Access Barriers Research Articles

Facilitators and barriers to contraception access and use for Hispanic American adolescent women: An integrative literature review.

Hispanic American adolescents experience high rates of pregnancy with profound consequences. Compared with White teens, Hispanic teens use contraception less frequently and often choose less effective forms of contraception. Access to contraception is a primary barrier to use which contributes to relatively high and disparate rates of pregnancy in Hispanic teens. This integrative review identifies facilitators and barriers of contraception access and use for Hispanic women, 13-17 years of age, living in the U.S. Following the Whittemore and Knafl (2005) methodology and PRISMA guidelines, peer reviewed studies were retrieved from PUBMED, CINAHL and EMBASE. The Mixed Methods Appraisal Tool was used to assess the study quality and thematic analysis was used to categorize barriers and facilitators. Of 131 studies retrieved, 16 met inclusion criteria. Individual, interpersonal and healthcare provider factors were identified as primary categories of barriers and facilitators with structural issues comprising an additional barrier category. Individual level barriers were disproportionately represented and further categorized into themes: beliefs/misconceptions, dislike of contraception, pregnancy risk perception, lack of knowledge, and lack of control. Barriers related to cultural and religious influences were identified in individual, interpersonal and structural levels. The most frequently reported facilitators were perceived parent comfort discussing sexual health and past experience of pregnancy. Limitations in this review may stem from heterogeneity in the acculturation and geography of participants and analysis by a single reviewer. Implications include considering the range of information sources and the influence they have on risk perception and risk mitigation for this population. Adolescents describe many modifiable influences on contraception access and use. Misperceptions related to contraception, stemming from beliefs and perceptions, can be corrected through increased access to reliable sources of sex education, parental support, and direct access to nurses and healthcare providers. Awareness of these influences can inform further research and intervention development to address these health disparities.

A systematic review of public health interventions to address breast cancer inequalities in low- and middle-income countries

BackgroundBreast cancer is the most diagnosed cancer in the world, with a worse prognosis documented in low- and middle-income countries. Inequalities pertaining to breast cancer outcomes are observed at within-country level, with demographics and socioeconomic status as major drivers.AimThis review aims to aggregate all available evidence from low- and middle-income countries on public health interventions that can be utilized to reduce breast cancer inequalities within the breast cancer continuum.MethodsThe study was a systematic review and narrative synthesis of available literature, with the literature search conducted between September and October 2021. The search was re-run in September 2022 to update the review. PubMed, Scopus, Embase, African Index Medicus and LILACS were searched, based on predetermined criteria. Randomized controlled trials, cohort studies and quasi-experimental studies were included for review, while studies without an intervention and comparator group were excluded. The Joanna Briggs Institute family of checklists was used for quality assessment of the included studies. Data pertaining to study design, quality control and intervention effectiveness was extracted.ResultsA total of 915 studies were identified for screening and 21 studies met the selection criteria. Only one study specifically evaluated the impact of an intervention on breast cancer inequalities. Diverse, multi-level interventions that can be utilized to address breast cancer inequalities through targeted application to disadvantaged subpopulations were identified. Educational interventions were found to be effective in improving screening rates, downstaging through early presentation as well as improving time to diagnosis. Interventions aimed at subsidizing or eliminating screening payments resulted in improved screening rates. Patient navigation was highlighted to be effective in improving outcomes throughout the breast cancer continuum.ConclusionFindings from the systematic review underline the importance of early detection in breast cancer management for low- and middle-income countries. This can be achieved through a variety of interventions, including population education, and addressing access barriers to public health services such as screening, particularly among under-served populations. This study provides a comprehensive database of public health interventions relevant to low- and middle-income countries that can be utilized for planning and decision-making purposes. Findings from the review highlight an important research gap in primary studies on interventions aimed at reducing breast cancer inequalities in low- and middle-income countries.Systematic review registrationPROSPERO registration number: CRD42021289643.

