Awareness Of Services Research Articles

Factors Associated With Utilisation of 4th Postnatal Care among Mothers Seeking Vaccination for Children in Selected Health Facilities in the City of Kigali, Rwanda

Maternal mortality remains a global public health concern. Maternal mortality rate was 211deaths per 100,000 live births in 2017 with sub-Saharan Africa accounting for two third. A strengthened postnatal care can significantly reduce this unacceptable mortality. This study aims at assessing the factors associated with the utilization of 4th postnatal care services among mothers seeking vaccination for their children in selected health centers located in the city of Kigali. A cross-sectional study design was conducted in 10 health centers and 403 mothers were recruited. Data was collected using an interview-administered questionnaire, Chi-square and multivariate analysis were used to examine the relationship between independent variables and PNC4 attendance. Mothers who participated in the study (56.7%) were between the ages of 26 and 35, 47.6% were cohabiting, and 49.6% had completed secondary and TVET school. The attendance of PNC4 was 27%. PNC4 service awareness (AOR = 10.922, 95% CI: 5.869-20.325, P 0.001), ANC attendance (AOR = 2.334, 95% CI, 1.050-5.188, P = 0.038), and religion belief (AOR=0.338, 95% CI, 0.177-0.645, P=0.001) were significantly associated with PNC4 attendance. The utilisation of PNC4 is still low. PNC4 should be strengthened to ensure the well-being of the mothers and children. Keywords: Postnatal care, Vaccination for Children, utilization, Selected Health facilities, Kigali, Rwanda

Effects of a clinic-based reproductive empowerment intervention on proximal outcomes of contraceptive use, self-efficacy, attitudes, and awareness and use of survivor services: a cluster-controlled trial in Nairobi, Kenya

This study was undertaken to evaluate the effect of a reproductive empowerment contraceptive counselling intervention (ARCHES) adapted to private clinics in Nairobi, Kenya on proximal outcomes of contraceptive use and covert use, self-efficacy, awareness and use of intimate partner violence (IPV) survivor services, and attitudes justifying reproductive coercion (RC) and IPV. We conducted a cluster-controlled trial among female family planning patients (N = 659) in six private clinics non-randomly assigned to ARCHES or control in and around Nairobi, Kenya. Patients completed interviews immediately before (baseline) and after (exit) treatment and at three- and six-month follow-up. We use inverse probability by treatment weighting (IPTW) applied to difference-in-differences marginal structural models to estimate the treatment effect using a modified intent-to-treat approach. After IPTW, women receiving ARCHES contraceptive counselling, relative to controls, were more likely to receive a contraceptive method at exit (86% vs. 75%, p < 0.001) and had a significantly greater relative increase in awareness of IPV services at from baseline to three- (beta 0.84, 95% CI 0.13, 1.55) and six-month follow-up (beta 0.92, 95% CI 0, 1.84) and a relative decrease in attitudes justifying RC from baseline to six-month follow-up (beta −0.34, 95% CI −0.65, −0.04). In the first evaluation of a clinic-based approach to address both RC and IPV in a low- or middle-income country (LMIC) context, we found evidence that ARCHES contraceptive counselling improved proximal outcomes related to contraceptive use and coping with RC and IPV. We recommend further study and refinement of this approach in Kenya and other LMICs. Plain Language Summary Reproductive coercion (RC) and intimate partner violence (IPV) are two forms of gender-based violence that are known to harm women’s reproductive health. While one intervention, ARCHES – Addressing Reproductive Coercion in Health Settings, has shown promise to improve contraceptive use and help women cope with RC and IPV in the United States, no approach has been proven effective in a low- or middle-income country (LMIC) context. In the first evaluation of a reproductive empowerment contraceptive counselling intervention in an LMIC setting, we found that ARCHES contraceptive counselling, relative to standard contraceptive counselling, improved proximal outcomes on contraceptive uptake, covert contraceptive use, awareness of local violence survives, and reduced attitudes justifying RC among women seeking contraceptive services in Nairobi, Kenya. Distal outcomes will be reported separately. Findings from this study support the promise of addressing RC and IPV within routine contraceptive counselling in Kenya on women’s proximal outcomes related to contraceptive use and coping with violence and coercion and should be used to inform the further study of this approach in Kenya and other LMICs.

