Provider Attitudes Research Articles

Assessment of healthcare providers’ knowledge, attitude, and practice toward medical research in southwest Saudi Arabia: a cross-sectional study

BackgroundMedical research plays a crucial role in advancing the treatment and prevention of diseases, in addition to enhancing public health.ObjectivesThis study aims to assess knowledge, attitude, and practice (KAP) of healthcare providers (HCPs) in relation to medical research, identify motivating factors and barriers that prevent them from conducting research, and identify associated factors with good knowledge, practice and positive attitude.MethodsIn this cross-sectional study, a validated questionnaire was employed to gather data of HCPs who work at healthcare institutions affiliated with MOH. The Proportionate stratified random sampling method was used to recruit HCPS. Proportion (%), and median and interquartile range (IQR) were used to represent the data. Logistic regression analysis was carried out to identify associated factors with good knowledge, positive attitude, and good practice.ResultsA total of 285 HCPs were included in the analysis. The median score for knowledge was 43%, with scores ranging from 14 to 57%, for most participants showing variability in their knowledge levels. For attitude, the median score was 100%, indicating a generally positive outlook, with scores between 80% and 100% for most participants. The practice score had a median of 59%, with scores ranging from 33 to 83%, showing a wide range in research activity among the HCPS. The most reported motivators were strength of the resume (91.80%) and fulfilment of work requirements (90.80%). The most reported barriers were lack of financial support (82.3%), poor time management (78.7%), no enough research facilities (75.2%), lack of motivation (74.8%), inadequate skills and knowledge (72.3%), and lack of rewards (71.6%). Good knowledge was significantly associated with taken research methodology course (p. value = 0.001) and qualification (p. values = < 0.05). Positive attitude was significantly associated with workplace and qualification. Nationality (p. value = 0.005) and taking a research methodology course (p. value = 0.001) were significantly associated with good practice.ConclusionAlthough HCPs showed a positive attitude towards medical research, their knowledge and practice were inadequate. They are necessarily needed for amelioration. This improvement can be achieved through effective and regular research methodology courses, workshops, and enhancement of the research environment.

Massachusetts School-Based Health Center Providers' Beliefs and Attitudes About Overdose Prevention

Massachusetts School-Based Health Center Providers' Beliefs and Attitudes About Overdose Prevention

Decrease in provider stigma is associated with improved quality health indicators among individuals receiving methadone in primary care centers in Ukraine.

People who inject drugs experience poor health and social outcomes which improve with opioid agonist therapies like methadone, yet provider stigma may influence healthcare utilization. In Ukraine, integrating methadone into primary care centers (PCCs) provides an opportunity to examine provider stigma and its impact on patient outcomes. This sub-analysis included patients randomized to receive methadone in PCCs as part of an implementation trial in which the control group received methadone in specialty addiction clinics in Ukraine. Methadone integration in PCCs was supported through continuous tele-education for providers. Provider stigma towards people who inject drugs, methadone, and attitudes towards evidence-based practices were assessed at baseline, 12, and 24 months using standardized scales (range 1-10). Patient-level outcomes were measured bi-annually over 24 months using a quality health indicator (QHI) score, a percentage of guideline-concordant primary and specialty health services accessed. Linear mixed-effects models examined the changes in provider stigma and attitudes, and the association of these measures with patient outcomes. The sample included 583 patients and the 112 providers in 24 clinics. Provider fear and stereotypes toward people who inject drugs improved significantly, by 0.6 (95 % CI 0.2-1.1) and 0.4 points (95 % CI 0.1-0.8), respectively, as did preference for methadone over abstinence-based treatment (0.7 points, 95 % CI 0.2-1.1). A 1-point improvement in provider prejudice correlated with a 7.0-point increase (95 % CI: 1.1-13.0) in patient primary care QHI scores at 12 months, while improved attitudes towards evidence-based practices were associated with an 8.3-point increase (95 % CI: 1.1-13.0). Preference for methadone maintenance over abstinence was associated with a 3.7-point increase (95 % CI: 0.6-6.7) in specialty care QHI scores at 12 months, and reduced stereotypes were associated with a 10.9-point increase (95 % CI: 1.2-20.7) at 24 months. Integrating methadone into PCCs with the support of provider tele-education may reduce provider stigma, particularly fear and stereotypes, toward people who inject drugs and methadone maintenance. Reducing provider stigma has the potential to improve patient outcomes through increased access to preventive care and screenings.

