Caregiving Behavior Research Articles

Content Validity for the Checklist of NICU Caregiver Behaviors.

To update and establish content validity for the Checklist of NICU Caregiver Behaviors. Structured literature review and Delphi analysis. Neonates born prematurely or who are sick in the NICU are frequently exposed to harmful stimuli that can affect brain development and result in adverse neurodevelopmental outcomes. In response to this risk, NICU caregiving now encompasses protecting and promoting neurodevelopment to affect long-term outcomes for neonates and their families. Developmentally supportive care (DSC) includes internationally recognized best practices for the care of neonates in the NICU. Implementation and operationalization of DSC is a priority for neonatology. Although evidence-supported guidelines exist for effective DSC strategies in the NICU, no validated tool exists to support implementation at the point of care. Nine expert reviewers from the United States and India including four occupational therapists, one nurse practitioner, one clinical nurse specialist, and three neonatal medicine specialists. The Checklist of NICU Caregiver Behaviors had been updated based on a structured review of the evidence. The updated checklist was then shared with a group of professionals with DSC expertise who provided further recommendations using a modified Delphi survey process. The project yielded the current NICU Caregiver Behavior Checklist. Expert reviewers provided 53 actionable recommendations in Round 1 and 18 actionable recommendations in Round 2 to support clarity and use of the tool. In response, the NICU Caregiver Behavior Checklist was reformatted as a collection of five checklists, each representing a core measure of DSC; the introduction section was expanded; language was broadened; and clarifications were provided to promote observations of target behaviors and allow for more site-specific recommendations and assessments. This evidence-based tool can be used as part of DSC education, as a self-assessment tool, and as a measure of NICU caregivers' use and quality of DSC.

The significance of mothers' neural responding to infant emotional cues for caregiving behaviors: The moderating role of infant temperamental distress.

We examined associations between mothers' (N = 137; 77.7% White/non-Hispanic) neural responding implicated in facial encoding (N170) and attention (P300) to infant emotional expressions and direct observations of their caregiving behaviors toward their 6-month-old infants. We also explored the moderating role of mother-reported and observer-rated infant temperamental distress. Few direct associations emerged that were not further moderated by temperament. Specifically, a dampened N170 to infant distress (vs. neutral) expressions was associated with mothers' intrusiveness, and a larger P300 to infant happy (vs. neutral) expressions was associated with mothers' sensitivity to distress. Among mothers who perceived their infants as high in temperamental distress, neural responding reflective of distinguishing (N170) and attending (P300) to infant distress (vs. neutral) expressions was associated with maternal sensitivity to distress, and neural responding reflective of encoding (N170) infant emotional (distress, happy, vs. neutral) expressions was associated with greater maternal sensitivity to nondistress. At lower levels of mother-reported temperamental distress, a heightened N170 to infant emotional (distress, happy, vs. neutral) expressions was associated with mothers' detachment. Findings indicate that distinctive patterns of neural responding to infant emotional expressions are associated with specific caregiving behaviors and demonstrate the significance of mothers' perceptions of infant temperamental distress in moderating the extent to which neural responding to infant expressions is associated with their caregiving behaviors. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Physical Activity, Sedentary Behaviour, Sleep and Mental Wellbeing in Family Caregivers of Adults With Intellectual and/or Developmental Disabilities.

Canadian 24-h movement guidelines recommend that adults achieve 150 min per week of moderate-to-vigorous physical activity (MVPA), 7-9 h of sleep per night and spend no more than 8-h per day sedentary to optimise health and wellbeing. Using a cross-sectional survey of 131 family caregivers of adults with intellectual and developmental disabilities, we aimed to (a) determine whether adherence to these guidelines predicts mental wellbeing in family caregivers and (b) explore the relationship between movement behaviours of family caregivers and their loved ones. While MVPA was found to weakly predict wellbeing, sleep and sedentary behaviour did not. The movement behaviours of the family caregivers were not closely related to that of their loved ones. Fostering physical activity is important to promote the wellbeing of adults with intellectual and developmental disabilities, as well as their family caregivers. Opportunities to be active together may be even more beneficial.