Perspectives of VA healthcare from rural women veterans not enrolled in or using VA healthcare.

Women Veterans have unique healthcare needs and often experience comorbid health conditions. Despite this, many women Veterans are not enrolled in the Veterans Health Administration (VHA) and do not use VHA services. Underutilization of VHA services may be particularly prevalent among rural women Veterans, who may experience unique barriers to using VHA care. Nonetheless, knowledge of rural women Veterans and their experiences remains limited. We sought to understand rural women Veterans' perceptions and needs related to VHA healthcare, including barriers to enrolling in and using VHA services, and perspectives on how to communicate with rural women Veterans about VHA services. Rural women Veterans were recruited through community engagement with established partners and a mass mailing to rural women Veterans not enrolled in or using VHA healthcare. Ten virtual focus groups were conducted with a total of twenty-nine rural women Veterans (27 not enrolled in VHA care and 2 who had not used VHA care in the past 5 years) in 2021. A thematic inductive analytic approach was used to analyze focus group transcripts. Primary themes regarding rural women Veterans' perceptions of barriers to enrollment and use of VHA healthcare included: (1) poor communication about eligibility and the process of enrollment; (2) belief that VHA does not offer sufficient women's healthcare services; and (3) inconvenience of accessing VHA facilities. Although VHA has substantially expanded healthcare services for women Veterans, awareness of such services and the nuances of eligibility and enrollment remains an impediment to enrolling in and using VHA healthcare among rural women Veterans. Recommended strategies include targeted communication with rural women Veterans not enrolled in VHA care to increase their awareness of the enrollment process, eligibility, and expansion of women's healthcare services. Creative strategies to address access and transportation barriers in rural locations are also needed.

Counseling and support services for healthcare workers in German university hospitals during the pandemic-descriptive results of a Germany-wide cross-sectional survey.

Due to the SARS-CoV-2 pandemic, healthcare workers (HCWs) are experiencing tremendous levels of emotional and physical stress. Hospitals are trying to help personnel cope with work-related pressure. The aim of this study was to assess HCWs' awareness and utilization of counseling and support services during the pandemic, HCWs' unmet counseling and support needs, and the type and content of these services. A cross-sectional online survey was conducted from January to June 2021 through the German national research organization Network University Medicine (NUM). All participating hospitals (6 in total) were asked to inform their employees about the study. A total of 1,495 HCWs were included in the analysis. Of these, 42.8% (n = 637) were frontline HCWs (who had contact with COVID-19 patients), 23.1% (n = 344) were second-line HCWs (who only had contact with non-COVID-19 patients) and 34.1% (n = 508) had no contact with any patients. Participating hospitals offer various counseling and support services for their staff. The percentage of respondents who were unaware of available counseling and support services ranged from 5.0 to 42.0%. Depending on the type of counseling and support services, 23.0-53.6% of the respondents indicated that counseling and support services were provided but not used, while 1.7-11.6% indicated that, despite the need for them, such services were not available. HCWs' overall satisfaction with the provided counseling and support services and their unmet support needs differed by patient contact: Frontline HCWs reported more unmet needs for counseling and support than second-line HCWs, while second-line HCWs reported more unmet needs than HCWs without patient contact. The results indicate that hospitals should make more efforts to inform HCWs about available counseling and support services. Hospitals could also create networks where HCWs could share information about the type and content of services and their experiences with various counseling and support services. These steps would enable hospitals to respond more quickly and effectively to the problems facing HCWs during pandemics.

Similarities between friends on service, activism, and awareness of inequities in an adolescent social network.