Knowledge and attitudes of undergraduate medical students towards palliative Care in Karachi, Pakistan

Background: Palliative care is a critical component of healthcare, especially for patients with life-limiting illnesses. However, the knowledge and attitudes of future healthcare providers, particularly medical students, towards palliative care remain underexplored in low- and middle-income countries like Pakistan. Objective: This study aims to assess the knowledge and attitudes of final-year medical students in Karachi, Pakistan, towards palliative care and explore the association of demographic factors with these perceptions. Methods: A cross-sectional, questionnaire-based study was conducted from July 2022 to July 2023, involving 400 final-year medical students from five universities in Karachi. The participants were selected using a non-probability convenience sampling method. Data were collected through an online questionnaire assessing knowledge and attitudes towards palliative care. The association between demographic factors and students' knowledge and attitudes was analyzed using SPSS version 26. Results: The study population consisted of 70.8% female and 29.3% male students, with 79.3% aged 20-25 years. A majority (53.7%) of participants demonstrated good knowledge of palliative care, while 46.3% had poor knowledge. Attitudinal analysis revealed that 74.7% had a moderate attitude towards palliative care, 24.3% had a favorable attitude, and 1.0% had an unfavorable attitude. Significant associations were found between university type, upbringing, and national origin with both knowledge and attitudes. Students from government universities and those with urban upbringing were more likely to have good knowledge and favorable attitudes. Additionally, gender was significantly associated with attitudes, with females showing more favorable attitudes towards palliative care (p&lt;0.001). Conclusion: The study highlights the need for targeted educational interventions to improve knowledge and attitudes towards palliative care among medical students in Pakistan. The findings suggest that demographic factors play a crucial role in shaping students' perceptions, underscoring the importance of curriculum reforms that address these disparities to prepare future healthcare providers for delivering effective palliative care.

P-1724. Knowledge, Attitude, and Practices (KAP) on Appropriate Antibiotic Use among Healthcare Providers in Qatar - A cross-sectional study

Abstract Background There has been growing awareness of antibiotic resistance as a significant public health issue, notably a widespread prescription of antibiotics for upper respiratory tract infections (URTIs). Understanding the knowledge, attitude, and practices (KAP) of healthcare providers is crucial in designing interventions to reduce inappropriate antibiotics use. Our aim was to determine the KAP of primary care physicians towards antibiotics prescriptions in the outpatient setting to develop strategies to improve appropriate antibiotics use. Physician responses to KAP Survey. Methods We employed a cross-sectional survey to determine the KAP of physicians at 4 Primary Healthcare Centers (PHCCs) in Qatar. The KAP questionnaire was structured into three main sections: evaluating physicians' knowledge regarding Upper Respiratory Infections (URIs) and antibiotics, examining attitudes encompassing beliefs or perspectives on antibiotic usage for URIs, and investigating practices to understand how physicians implement their knowledge and attitudes in their actions. A 5-point Likert scale was used for the questions. Results A total of 141 physicians were surveyed and 96% responded. Nearly 80% were &amp;gt;40 years old, approximately half were women and 69% had ≥10 years of clinical experience. A majority of physicians (97.8%) agreed that inappropriate antibiotic use contributes to the rise of antibiotic resistance, 80.8% expressed disagreement with prescribing antibiotics for fever alone, and 40.4% admitted to experiencing patient pressure to prescribe antibiotics even when unnecessary. Conversely, 13.4% admitted to frequently prescribing antibiotics solely due to patient requests, and 37.6% confirmed encountering patient complaints or patient migration to other doctors if antibiotics were not prescribed. Conclusion Primary care physicians are knowledgeable about the role and risks associated with antibiotics, but frequently felt pressured by the patients/families to prescribe antibiotics. Intervention strategies to educate the public and empower the physicians are needed to address the inappropriate use of antibiotics. Disclosures Adeel A. Butt, MD, MS, Gilead Sciences: Grant/Research Support