Boundaryless Access: Lowering Barriers of Access to Advanced Microscopy Facilities

Boundaryless Access: Lowering Barriers of Access to Advanced Microscopy Facilities

Influential Factors Affecting the Intention to Utilize Advance Care Plans (ACPs) in Thailand and Indonesia

Demographic shifts resulting from population aging are evident globally, including in Southeast Asia, Thailand, and Indonesia. The relevance of advance care plans is becoming increasingly apparent as the worldwide demographic transforms due to aging. This study sought to investigate the factors influencing the use and implementation of advance care plans (ACPs) using the health belief model (HBM) and technology acceptance model (TAM). This study selected a sample of individuals aged 30–60 in Indonesia and Thailand based on established inclusion and exclusion criteria. The study utilized the purposive random sampling method, integrating aspects of purposive and random selection. A total of 532 questionnaires were distributed via an online form, and 472 were obtained after data cleaning. Most respondents to this survey came from Indonesia, comprising 238 out of 472 respondents (50.4%), and from Thailand, comprising 49.5%; most respondents were women who were between 36 and 40 years old, and most reported graduating with a bachelor’s degree. A significant construct influences the use of advance care plans, i.e., perceived barriers. The perceived barrier (PBA) construct included data security, accessibility, and language barriers. In summary, overcoming existing barriers can indirectly increase the benefits of advance care plans. The results show that perceived usefulness (β = 0.189, p < 0.001), perceived ease of use (β = 0.150, p < 0.01), perceived susceptibility (β = 0.153, p < 0.01), perceived severity (β = 0.105, p < 0.05), and perceived benefits (β = 0.241, p < 0.001) all had significant positive effects on behavioral intention. In contrast, health motivation (β = 0.073, p = 0.100) and perceived barriers (β = 0.034, p = 0.134) did not show significant relationships with behavioral intention in Indonesia and Thailand, offering insights into both countries’ development strategies and the promotion of advance care plans with media as the technology.

Feasibility and Preliminary Effects of a Social Media-Based Peer-Group Mobile Messaging Smoking Cessation Intervention Among Chinese Immigrants who Smoke: Pilot Randomized Controlled Trial.

Chinese immigrants experience significant disparities in tobacco use. Culturally adapted tobacco treatments targeting this population are sparse and the use is low. The low use of these treatment programs is attributed to their exclusive focus on individuals who are ready to quit and the wide range of barriers that Chinese immigrants face to access these programs. To support Chinese immigrant smokers at all levels of readiness to quit and address their access barriers, we developed the WeChat Quit Coach, a culturally and linguistically appropriate WeChat (Tencent Holdings Limited)-based peer group mobile messaging smoking cessation intervention. This study aims to assess the feasibility, acceptability, and preliminary effects of WeChat Quit Coach. We enrolled a total of 60 Chinese immigrant smokers in 2022 in New York City for a pilot randomized controlled trial (RCT) and a single-arm pilot test. The first 40 participants were randomized to either the intervention arm (WeChat Quit Coach) or the control arm (self-help print material) using 1:1 block randomization stratified by sex. WeChat Quit Coach lasted 6 weeks, featuring small peer groups moderated by a coach, daily text messages with text questions, and chat-based instant messaging support from the coach in response to peer questions. The next 20 participants were enrolled in the single-arm pilot test to further assess intervention feasibility and acceptability. All 60 participants were offered a 4-week supply of complimentary nicotine replacement therapy. Surveys were administered at baseline and 6 weeks, with participants in the pilot RCT completing an additional survey at 6 months and biochemical verification of abstinence at both follow-ups. Of 74 individuals screened, 68 (92%) were eligible and 60 (88%) were enrolled. The majority of participants, with a mean age of 42.5 (SD 13.8) years, were male (49/60, 82%) and not ready to quit, with 70% (42/60) in the precontemplation or contemplation stage at the time of enrollment. The pilot RCT had follow-up rates of 98% (39/40) at 6 weeks and 93% (37/40) at 6 months, while the single-arm test achieved 100% follow-up at 6 weeks. On average, participants responded to daily text questions for 25.1 days over the 42-day intervention period and 23% (9/40) used the chat-based instant messaging support. Most participants were satisfied with WeChat Quit Coach (36/39, 92%) and would recommend it to others (32/39, 82%). At 6 months, self-reported 7-day point prevalence abstinence rates were 25% (5/20) in the intervention arm and 15% (3/20) in the control arm, with biochemically verified abstinence rates of 25% (5/20) and 5% (1/20), respectively. WeChat Quit Coach was feasible and well-received by Chinese immigrants who smoke and produced promising effects on abstinence. Large trials are warranted to assess its efficacy in promoting abstinence in this underserved population. ClinicalTrials.gov NCT05130788; https://clinicaltrials.gov/study/NCT05130788.