This brief report characterizes the tendency of adolescent friends to be similar on civic behaviors and critical consciousness. Using two waves of network data from a high school that serves primarily low-income Latiné youth (2019, N = 519; 2020, N = 521), the present study examined homophily on service, activism, and awareness of inequities. The results of Exponential Random Graph Models indicated that adolescents tended to be friends with peers who had similar service behavior and awareness of inequities, but not activism. The findings suggest that schools could foster civic engagement by providing infrastructure that encourages civic interactions between peers. The current study highlights the potential that social network analysis holds for generating novel insights into the relational underpinnings of youth civic engagement.

The burden of acute eye conditions on different healthcare providers: a retrospective population-based study.

The demand for acute eyecare exponentially outstrips capacity. The public lacks awareness of community eyecare services. To quantify the burden of acute eyecare on different healthcare service providers in a national population through prescribing and medicines provision by GPs, optometrists, and pharmacists, and provision of care by accident and emergency (A&E) services. A secondary aim was to characterise some of the drivers of this burden. A retrospective data-linkage study set in Wales, UK. Analysis of datasets was undertaken from the Secure Anonymised Information Linkage Databank (GP and A&E), the Eye Health Examination Wales service (optometry), and the Common Ailments Scheme (pharmacy) during 2017-2018. A total of 173 999 acute eyecare episodes delivered by GPs (168 877 episodes) and A&E services (5122) were identified during the study. This resulted in 65.4 episodes of care per 1000 people per year. GPs prescribed a total of 87 973 653 prescriptions within the general population. Of these, 820 693 were related to acute eyecare, resulting in a prescribing rate of 0.9%. A total of 5122 eye-related and 905 224 general A&E attendances were identified, respectively, resulting in an A&E attendance rate of 0.6%. Optometrists and pharmacists managed 51.8% (116 868) and 0.6% (2635) of all episodes, respectively. Older females and infants of both sexes were more likely to use GP prescribing services, while adolescent and middle-aged males were more likely to visit A&E. GP prescribing burden was driven partially by economic deprivation, access to services, and health score. Season, day of the week, and time of day were predictors of burden in GP and A&E. Acute eyecare continues to place considerable burden on GP and A&E services in Wales, particularly in urban areas with greater economic deprivation and lower overall health. This is likely to increase with a rapidly ageing population. With ongoing pathway development to better utilise optometry and pharmacy, and improved public awareness, there may be scope to change this trajectory.

An Assessment of Consumer Awareness and Coverage of Digital Television Services in Uganda

The research examined the relationship between consumer awareness and coverage of digital TV services in Uganda. The study utilised an appropriate study design help gather data. survey tools and interviews guides helped gather information from people who owned television sets. Analysis of data involved describing, correlations and regressions. Research findings concludes consumer awareness predicts Coverage of Digital TV Services. It is recommended that there is need for revision of the current policy objective 4 a) so that it can cater for new media like social media to promote consumer awareness. The means of disseminating consumer awareness need to be diversified. Government should compel all content providers to create space in their programming for consumer awareness.

Smart Parking System for Green Computing

A “smart city” is one that makes use of info and comm technologies (ICTs) to increase the awareness, interaction, and effectiveness of city services and monitoring. It might be smart technology, smart design, smart mobility, smart utilities, smart housing, smart healthcare, smart transportation, smart lighting, smart phone detection, smart road, smart traffic management, and smart parking etc. The solicitation of smart cities will increase unexpectedly with the rapid increase in IoT infrastructure. Smart city idea notably going up to city lifecycle. The focal point of this paper is to present an intelligent parking system consuming a novel iOS app-based implementation for smart cities’ demands, which permits a driver to determine a parking lot and a vacant slot in that lot indoor a municipality. This paper additionally focuses on reducing the searching time for determining the parking lot using our proposed method, namely, the booking method. This, in short, lessens the gasoline deployment which in turn cuts carbon trails in the weather, as a way of life, additionally averting useless traveling via packed parking lots in a parking lot that can be useful in decreasing illegal parking and in a way help with the traffic jams we see in our city.

Introducing Telemedicine in Italy: Citizens' Awareness of a New Healthcare Resource.