P-1685. Knowledge, Attitudes, and Practice of Healthcare Providers Regarding Oral Antibiotic Use in a Health System

Abstract Background Treating infections with oral (PO) antibiotics is associated with reduced risk for catheter associated infections, costs, and length of stay. However, barriers in appropriate transition to PO antibiotics exist. Intravenous versus oral antibiotics by treatment indication The most common treatment indications were pneumonia, cellulitis, bacteremia, and urinary tract infection. A lower proportion of patients with cystitis and bacteremia were transitioned to oral antibiotics compared to other indications. Methods This study aims to understand the knowledge, attitudes, and practice of healthcare providers regarding PO antibiotics. This is a cross-sectional, descriptive survey followed by a multi-center, retrospective chart review. A web-based questionnaire was distributed electronically and promoted during meetings to healthcare providers. The retrospective chart review included admitted adult patients who were administered antibiotics for targeted infections. Patients that were pregnant, incarcerated, had inadequate PO absorption, or lack of source control were excluded. The primary outcome was to identify areas for antimicrobial stewardship intervention. This was done by identifying discordances between provider knowledge or attitudes and prescribing practices. Descriptive statistics and regression analyses were conducted. Results The survey collected 119 total responses from pharmacists (47.1%), physicians (36.1%), medical residents (5.9%), and advanced practice providers (5%). Providers were most comfortable using PO antibiotics for cellulitis (88.2%), cystitis (86.6%), and community acquired pneumonia (82.4%), and were least comfortable using PO antibiotics for osteomyelitis (26.1%), prosthetic joint infection (16.8%), and endocarditis (14.3%). The most common barrier was the concern that PO antibiotics are not as effective (86.6%). The retrospective chart review included 224 patients, of which 164 were transitioned to PO antibiotics at any point. A lower proportion of patients with cystitis (60%) and bacteremia (57.7%) were transitioned to PO. The largest discordance between comfort using PO antibiotics and actual prescribing practices occurred with cystitis. Average duration of intravenous (IV) antibiotics were 4.2 days for pneumonia, 4.2 days for cellulitis, and 3.3 days for cystitis. Conclusion Antimicrobial stewardship initiatives can be targeted at education on oral antibiotic options that have high efficacy, improving IV to PO conversion rates for cystitis, and implementing criteria for early transition to PO antibiotics. Disclosures All Authors: No reported disclosures

P-46. A Comparative Analysis of Vaccine Uptake in Face-to-Face vs. Virtual Care for Active Duty Air Force Members Living with HIV