Connecticut Implements a Team-Based Approach to Cardiovascular Disease Prevention Using Community Health Workers and Mobile Medical Devices.

The Connecticut Department of Public Health's Early Detection and Prevention Program uses an integrated approach to deliver breast and cervical cancer screening services, cardiovascular disease risk assessment, health coaching, and the identification of social determinants of health to women from economically disadvantaged and minority communities. Statewide contracted providers who represent twenty hospitals and their fee-for-service providers employ community health workers (CHWs) to conduct outreach, screening assessments using mobile medical devices, and risk reduction counseling in community settings to reduce service access barriers, while also engaging eligible women who may not typically frequent clinical services. Mobile medical screening devices enhance healthcare accessibility by enabling screenings to be conducted in a participants preferred setting, whether it is a clinic or within the community, with the added benefit of delivering rapid screening results. Utilizing these results, CHWs provide risk reduction counseling to develop individualized health action plans at the outreach session.

Public Health Challenges and Responses to the Growing Ageing Populations

ABSTRACTBackgroundHuman populations are rapidly ageing worldwide due to declining birth rates and rising life expectancies. This profound demographic shift presents complex public health challenges. Synthesizing evidence on key public health issues impacting ageing populations and policy strategies is required to address these needs.MethodsThe study employs narrative literature review based on the PubMed database. Data have been extracted on public health challenges to ageing populations and its recommended policy solutions.ResultsThe key public health challenges identified include rising chronic disease burden, risks for preventable multi‐morbidities and co‐morbidities, disability and dependencies, mental health issues, caregiving gaps, long‐term care system deficiencies, health inequities, healthcare access barriers, end‐of‐life care needs, financial instability, ageism/elder abuse, adverse built environments, climate/disaster threats, and social isolation. Evidence‐based policy responses span interventions in healthcare, social services, urban planning, emergency preparedness, economics, technology, anti‐ageism advocacy and so on.ConclusionsProactively addressing the array of public health challenges faced by rapidly growing ageing populations globally requires implementing collaborative, multisectoral policy solutions focused on promoting healthy, equitable, and socially engaged ageing. Healthcare systems, communities, and policies must be optimized to meet the needs of elderly people and tap into their strengths.

Patient experiences of buprenorphine dispensing from a mobile medical unit

BackgroundOverdose deaths continue to rise within the United States, despite effective treatments such as buprenorphine and methadone for opioid use disorder (OUD). Mobile medical units with the ability to dispense buprenorphine have been developed to engage patients and eliminate barriers to accessing OUD treatment. This study reports survey responses of patients of a mobile medical unit dispensing buprenorphine in areas of Chicago, IL with high overdose rates.MethodsAll patients who were dispensed buprenorphine via the mobile medical unit were invited to participate in a 7-item anonymous survey between May 24, 2023, and August 25, 2023. The survey included 5-point satisfaction scale, multiple-choice, and open-ended questions. Outcomes included satisfaction with buprenorphine dispensing from the mobile medical unit, satisfaction with filling buprenorphine at a pharmacy in the past, barriers experienced at pharmacies when filling buprenorphine, and whether the client would have started treatment that day if the mobile medical unit had not been present. Satisfaction scale and multiple-choice question responses were assessed using descriptive statistics. Wilcoxon signed-rank test was used to compare median satisfaction levels between receiving buprenorphine from the mobile medical unit versus filling a buprenorphine prescription at a community pharmacy. Open-ended questions were analyzed qualitatively using inductive thematic analysis.Results106 unique patients were dispensed buprenorphine from the mobile unit during the study period. Of these patients, 54 (51%) completed the survey. Respondents reported high satisfaction with the buprenorphine dispensing process as a part of a mobile medical unit. Of those who had previously filled buprenorphine at a pharmacy, 83% reported at least one barrier, with delays in prescription dispensing from a community pharmacy, lack of transportation to/from the pharmacy, and opioid withdrawal symptoms being the most common barriers. 87% reported they would not have started buprenorphine that same day if the mobile medical unit had not been present. Nearly half of survey participants reported having taken buprenorphine that was not prescribed to them. Qualitative analysis of open-ended survey responses noted the importance of convenient accessibility, comprehensive care, and a non-judgmental environment.ConclusionsMobile medical units that dispense buprenorphine are an innovative model to reach patients with OUD who have significant treatment access barriers. This study found that patients who experienced barriers to accessing buprenorphine from a pharmacy were highly satisfied with the mobile medical unit’s buprenorphine dispensing process. Programs seeking to develop mobile buprenorphine dispensing programs should consider patient priorities of accessibility, comprehensive care, and welcoming, non-judgmental environments.