In recent years, especially during the COVID-19 pandemic, new technologies have emerged as useful resources in healthcare. Telemedicine services may decrease opportunities for contagion by limiting direct medical contacts; they can lead to greater access to and better quality of care, especially for the elderly and chronically ill patients. However, there are still some difficulties in their widespread use, such as lack of knowledge about the effectiveness and safety of telemedicine; lack of awareness of its existence; privacy issues; and lack of computer literacy. The aim of this study is to assess the awareness of and attitude toward telemedicine in the Italian adult population, considering sociodemographic characteristics and territorial differences in telemedicine service implementation. A questionnaire was administered to Italian citizens from October 2022 to February 2023 using communication and social media in order to collect sociodemographic and health characteristics and data on awareness and use of telemedicine services. Less than half of the respondents (n = 1002) were aware of telemedicine services in their region; most of them did not use the available services due to a preference for in-person visits or lack of need. More than 90% of participants who used these services were satisfied with them. A negative attitude toward telemedicine was found in a higher proportion of older adults. This study demonstrated that, although telemedicine services are active in Italy, a large part of the population ignores its availability. Therefore, further efforts should be made to increase citizens' awareness and the use of telemedicine in our country.

Attitudes and Perceptions of Postgraduate Medical Trainees towards the Library User Education (LUE) Programme

Library user education aims to make library users proficient in research and lifelong learners. The impact of library user education extends beyond the classroom and orientation, allowing users to engage themselves and effectively identify, access, retrieve, and use library information resources to their advantage. It also raises awareness of the library's available information resources.The Postgraduate Institute of Medicine (PGIM) library at the University of Colombo has identified the importance of acquiring user perceptions through user education programmes. This study aimed to assess postgraduate trainees' perceptions and investigate the impact of the user education programme conducted by the PGIM library. The library user education programmes considered in this study are the PGIM library resources and services, which include the library digital repository, literature review, E-Resources, avoid in gplagiarism and managing references. The survey research design was used for the study, while the questionnaire instrument was used for data collection.The study population comprises all users participated for the library user education programme in 2020 -2021. The study found out that the user education programme had positively affected the postgraduate trainees' use of the library and academic performance. Awareness, accessibility, and utilisation of library services and resources impact the library user education programme.The study also emphasised the significance of ongoing library user education programmes in developing research skills among medical students in order for them to develop medical information retrieval, supporting research work and other findings provided to medical trainees, which supports their professional life.

Analisis Faktor Yang Mempengaruhi Kepatuhan Wajib Pajak UMKM dalam Melaksanakan Kewajiban Perpajakan pada Masa New Normal UMKM di Kecamatan Pedurungan

The country's economy is the same as the household economy which recognizes sources of income and expenditure items. One source of state revenue is tax which is a very important income for the implementation and improvement of national development. Realizing this, the government always promotes the importance of taxes for national development. This study aims to examine the effect of Taxpayer Awareness, Knowledge and Understanding of Tax Regulations, Tax Sanctions, and Fiscal Services on taxpayers. There are several factors that influence MSME taxpayer compliance. These factors include taxpayer awareness, knowledge and understanding of taxpayers, tax sanctions, and tax authorities services. Taxpayer awareness is one of the most important factors influencing the level of taxpayer compliance. The object of research is a research target that explains what and or who will be the object of research. The object in this study is the MSME taxpayer. The analytical tool used in this study is regression. The model test performed includes the F test, namely the overall (simultaneous) test and the coefficient of determination, while the t test is used for partial testing. Based on the test results show that the Taxpayer has no effect on Taxpayer Compliance. Knowledge and Understanding of Tax Regulations has a positive and significant effect on Taxpayer Compliance. Tax sanctions have a positive and significant effect on taxpayer compliance. Fiscal Services have no effect on Taxpayer Compliance.

What do rural young people want from their mental health service.