Abstract Background Military regulation requires US Air Force (USAF) members living with HIV receive Infectious Disease evaluation at the Medical Evaluation Unit (MEU). With a worldwide distribution of the USAF, telehealth utilization began in 2020 with improvements in clinical outcomes and decreased costs. However, not all facets of care are easily amenable to telehealth. We aimed to review differences in vaccination rates since transition from face to face (F) to virtual (V) visits. Methods All USAF active-duty members with incident HIV diagnosis between 2018 and 2023 were included. Only airmen stationed local to the MEU were evaluated F after 2020. Demographic, and clinical information was compiled. Vaccines of interest were selected according to current guidelines: human papilloma virus (HPV), meningococcal ACWY, pneumococcal, recombinant zoster and Mpox vaccines. Vaccine completion rates and time from HIV diagnosis to first vaccine dose was compared between groups. Results All 108 patients were male. Forty-four percent of visits occurred F and 56% were V. Median age was similar, 27 years for F and 26 years for V (p=0.84). Overall, demographics were not significantly different between groups (Table 1). Initial CD4 count was lower among those who received V care (472 vs 567; p=0.01). It took longer for patients to receive their first vaccine dose with V visits compared to F visits (99 vs 3 days; p&amp;lt; 0.01) (Table 2). Likewise, days from HIV diagnosis to first dose of vaccine administration was longer with V visits compared to F (134 vs 36; p&amp;lt; 0.01). Vaccine completion rates varied by type. Pneumococcal and HPV completion rates were higher in the F group compared with V group (p=0.02). Completion rates of the meningococcal ACWY primary series were similarly higher in the V group 92% vs 55%; p=&amp;lt; 0.001). Mpox completion rates were higher with F visits but not statistically significant (8% vs 3%; p=0.4). Recombinant zoster vaccine completion rates were nearly identical (22% vs 23%; p=0.96). Conclusion Vaccination rates were lower and took longer among USAF personnel who underwent V visits compared to F. As healthcare systems increasingly employ telehealth, future studies should investigate provider and patient attitudes on vaccine counseling during V visits to ensure the delivery of high-quality care in the virtual era. Disclosures All Authors: No reported disclosures

Designing and validating an adaptation tool for endometriosis: an exploratory mixed method study protocol

BackgroundEndometriosis is a benign and chronic gynecological estrogen-dependent condition. Research findings have highlighted its impact on different aspects of women's lives. Enhancing quality of life and supporting the well-being of those affected is advised. Yet, none of the conducted studies have taken action toward these objectives. Therefore, the present study will be conducted with the aim of "Designing adaptation tool for endometriosis".Methods/designThe method used in this study is an exploratory mixed-method study. The study will consist of two phases, starting with a qualitative phase followed by a quantitative phase. Upon approval Ethics Code from the endometriosis clinic at Imam Reza Hospital in Mashhad, Iran. The research will involve women of reproductive age diagnosed with endometriosis. In-depth and semi-structured interviews with open-ended questions will be conducted. The research aims to explore the experiences of women with endometriosis in adapting to the condition, utilizing qualitative content analysis with an approach based on the "ROY adaptation model." Sampling will be purposive until data saturation is achieved. Data analysis will follow the suggested steps using Elo Kingas' method and MAXQDA20 software. Tool design will involve an inductive approach (informed by qualitative findings) and a comparative method (based on literature review) to develop and refine tool items.DiscussionThis study is the first to employ a mixed-method approach in developing an adaptation tool for endometriosis. It uncovers underlying issues in the attitudes of patients, medical staff, and healthcare providers, offering insight into factors that can enhance the health and quality of life of affected women. The research findings can inform the creation of a relevant strategy for policymakers, planners, and healthcare professionals to better address the needs of women impacted by endometriosis.Ethical code: IR.MUMS.NURSE.REC.1403.069.

Medication reconciliation: impact of an educational intervention on the knowledge, attitude and practices of healthcare professionals - a prospective quasi-experimental study in a Saudi referral hospital