Factors affecting patient retention to hypertension treatment in a North Indian State: A mixed-method study.

Hypertension is a global health challenge, especially in low-to-middle-income countries, where awareness and control are suboptimal. Despite available treatments, poor medication adherence hampers blood pressure control, leading to adverse outcomes and increased costs. In response, the GOI has initiated national action plans to address noncommunicable diseases, including hypertension. The study aimed to analyze patient retention rates in hypertension treatment across healthcare levels and understand providers' and patients' perspectives on control factors. Using a mixed-method concurrent design in a North Indian district, retrospective data collection covered hypertensive patients registered from January 2020 to July 2020, followed for a year (August 2020-July 2021). Quantitative data included socio-demographic characteristics and patient follow-up rates. Qualitative data comprised focus group discussions (FGD) and in-depth interviews (IDI) with healthcare providers (HCPs) and patients. Findings identified challenges in patient retention and medication adherence, notably among females and at higher-level healthcare facilities, leading to substantial loss of follow-up. Only 63% of hypertensive outpatients maintained controlled blood pressure in the past year. Male patients exhibited more consistent attendance than females. Despite sufficient HCP knowledge, patient retention was better at Health and Wellness Centers (HWCs) levels, while blood pressure control was poorer at higher facilities. Barriers such as medication side effects, pill burden, and limited healthcare access hindered hypertension control, highlighting the need for improved primary care services, including extended clinic hours and diagnostic facilities. Improving hypertension control requires addressing medication adherence and healthcare access barriers. Strengthening primary care services and implementing patient-centered interventions are crucial steps.

Using the Index of Concentration at the Extremes to Evaluate Associations of Economic and Hispanic/Latino-White Racial Segregation with HIV Outcomes Among Adults Aged ≥ 18 Years with Diagnosed HIV - United States, 2021.

To examine associations between Index of Concentration at the Extremes (ICE) measures (proxy for structural racism) for economic and Hispanic/Latino-White racial segregation and HIV outcomes among adults in the U.S. Census tract-level HIV diagnoses, linkage to HIV medical care within 1 month of diagnosis (linkage), and viral suppression within 6 months of diagnosis (viral suppression) data for 2021 from the National HIV Surveillance System were used. Three ICE measures were obtained from the American Community Survey: ICEincome (income segregation), ICErace (Hispanic/Latino-White racial segregation), and ICEincome + race (Hispanic/Latino-White racialized economic segregation). Rate ratios (RRs) for HIV diagnosis and prevalence ratios (PRs) for linkage and viral suppression were used to examine differences in HIV outcomes across ICE quintiles with Quintile5 (Q5: most privileged) as reference group and adjusted by selected characteristics. Among the 32,529 adults, diagnosis rates were highest in Quintile1 (Q1: most deprived) for ICEincome (28.7) and ICEincome + race (28.4) and Q2 for ICErace (27.0). We also observed higher RRs in HIV diagnosis and lower PRs in linkage and viral suppression (except for ICErace for linkage) in Q1 compared to Q5. Higher RRs and lower PRs in ICE measures were observed among males (diagnosis), adults aged 18‒34 (diagnosis and linkage) and aged ≥ 45 (viral suppression), and among adults in the South (all 3 HIV outcomes). Barriers in access to care/treatment in more Hispanic/Latino-White racialized economic segregated communities perpetuate the disproportionate impact of HIV on the population. Removing barriers to HIV care/treatment created by systemic racism/segregation may improve HIV outcomes and reduce disparities.

High silent prevalence of human herpesvirus 1 (HSV-1) infection affecting the indigenous reservation of the municipality of Dourados, Central-West Brazil