Rural young people have high rates of mental illness and low rates of help-seeking making it crucial to extend research about service improvement in rural and remote Australia. To describe what rural young people want from their headspace service, and what rural headspace clinicians understand they provide. This study used a qualitative methodology with reflexive thematic analysis to analyse participant interviews and systematically derive common themes. Thirteen participants were interviewed comprising young people aged 16 to 18 years who had accessed one of three rural headspace services, together with clinicians working in those services. Key themes for both young people and clinicians comprised accessibility, flexibility, engagement, safety, youth-focus, and evidence-based treatment although there were some differences of emphasis amongst themes. There was also an additional theme for young people of awareness, and for clinicians of caring. The results supported that what young people were seeking was largely consistent with what headspace clinicians were providing. There were however some specific issues relevant to service provision in a rural context such as increased awareness of services, the need to focus on evidenced based interventions, and better promotion in schools and the local community. Service gaps such as unmet needs for young people with higher risk who might fall outside of agency requirements were also identified. Results of this study help inform better service delivery and increased awareness for mental health of young people in rural communities to improve access and outcomes.

Perceptions of Primary Care Providers on Public Health Services in Primary Care in Oman: A Qualitative Study.

Background The integration of public health functions in primary care is not well-defined in the literature. This paper examines the perceptions of healthcare workers on public health services in primary care, as well as the challenges and views on strengthening the integration of public health functions in a primary care setting in Oman. Methodology This qualitative study (employing a face-to-face interview) was conducted in a primary healthcare setting in Muscat from January 1, 2022, to May 31, 2022. This study is based on interpretative phenomenological analysis using purposeful sampling. Participants were interviewed to answer the study questions. The targeted participants included directors and other official personnel, physicians, nurses, pharmacists, nutritionists, health educators, and lab technicians. Verbal consent was obtained from the participants before the interview, and all responses were anonymously audio recorded, transcribed verbatim, and analyzed using thematic analysis. Results A total of 10 primary care providers were interviewed once for 30 minutes over a two-week period. All participants were females apart from one male participant. The study included three physicians, five nurses, one pharmacist, and one nutritionist. All participants had over 10 years of experience as primary care providers at the time of the interview. The main themes were a lack of awareness of public health services in a primary care setting, challenges to practicing public health in a primary care setting, and recommendations to strengthen the integration of public health services in primary care. In general, there were inconsistent views on public health services in a primary care setting, and the interactions between the functions were not clear. Participants reported an absence of clear guidelines, training, and competencies for public health in a primary care setting. Building public health capacities and reforming the health system were highly recommended to integrate public health into primary health care. Conclusions Understanding how public health and primary care interact is crucial to improve population health. Building competencies and supportive health systems are required for the effective integration of public health in primary care settings.

Trend Comparison Of Bank Sustainable Financial Statements Based On Assessment Of Economic Aspects, Environmental Aspects, And Social Aspects

The acceleration of unbalanced economic development has an impact on environmental damage and social inequality. This article aims to find out how the trend of comparing sustainable financial statements in banks is based on assessments from economic aspects, environmental aspects, and social aspects. This sustainable financial report is the first time it has been applied to financial service institutions that have been determined based on the regulatory policies of the Indonesian Financial Services Authority. descriptive quantitative is used as a method that helps researchers in conducting research with trend analysis of sustainable financial statements comparison in banking from 2020-2021, at the bank that won the Annual Report Award in the Category of Listed Financial Banking. Research results based shows that economic, social, and environmental damage can be overcome with awareness by each bank in providing financing to consumers who care about these three aspects. This sustainable financial report is so that it can be used by the company as a policy improvement on the awareness of the financial services industry to apply from economic, environmental, and social aspects

Non-Consensual Sex and Help-Seeking Behavior Among PrEP Users in Belgium: Findings from an Online Survey