BackgroundMedication reconciliation has been acknowledged as a key intervention against medication errors. More than half of the medication errors that happen during care transitions are caused by unjustified medication discrepancies and up to one-third of these mistakes may be harmful. The study aimed to evaluate the knowledge, attitude and practices (KAP) of health care providers in on medication reconciliation process, pre and post educational intervention.MethodsA hospital-based prospective quasi-experimental pre-post intervention study was conducted from November 2023 to February 2024 among 346 healthcare professionals (medical doctors, pharmacists and nurses) practicing in King Saud Hospital (KSH), Unayzah, Saudi Arabia. The subjects were recruited using the convenience sampling method.An educational intervention workshop was conducted among the healthcare professionals. The KAP was assessed before and after the educational intervention using a content and face validated self-administered questionnaire. The statistical analyses were conducted using the Statistical Package for Social Sciences (SPSS). Wilcoxon Signed Rank Test was used to differentiate the mean response scores for knowledge, attitude, and practice domains, between pre and post intervention. Kruskal Wallis Test followed by Dunn’s post hoc test was used to compare the mean response scores for knowledge, attitude and practice domains based on educational qualification and practicing experience for the pre and post-test period. The level of significance is determined at P < 0.05.ResultsThere was a significant improvement in the participants’ knowledge, attitude and practice after the educational intervention with mean scores of 0.72 (SD = 1.67, p < 0.0001*), 0.76 (SD = 1.97, p < 0.0001*), and 0.56 (SD = 2.05, p = 0.001*) respectively. The overall KAP scores showed a statistically significant enhancement after the education intervention with a mean score difference of 2.04 (SD = 4.76, p < 0.0001*).Our study upholds that MedRec is highly valued by the participants due to its significant role in reducing medication errors and enhancing patient safety, and that it has the ability to recognize medication discrepancies and reduce adverse drug events.ConclusionThe education intervention effectively influenced the knowledge, attitude and practice of healthcare professionals regarding medication reconciliation. This study underscores the importance of continuous education and training for healthcare professionals to minimize medication discrepancies and improve patient care.

HIV Prevention in Syringe Service Programs Since the Start of COVID-19: Where Do We Go From Here?

This narrative review addresses post-2020, specific, complex challenges for use of and adherence to pre-exposure prophylaxis (PrEP) for HIV prevention among out-of-treatment people who use drugs (PWUD) at syringe services programs (SSPs). The COVID-19 pandemic and its associated changes to the provision of healthcare have significantly impacted HIV prevention, especially for PWUD. Through a synthesis of literature and clinical experience, we (1) characterize the operational changes imposed by the pandemic on SSPs that shaped the current HIV prevention landscape; (2) describe three levels of current challenges for PWUD, including consumer attitudes, non-medical and medical provider attitudes, and structural and scalability barriers; (3) characterize current models for PrEP in SSPs; and (4) offer practical recommendations for HIV prevention in harm reduction programs. PrEP is a highly effective prevention tool if taken as prescribed. It has been enthusiastically promoted by members of the research, public health and provider communities. Despite its efficacy, PWUD struggle to engage with the PrEP care continuum. We highlight opportunities to advance HIV prevention for PWUD by enhancing tailored, whole-person approaches that may set aside PrEP in favor of other risk reduction routes. For most PWUD who receive services at SSPs, PrEP is a single tool and not realistic until other social and structural determinants of health are addressed.

Experiences with Oral Pre-Exposure Prophylaxis (PrEP) Service Delivery and Use Among Adolescent Girls and Young Women (AGYW) in Routine Primary Care Settings, South Africa.

In South Africa, oral PrEP was included in national guidelines as part of a combination HIV prevention package for adolescent girls and young women (AGYW) in 2017. Understanding their experiences of accessing and using PrEP is necessary to evaluate and improve PrEP service delivery approaches. This descriptive study explored AGYW's knowledge and understanding of PrEP, their experiences and influences on PrEP access and use in real world settings in South Africa. We conducted 44 in-depth interviews with female PrEP users (15-24 years) enrolled in Project PrEP. Interviews were audio recorded and transcribed for analysis using thematic analysis procedures. Participants reported positive experiences and overall satisfaction with accessing health services (i.e., youth-friendly clinic spaces, friendly and non-judgemental staff, privacy during consultations). Distance from the clinic, long queues, negative provider attitudes, and occasional stock-outs were key health service barriers to accessing PrEP. Individual motivating factors to continued PrEP use included creating daily pilltaking routines and the goal to remain HIV negative, while barriers included pill fatigue, frequent clinic visits, and side-effects. Positive relationships with partners and family facilitated disclosure of PrEP use, while stigma was identified as a community barrier to accessing PrEP services. Our study highlights AGYWs' experiences with PrEP access and use in a real-world setting. Facilitators and barriers identified in this study can be leveraged to strengthen efforts to support young women and ensure effective PrEP use. The findings also contribute to the development of appropriate service delivery.