BackgroundThe indigenous population located in the central region of Brazil, is the second largest in terms of population size in the country. The Indigenous Reserve of Dourados has risk factors that increase the vulnerability of the indigenous population to infectious diseases, especially Human alphaherpesvirus (HSV-1), a neglected disease with high prevalence in priority populations in developing countries. The virus can also cause many more severe diseases, including widespread neonatal infections, herpetic keratitis, and herpes encephalitis, which can be fatal if left untreated. We estimated the prevalence of anti-HSV-1 antibodies and correlated it with the demographic and behavioral characteristics of the Indigenous population of the Jaguapirú and Bororó villages (Dourados, Mato Grosso do Sul (MS), Brazil).MethodsOur approach was cross-sectional. From March 2017 to November 2018. Using anti-HSV-1 (Gg1) IgM and anti-HSV-1 (gG1) IgG Euroimmun and the detection and quantification of HSV-1 viral load in plasma samples, through real-time PCR. The maps were constructed using QGIS and the statistical analyses using R Studio software.ResultsA total of 1138 individuals (> 18 years old) were enrolled. The prevalence of anti-HSV-1 IgM and IgG were 20% and 97.5%, respectively. The prevalence of anti-HSV-1 antibodies for IgG was higher in both sexes. Anti-HSV-1 IgM antibodies were present in 17.1%, 21.2%, 12.5%, and 22% of the participants with urinary problems, genital wounds, genital warts, and urethral discharge, respectively. Real-time PCR was used for confirmatory testing; HSV-1 DNA was detected in 25.6% (54/211) of anti-HSV1 IgM-positive samples. Viral loads ranged from 5.99E + 02 to 3.36E + 13.ConclusionsThe seroprevalence of HSV-1 IgM and detection of HSV-1 DNA in the Indigenous population confirmed high silent prevalence. Furthermore, the seroprevalence of HSV-1 in the Indigenous population was higher than that reported in the general adult Brazilian population. Various socioeconomic factors, drug use, and health and sexual behaviors could contribute to the facilitation of HSV-1 transmission in the Indigenous population. Our results may help develop culturally appropriate intervention programs that eliminate health access barriers and improve the implementation of public health policies aimed at promoting information regarding the prevention, treatment, and control of HSV-1 infection in Brazilian Indigenous populations.

Barriers to initial COVID-19 booster among U.S. adults who completed a primary vaccine series in the CHASING COVID cohort, September 2021 - October 2022.

It is crucial to understand factors associated with COVID-19 booster uptake in the U.S. given the updated COVID-19 vaccine recommendations. Using data from a national prospective cohort (N=4,616) between September 2021-October 2022, we examined socioeconomic, demographic, and behavioral factors of initial booster uptake among participants fully-vaccinated with the primary COVID-19 vaccines series. Cox proportional hazards models were used to estimate the associations of each factor with time to initial booster uptake. Most participants (86.5%) reported receiving their initial booster. After adjusting for age, race/ethnicity, education, region, and employment, participants with greater risk for severe COVID-19 had similar booster uptake compared with those with lower risk (aHR: 1.04; 95% CI: 0.95, 1.14). Participants with greater barriers to healthcare (aHR: 0.89; 95% CI: 0.84, 0.96), food insecurity (aHR: 0.82; 95% CI: 0.75, 0.89), and housing instability (aHR: 0.81; 95% CI: 0.73, 0.90) were less likely to report receiving initial booster compared with those without those barriers. Factors motivating the decision to vaccinate changed from safety-related concerns for the primary series to perceived need for the booster. It is key to address economic and health access barriers to achieve equitable COVID-19 vaccine uptake and continued protection against COVID-19.

Simulation Training in Vascular and Endovascular Surgery: A Nationwide Survey Among Surgeon Educators and Trainees in France

Vascular surgical training is evolving towards simulation-based methods to enhance skill development, ensure patient safety, and adapt to changing regulations. This study aims to investigate the utilization of simulation training among vascular surgeons in France, amidst ongoing shifts in teaching approaches and educational reforms. A national survey assessed the experiences and perceptions of vascular surgery professionals regarding simulation training. Participation was open to self-reported health professionals specialized (or specializing) in vascular surgery, including interns or fellows. Participants were recruited through various channels, and data were collected via a questionnaire covering participant characteristics, simulation experiences, and perceptions. Seventy-six participants, predominantly male (74%) took part in the survey. While 58% reported access to simulation laboratories, only 17% had organized simulation sessions 1-3 times a year, and 5% had sessions more than 10 times annually. High fidelity simulators were available in 57% of institutions, while low fidelity simulators were available in 50%. Regarding funding, 20% received financial assistance for training, predominantly from industry (18%). One-third of the participants experienced 9 or more sessions (34%), lasting between 1 and 2hours (34%), 30% expressed satisfaction with access to simulation, while 33% were dissatisfied with communication of simulation training opportunities. Despite recognizing the benefits of simulation training, its integration into vascular surgery education in France remains incomplete. Challenges such as limited access and communication barriers hinder widespread adoption. Collaborative efforts are needed to ensure uniformity and enhance the effectiveness of simulation training in vascular surgery education.