ABSTRACT Non-consensual sex poses a threat not only to sexual health but also to mental and physical health in general. HIV pre-exposure prophylaxis (PrEP) users might be particularly vulnerable to non-consensual sex because of interplaying factors such as mental health disorders, a high number of sex partners, engagement in chemsex, and the widespread use of dating apps. The objectives of this study were to assess the occurrence of non-consensual sex, its associated factors, and related help-seeking behavior among PrEP users. We analyzed data from an online survey among PrEP users in Belgium (09/2020-02/2022). Almost one in five participants (34/187, 18.2%) reported having ever experienced non-consensual sex. The most reported form was having sex against one’s will, followed by having been given drugs against one’s will, and having had sex without a condom against one’s will. The vast majority of those who had experienced non-consensual sex (29/34, 85.3%) did not seek help afterward, mostly due to a lack of perceived need (21/29, 72.4%). Reported barriers to seeking help were shame (6/29, 20.7%) and lack of awareness of help services (3/29, 10.3%). Having experienced non-consensual sex in the past five years was associated with younger age and suicidal ideation in a multivariable logistic regression model. We conclude that addressing barriers to non-consensual sex help services is crucial to maximize their use and minimize the consequences of non-consensual sex experiences. PrEP consultations also represent an opportunity to offer such help given PrEP users are already familiar with these PrEP services and engaged in care.

Strategy For Increasing The Competence and Capability of Financial Literacy of MSMEs

In its efforts to promote financial inclusivity, the Indonesian government has set a goal of achieving a 75% inclusion rate by 2019. However, as accessibility to formal financial services becomes more convenient for the general population, the risks within the financial industry also escalate. Unfortunately, ordinary individuals are ill-prepared for these circumstances as their understanding of financial products remains limited. The primary issues at hand are twofold: firstly, the lack of financial literacy among micro, small, and medium enterprises (MSMEs) and housewives in Indonesia, and secondly, the need for effective strategies to enhance financial literacy among MSMEs and housewives specifically in UMKM Azalea, located in West Jakarta. PKM aims to deliver training, knowledge, and solutions while offering capital resources. The research methodology employed is a descriptive qualitative approach. The outcomes of PKM reveal that there is a significant deficiency in financial literacy among Azlea MSMEs and households, with only 50% possessing adequate knowledge. Strategies for enhancing competency and capability encompass various aspects, including: a) fostering awareness and understanding of diverse financial products and services, b) comprehending the risks associated with financial products, c) ensuring customer protection, and d) cultivating skills in financial management.

THE SIGNIFICANCE OF FINANCIAL LITERACY FOR CONSUMER PROTECTION: A STUDY OF BANK CUSTOMERS IN DAKSHINA KANNADA DISTRICT

Awareness of available financial services from formal financial institutions is essential. Creating awareness for customers on products and services of financial institutions is called financial literacy. The term financial literacy was used when the financial inclusion concept emerged in the year 2005. Even though having a good number of banks and banking institutions, most of the people in India were excluded from formal financial services because of a lack of awareness and financial literacy. They depend upon money lenders where they get money when they needed and not had more formalities to access their monetary needs. People need to be given knowledge of formal banking facilities and brought them into formal banking penetration (Dsouza S. 2017). Financial literacy is not only creating awareness on available banking services, it also creates awareness of consumer rights and responsibilities. This paper is to study……… This paper analyses financial literacy among consumers and also examine the impact of financial literacy on consumer protection. A random sample of 106 customers was chosen as the respondents for the study. A self-administered questionnaire was used for the collection of primary data and distributed to the random samples. The result shows that most of the respondents are unaware of the grievance redressal system exists for banking customers. The study also explains the problems faced by consumers, awareness level on consumer rights, and available banking services. KEYWORDS: Financial Literacy, Banking Products and Services, Consumer Rights and Protection

Graduate Student Library Needs at Memorial University of Newfoundland: A Case Study

Libraries are important structures for graduate students in research intensive universities, such as Memorial University of Newfoundland (MUN). Given the complex needs of those students, it is crucial to have an updated glimpse into what works and does not work for students. The objectives of this survey were to investigate graduate students’ awareness and use of library services and resources at MUN and to explore how important and adequate existing services and resources seemed to MUN graduate students. Fortunately, the survey findings showed favourably in terms of user satisfaction, with many of the library services and resources that were rated as very important also being rated as very satisfactory. Other findings indicated that respondents placed increased importance on access to comprehensive collections of E-resources, which is not surprising given the conditions of the COVID-19 pandemic. Also found was an increased need for writing resources and literature search strategies. Overall, a recurring theme for improvement was an increased promotion of our services and resources so that we can better reach our students. The insights gained from the survey will help us target this area of improvement and direct future development of graduate student-focused services and resources.