A Novel Approach to Assessing the Potential of Electronic Decision Support Systems to Improve the Quality of Antenatal Care in Nepal.

Electronic decision-support systems (EDSSs) aim to improve the quality of antenatal care (ANC) through adherence to evidence-based guidelines. We assessed the potential of the mHealth integrated model of hypertension, diabetes, and ANC EDSS and the World Health Organization EDSS to improve the quality of ANC in primary-level health care facilities in Nepal. From December 2021 to January 2023, we conducted a mixed-methods evaluation in 19 primary-level ANC facilities in Bagmati Province, Nepal. Implementation was from March 2022 to August 2022. We conducted a health facility survey, ANC clinical observations, longitudinal case studies and validation workshop, in-depth interviews, monitoring visits, research team debriefing meetings, health care provider attitude survey, and stakeholder engagement and feedback meetings. Results were integrated using concurrent triangulation to develop explanations about the EDSS implementation process and the effects observed. We identified 9 themes on implementation challenges that hindered the EDSS from generating the desired improvements to ANC quality. Facility readiness and provider confidence in using the EDSS were mixed. It was not always used or used as intended, and the approach to ANC provision did not change. EDSS inflexibility did not reflect how staff made decisions about pregnant women's needs or ensure that tests were done at the right time. There was mixed evidence that ANC staff believed that the EDSS benefited their work. The EDSS did not become fully integrated into existing health systems. Engagement of essential stakeholders fell short. Different understandings of and inconsistent use of the EDSS highlighted the need for increased training and support periods, greater stakeholder engagement, and further integration into existing health systems. Our novel approach to integrating findings from multiple substudies offers uniquely valuable insights into the many factors needed for the successful implementation of an EDSS to improve the quality of ANC in Nepal.

Assessment of provider attitudes and collaborative practices of children on Medicaid

ABSTRACT Collaborative pediatric primary healthcare frameworks effectively address complex needs of clinically involved patients, but understanding and consistent implementation remain challenging. We surveyed 33 providers to assess practices and attitudes toward collaborative management of pediatric Medicaid patients. Over half reported difficulties treating these patients, with over 60% experiencing significant problems connecting them to needed care. Providers routinely screened for an average of four social determinants of health, and 60% regularly referred patients to community-based support or exchanged information with referral partners. Results indicate several barriers, such as communication gaps and lack of patient tracking systems, as preventing collaboration and decreasing patient access to available resources. This study highlights the importance of assessing clinical practice patterns and attitudes as a first step toward effective collaborative healthcare delivery for pediatric Medicaid patients.

Patient and Provider Attitudes Toward Patient-Facing Kidney Organ Offer Reporting

Patient and Provider Attitudes Toward Patient-Facing Kidney Organ Offer Reporting

Patient and Healthcare Provider Perspectives on Showering for Patients With Hemodialysis Central Venous Catheters: A Survey Study.