Defining indicators for disease burden, health outcomes, policies and barriers and facilitators to health services for migrant populations in the Middle East and North African region: a protocol for a suite of systematic reviews

IntroductionThe Middle East and North African (MENA) region is characterised by high and complex migration flows, yet little is known about the health of migrant populations, their levels of underimmunisation...

Timeliness and quality of peripartum care provision during a health system strengthening initiative in rural Guinea-Bissau: a qualitative situation analysis

Guinea-Bissau has among the world’s highest maternal and perinatal mortality rates. To improve access to quality maternal and child health (MCH) services and thereby reduce mortality, a national health system strengthening initiative has been implemented. However, despite improved coverage of MCH services, perinatal mortality remained high. Using a systems-thinking lens, we conducted a situation analysis to explore factors shaping timeliness and quality of facility-based care during labour, childbirth, and the immediate postpartum period in rural Guinea-Bissau. We implemented in-depth interviews with eight peripartum care providers and participant observations at two health facilities (192 h) in 2021-22, and analysed interview transcripts and field notes using thematic network analysis. While providers considered health facilities as the only reasonable place of birth and promoted facility birth uptake, timeliness and quality of care were severely compromised by geographical, material and human-resource constraints. Providers especially experienced a lack of human resources and materials (e.g., essential medicines, consumables, appropriate equipment), and explained material constraints by discontinued donor supplies. In response, providers applied several adaptation strategies including prescribing materials for private purchase, omitting tests, and delegating tasks to birth companions. Consequences included financial barriers to care, compromised patient and occupational safety, delays, and diffusion of health worker responsibilities. Further, providers explained that in response to persisting access barriers, women conditioned care seeking on their perceived risk of developing birthing complications. Our findings highlight the need for continuous monitoring of factors constraining timeliness and quality of essential MCH services during the implementation of health system strengthening initiatives.

Stakeholders' Perceptions on the Implementation of the HPV Vaccine School-Entry Requirement in Puerto Rico during the COVID-19 Pandemic.

This study explored the implementation of the human papillomavirus (HPV) vaccine school-entry requirement in Puerto Rico during the COVID-19 pandemic. We conducted 26 semi-structured interviews with stakeholders and community-based organizations from August 2021 to March 2022. The interview guide was developed using the 2009 Consolidated Framework for Implementation Research (CFIR). The interviews were recorded and transcribed in Spanish. Data were analyzed using applied thematic techniques. These themes included the following: (i) Intervention characteristics: Participants noted that the school-entry requirement was effective in increasing vaccination uptake prior to the pandemic. Issues with the immunization registry were noted; (ii) Outer setting: External influences, access barriers, and an increase in HPV vaccine exemptions since the implementation of the COVID-19 vaccine were discussed; (iii) Inner setting: Communication within organizations and HPV vaccination efforts improved as the pandemic progressed; (iv) Characteristics of individuals: Most agreed with the school-entry requirement, including exemptions; and (v) Process: Results showed the need to reinforce the population's education about HPV and the vaccine. Implementation of the policy was challenging during the early stages of the pandemic due to measures enacted to stop the spread of COVID-19 and focus on the COVID-19 vaccine. Efforts to increase HPV vaccine should focus on increasing HPV vaccine education and creating collaborations.

‘Five rungs down’: encounters between disabled parents and the medical institution

Disabled people face particular additional barriers of access to health care. In this article, we explore how these barriers increase when disabled parents require medical attention for their children. Using the small story research technique, we analysed 24 interviews with disabled parents conducted as part of a qualitative-narrative study in Chile. We identified stories in which the participants describe encounters with the medical institution in which they are invisibilised and disempowered. A paternalistic and biomedical approach, which actively ignores how to interact with disabled people, prevails among healthcare staff. Disabled parents irritate the medical institution because they do not have ‘standard’ bodies and are in the position of the carers of others (their children), rather than that of people who require care. These parents develop strategies to resist the way they are treated, making extra efforts to obtain medical attention for their children.

Robotont 3-an accessible 3D-printable ROS-supported open-source mobile robot for education and research.