Examining Utilization of Formal Supports and Related Impacts on Overall Well-Being Among East Asian American Family Caregivers of Persons With Dementia: A Mixed-Methods Study.

Although East Asian American family caregivers are known to underutilize formal support services, there is a lack of evidence regarding the associations of formal service utilization with caregivers' well-being. This study examined the prevalence of different types of home-and community-based formal service utilization among Korean and Chinese American family caregivers of persons with dementia and how utilization of such services was associated with their well-being. We also explored their overall experience in accessing and utilizing formal dementia support services and programs. We employed a convergent mixed-methods study design. In a convenience sampling method, we recruited 62 family caregivers. Logistic regression and thematic analysis were utilized to analyze data. The results showed in-home services were mostly utilized among family caregivers of these ethnic groups. Out of 9 different support services, those who utilized nutrition programs and case management were more likely to report higher overall well-being. Four themes were developed: (1) awareness of formal support services but uncertainty on how to access them, (2) language barriers imposing additional challenges in accessing formal support services, (3) traveling to access culturally appropriate services, and (4) desire for culturally tailored medical and long-term care services. Findings from this study suggest the importance of case management services to overcome barriers to accessing and utilizing a wide range of formal support services and provision of culturally appropriate food in formal support services to increase East Asian American family caregivers' utilization of long-term care services.

Stakeholders' Initial Experience With Telemedicine Services Introduced at 13 Government Medical Colleges in Uttar Pradesh, India During the COVID-19 Lockdown: A Qualitative Study.

India went into a stringent lockdown in response to the coronavirus disease 2019 (COVID-19) pandemic in March 2020, and routine outpatient and elective health services were suspended. Thus, access to healthcare services got significantly disrupted. To mitigate the impact, 21 state-owned medical colleges in Uttar Pradesh, the most populous and among the most resource-constrained states in India, had to hastily launch telemedicine (TM) services. This created an opportunity to understand how stakeholders would react to suchservices and what initial challenges could be faced during service delivery. Through this study, we explored the experiences of stakeholders from 13 such "new-adopter" TM centres with the main objective to identify the perceived benefits and gaps related to TM services, and what "people-centric" TM services could look like going forward. We used an exploratory-descriptive qualitative design with a constructivist paradigm. Using interview schedules with open-ended questions and unstructuredprobes, we interviewed 13 nodal officers, 20 doctors, and 20 patients (i.e., one nodal officer and one to two doctors and patients from each of the 13 new-adopter centres) and stopped thereafter since we reached saturation of information. We analysed the data on NVivo (QSR International,Burlington, MA) and reported the findings using the ConsolidatedCriteriaforReportingQualitativeResearch (COREQ) checklist. The perceived benefits that were reported included non-dependency on physical contact, economic benefit, better management of patient load, and ease of access to healthcare services. The common gaps identified in the TM services were lack of physical clinical examination, impeded communication due to lack of face-to-face interaction, technological challenges (e.g., inconsistent internet connectivity and unavailability of smartphones), lack of human resources and resources to manage the TM centres, cumbersome compliance requirements coupled with unclarity on medico-legal implications, and limited awareness of services among clients. Need for adequate promotion of TM services through information-education-communication efforts and frontline workers, strengthening of logistics for long-term sustainability, setting up a dedicated TM department at the hospitals, capacity building of the existing staff, reducing gaps in communication between doctors and patients for better consultation, and improved access to the prescribed medicines were some of the suggestions from different stakeholders. The stakeholders clearly appreciated the benefits of TM services offered through the new-adopter centres amidst the pandemic disruptions. However, there were certain gaps and unmet expectations, which, if addressed, could improve the TM centres' performance with further people-centricity and enhance healthcare access and the popularity of system-based services. Avenues for sustaining the TM services and their efficient scale-up should be explored.