Patients on hemodialysis using a central venous catheter (CVC) are often advised not to shower due to infection risk. This study aimed to assess practices and attitudes of patients and healthcare providers about showering with CVCs. Survey study. Online survey administered to members of the Canadian Society of Nephrology (CSN, n=972) and two international professional societies (convenience sample). Pen and paper survey administered to patients on maintenance hemodialysis with CVCs able to comprehend English from two hemodialysis programs in Ontario, Canada that advise patients not to shower (St Joseph's Healthcare Hamilton [SJHH], n=119, and University Health Network, Toronto [number of patients asked to complete surveys unavailable]). Descriptive statistics. 304 healthcare provider respondents (CSN response rate 26%). The most common recommendations were strongly against or against showering (45%). Catheter-related bacteremia (CRB) was ranked as the most important outcome (60%). Most respondents (53%) thought that a well conducted prospective cohort study demonstrating improvement in a patient reported outcome with no obvious increase in CRB would reduce the frequency of advice to avoid showering. There were 89 patient respondents (SJHH response rate 45%); 69% were currently showering, and 74% reported "strongly agree" or "agree" to the statement "I want to shower". Prevention of infection was most important to patients in terms of catheter care (78%). 35% of patients would be willing to participate in a shower study. Low response rate. Response rate unavailable from Toronto dialysis units. Exclusion of non-English-speaking patients. There is variability in personal hygiene recommendations to patients with CVCs, highlighting the need for high quality evidence in this area. A rigorous prospective study examining patient-reported outcomes and CVC-related infections is needed prior to recommending to patients with a CVC that showering is safe.

Knowledge, attitude, and practice of beef providers and consumers regarding microbial safety measures along beef supply chain in southwest Ethiopia

Knowledge, attitude, and practice of beef providers and consumers regarding microbial safety measures along beef supply chain in southwest Ethiopia

Knowledge, Attitude and Practices about Provision of Voluntary Medical Male Circumcision Services among Service Providers in Mufumbwe District of North-Western Province

Background: Male circumcision, a surgical removal of the foreskin that covers the penis is identified to be effective towards prevention of Human Immunodeficiency Virus and Sexually transmitted infections among heterosexual partners worldwide. The practice is recommended to be provided by trained personnel traditional or community members, mostly Healthcare practitioners. To provide Voluntary Male Circumcision to a given population requires right knowledge, positive attitude and good practices among the Circumcision providers. Objectives: To assess the Knowledge levels attitude and practices towards provision of medical male circumcision services among service providers in Mufumbwe, district of Northwestern province. Method: This was a Mixed methods study that was conducted from May 2022 to September 2022. Data was collected using semi structured questionnaire. Purposive sampling was applied to one (1) Medical Officer, three (3) Medical licentiate and three HIV Nurse prescribers. Purposive sampling was also be used to select other respondents from one (1) Hospital, five (5) Rural Health Centres and Convenience sampling was used to select respondents from 22 rural health post. Findings: The sample consisted of 91 participants. 12(13.48%) were trained and 77 (86.52%) were not trained form a total of 87 (100.00%) responses. A total of 91 participants knowledge level were recorded and a good score of 60 (65.93%). From a total of 69 non-MC providers, it was found that 63 (91.30%) had positive attitude and the attitude of Mc providers was analysed and found to be 19 (95.00%) positive. And practices that are associated with healthcare practitioners in regard to providing voluntary medical male circumcision services in Mufumbwe district Northwestern province. 6 (33.33%) from 18 responded offered MC in the past 12 months. 18 respondents from 71 respondents who did not know how to circumcise, 13(72.22%) said they refer the clients.

Using Implementation Science to Assess Barriers to Agreement on Sedation Goal Setting and Assessment.

Sedation assessment and goal setting using a validated assessment tool are key components of the ICU Liberation bundle. Appropriate integration of these bundle elements into daily practice remains challenging. Understanding barriers is an important step toward implementation of these best practice bundle elements. Two-phased explanatory mixed methods assessment carried out 2022-2023. Forty-bed quaternary PICU. Bedside nurses and prescribers caring for mechanically ventilated patients on sedative infusions. None. Forty-one nurses and 32 prescribers participated in the phase 1 pre-education assessments (2022). We identified lack of correlation between the providers' stated State Behavioral Scale (SBS) numerical goal and descriptive goal and hypothesized that this discrepancy was either due to a knowledge gap or disagreement on sedation goals. To investigate this hypothesis, we performed a phase 2 assessment (2022-2023), starting with a multipronged educational activity, followed by a repeat survey that included a qualitative interview. One hundred ninety nurses and 45 prescribers received the educational activity. Twenty-eight nurses and 22 prescribers participated in the phase 2 assessments with the qualitative interview. Although correlation of the sedation goal between providers improved, it remained poor. Subsequent qualitative interview data indicated that the reasons for persistent disagreement in the sedation goal for a given patient were related to individual providers' beliefs and attitudes toward sedation, rather than lack of understanding about using the SBS to set a target sedation goal. Barriers to setting and managing daily patient sedation goal in the PICU extend beyond providers' knowledge gaps. An improved understanding of underlying barriers is essential for successful implementation of evidence-based sedation guidelines.

