaders revealed concerns about milk safety and fear about potential attachments or acquired traits through the donated milk to the babies that may receive it. Donors viewed milk donation as a life-saving act, although fears of breast cancer and lumps arose from misconceptions. To address these perspectives, creative media, such as videos and messages, were designed to raise awareness, promote behavioral change, and create demand for the HMB services. The establishment and integration of HMB services at hospitals in Uganda is feasible.

Decision-making concerning involuntary oral care in older individuals with dementia

Many older individuals with dementia show care-resistant behavior for oral care. Providing care despite resistance is considered to be involuntary care. The Dutch law, 'Wet zorg en dwang' (care and coercion), states that care must be ceased in the presence of resistance, unless there is (a risk of) serious harm. This study was conducted to gain insight into the attitudes of healthcare providers with regard to involuntary oral care in older individuals with dementia. An online questionnaire consisting of general questions, case specific questions and knowledge questions about the Dutch law was filled out by 392 care providers. In all cases, a discrepancy was seen between the assessment of oral health problems as potentially harmful and the willingness to provide involuntary oral care. Hence, many healthcare providers are aware of the subsequent potential health risks related to not providing care, but are still reluctant to provide involuntary oral care. A large part of the healthcare providers also has a low level of knowledge with regard to the Dutch law 'Wet zorg en Dwang'.