Educational robots offer a platform for training aspiring engineers and building trust in technology that is envisioned to shape how we work and live. In education, accessibility and modularity are significant in the choice of such a technological platform. In order to foster continuous development of the robots as well as to improve student engagement in the design and fabrication process, safe production methods with low accessibility barriers should be chosen. In this paper, we present Robotont 3, an open-source mobile robot that leverages Fused Deposition Modeling (FDM) 3D-printing for manufacturing the chassis and a single dedicated system board that can be ordered from online printed circuit board (PCB) assembly services. To promote accessibility, the project follows open hardware practices, such as design transparency, permissive licensing, accessibility in manufacturing methods, and comprehensive documentation. Semantic Versioning was incorporated to improve maintainability in development. Compared to the earlier versions, Robotont 3 maintains all the technical capabilities, while featuring an improved hardware setup to enhance the ease of fabrication and assembly, and modularity. The improvements increase the accessibility, scalability and flexibility of the platform in an educational setting.

Analyzing the CTOSH listserv to understand the needs, barriers, resources, and strategies used by homeless service providers in central Texas

ABSTRACT Introduction: People experiencing homelessness (PEH) have complex needs but access barriers and unclear communication channels contribute to many needs being unmet. The purpose of the current study was to examine use of a free e-mail listserv by homeless service providers in order to better understand informal systems for communicating needs and identifying available resources. The following specific aims were assessed: (1) examine and classify reasons why homeless service providers use the listserv, (2) describe the most common needs expressed, (3) assess the high priority barriers to health and wellness, and (4) identify strategies that homeless service providers use to overcome barriers. Methods: Qualitative descriptive methods were used to analyze n = 5630 emails sent over a 4-year period from 2/1/2017 to 2/28/2021. Results: The CTOSH listserv is a valuable tool that enables sharing institutional knowledge and collective experience thereby facilitating interorganizational collaboration. Findings reveal several strategies that listserv users employed to overcome service barriers and resource scarcity, and also indicate that informal communication channels are critical during times of crisis. Conclusions: Implications include future research to develop agile tools such as the CTOSH listserv and the creation of a community of practice to better support the complex work of homeless service providers.

Factors related to first COVID-19 booster vaccine acceptance in Indonesia: A cross-sectional multi-center study.

A positive community perception of the coronavirus disease 2019 (COVID-19) vaccination program is crucial for increasing vaccination coverage and achieving herd immunity. This study aimed to identify factors influencing the acceptance of a COVID-19 booster vaccine in Indonesia. It was conducted as a cross-sectional, multicenter study using a validated questionnaire distributed online to Indonesian participants aged 18 years and older. The questionnaire covered sociodemographic characteristics, clinical conditions of both the participants and their closest contacts, the Health Belief Model (HBM) domain, and preferences for the location of receiving a booster vaccine, as well as reasons for declining a booster vaccine. Of 1550 respondents, 78.6% had received the first COVID-19 booster dose. Sociodemographic factors influencing first booster vaccine acceptance in Indonesia included age (OR36-45 vs 18-25 years: 2.43; 95%CI: 1.13-5.24; OR>45 vs 18-25 years: 3.58, 95%CI: 1.96-6.52), length of education (OR13-16 vs <12 years: 1.34; 95%CI: 1.00-1.80; OR>16 vs <12 years: 4.15, 95%CI: 2.12-8.09), monthly income (ORIDR3,500,000 vs 1,500,000: 1.72; 95%CI: 1.19- 2.49), and occupation (ORHealth workers vs not-working: 1.81; 95%CI: 1.00-3.29). Clinical aspects and HBM domains associated with booster vaccine acceptance were the presence of chronic disease (OR: 1.94; 95%CI: 1.03-3.66), previously tested positive for COVID-19 (OR: 1.90; 95%CI: 1.24-2.89), having a family member or friend who was hospitalized due to COVID-19 (OR: 1.86; 95%CI: 1.32-2.62), perceived susceptibility (OR: 1.20; 95%CI: 1.02-1.41), perceived access barriers to COVID-19 vaccination (OR: 0.52; 95%CI: 0.44-0.61), and perceived benefits of COVID-19 vaccination (OR: 1.67; 95%CI: 1.41-1.97). In conclusion, factors influencing the first COVID-19 booster vaccine acceptance in Indonesia ranged from demographic and clinical characteristics as well as HBM domains. Effective strategies to expand COVID-19 booster vaccine coverage should consider these factors to encourage participation in the vaccination program.