A qualitative study to understand the facilitators of and barriers to retention in care to the national PMTCT Option B+ programme in Uganda.

Effective prevention of mother to child transmission (PMTCT) programmes require women and their infants to have access to a cascade of HIV care and treatment interventions. Retention in care reduces the risk of vertical transmission and opportunistic infections among mothers living with HIV. Uganda has made great strides in ensuring the success of the prevention of mother to child transmission program. Although an increasing number of people living with HIV (PLHIV) in Uganda are benefiting from the rapid scale-up of antiretroviral therapy (ART), retention in HIV care and treatment services remains a major concern. Identifying and understanding the reasons for dropping out of care among mothers enrolled in the Option B+ program among those who were retained and those who dropped out is key to inform policy and program practice. We conducted a qualitative study to understand the facilitators of retention and reasons for loss to follow-up among HIV positive mothers in central Uganda who engaged in the Option B+ program. We conducted 29 focus group discussions (FGDs) with Village Health Teams (VHT) and 'Peer Mothers'. We performed 21 in depth interviews (IDI) with mothers who had been lost to follow up during the post-partum period, and 27 among those who remained in care. These were conducted in 18 districts in Central Uganda. Participants identified barriers and facilitators to retention in HIV care. Barriers included self-stigma and fear of disclosure, mental health challenges, community perceptions, poor health provider attitudes and structural challenges, lack of transportation and food, long waiting time at health facilities and client mobility. Both the clients retained and not retained in care discussed mental illness, feeling sick and competing priorities as barriers. Facilitators for retention in care included adequate community support systems, early initiation on ART, giving birth to HIV negative children and economic stability. These were noted as key enabling factors for retention. It was also highlighted that presence of friendly clinic staff members, scheduling reminders were important aspects of retention. Findings highlighting barriers covering personal, interpersonal, structural and community suggest that developing client-centered models addressing social and community barriers and provide more holistic services is key to retaining mother-infant pairs in care. Emphasis on the use of community health workers and provision of financing, as well as institutionalization of quality improvement would provide alternatives for overcoming barriers to retention in care.

STIGMA AND AGEISM IN THE GERIATRIC EDUCATION CONTEXT: USING PATIENT-CENTERED CARE APPROACHES

Abstract Healthcare professionals remain ill-prepared to meet the unique needs of the aging population. Yet, implementing effective geriatrics educational programming remains challenging across health care disciplines due to low participation rates and uptake. Persistent stigma, ageism, and stereotypes endemic to healthcare, and society at large, contribute to the devaluing of geriatrics content reducing the potential for effective and equitable care for older adults. Geriatric educators are challenged to address the ingrained stigma and ageism among both their learners and healthcare organizations. However, re-imagining geriatrics education to be anchored in a patient-centered care approach, addressing specific, concrete patient needs, has been shown to reduce ageist attitudes and behaviors in the healthcare workforce. Participating in intergenerational activities has also shown a positive impact on health care provider attitudes toward older patients. Furthermore, prioritizing preventive medicine and public health throughout the life course also effectively contributes to postponing the onset of disease and disability among patients. Implementing these basic educational approaches is a pathway to achieving the goal of improved outcomes for patients of all ages.