THE ROLE OF APPRAISAL IN CAREGIVER CHARACTERISTICS ASSOCIATED WITH ELDER NEGLECT

Abstract Elder neglect occurs when a caregiver fails to meet a need, compared to elder abuse which involves specific abusive actions. Despite this, neglect and abuse are typically studied together as elder mistreatment. We investigated the characteristics associated with neglectful behaviors of caregivers of people living with dementia (PLWD). California dementia caregivers (N=92) completed a cross-sectional anonymous online survey about their caregiving experience and mistreatment of the PLWD from any source. 44.6% of caregivers were caring for a parent, 51.1% were Hispanic/Latino, and 68.1% were female. Eighteen (19.6%) caregivers reported at least one neglectful behavior in the last year, defined as leaving the PLWD alone inappropriately, not providing them with needed medical care, food, or water, or being impaired in caregiving due to alcohol or drugs. Of these, 11 (61.1%) also reported abuse in the last year: nine psychological, five financial, and five physical abuse. Bivariate tests comparing characteristics of caregivers with and without neglectful behaviors showed no difference in time spent caregiving, outside caregiving help, or social support and loneliness. Those who reported neglectful behaviors were significantly more likely to live with the PLWD (X2 =7.2, p=.028), believe the PLWD could “do better if they tried” (X2 =9.0, p=.029), and have higher burden scores (t=-2.61, p=.011). Our findings suggest that caregiver neglect may be associated with the caregivers’ perceived experiences rather than objective measures. Service providers should be attentive to caregivers’ understandings of their experiences, which may be related to neglectful behaviors, and reducing neglectful behavior may reduce overall mistreatment.

DOES CAREGIVING HASTEN AGING? EXPLORING THE LINK BETWEEN TRIPLE-DUTY CAREGIVERS’ TRANSITIONS AND SUBJECTIVE AGE

Abstract Perceptions of aging serve as crucial indicators for evaluating positive aging. This study examines the relationship between various caregiving transition types and subjective aging over time. Utilizing data from the 2018 and 2020 waves of the China Longitudinal Aging Study, we examine six transition types, incorporating both intra- and extra-familial caregiving behaviors, by constructing three subjective aging change patterns: “Consistent over time”, “Accelerated growth”, and “Relative decline”. The findings reveal that sustained caregiving is associated with a relative decline in subjective age, with a more pronounced effect observed in the reduction of ongoing extramural caregiving. Caregiver role transitions, such as exiting caregiving and transitioning between intra- and extra-familial caregiving, lead to an accelerated increase in subjective age, while entering caregiving aligns subjective age with the passage of time. In the context of caregiving role transitions, a positive self-perception of aging enhances the subjective age of female caregivers, whereas a positive general aging attitude reduces the subjective age of male caregivers. The study underscores the significance of caregiving experiences as crucial predictive factors for subjective aging. Establishing comprehensive family support policies throughout the caregiving lifecycle, promoting voluntary caregiving participation, can contribute to enhancing adaptive aging

The Sustainability Spillover: Uncovering the Link between Informal Elder Care and Eco-Conscious Behaviors across the European Union

Abstract Background and Objectives This study explores the association between informal caregiving for older adults and environmentally sustainable behaviors across the 27 European Union countries, aiming to identify how the gendered and domestic nature of environmentalism relates to elder care. Research Design and Methods Data from 41,742 respondents aged 16–74 were analyzed from the Survey of Gender Gaps in Unpaid Care, Individual and Social Activities and conducted by a scientific consortium in 2022. Frequency of sustainable behaviors was measured across 10 indicators. Multilevel mixed-effects linear regressions examined associations between caregiving and sustainable behaviors, adjusting for demographic, socioeconomic, and attitudinal covariates. Results Informal caregivers engaged in eco-friendly actions significantly more frequently than non-caregivers across all 10 sustainable-behavior indicators (p<0.001). The “caregiver effect” was strongest for sustainable-consumption choices like buying eco-friendly (β=0.16), fair-trade (β=0.15), and used products (β=0.17), and weaker for household practices such as recycling (β=0.05) and mindful resource consumption (β=0.06). Caregivers attained higher composite environmental behavior scores (33.93±8.23) than non-caregivers (31.88±8.00; p<0.001). This association remained robust after adjusting for gender, age, education, employment, household size, attitudes, and other covariates. Caregiving had the strongest association with buying used items (β=0.20) and eco-friendly products (β=0.14). Country-level analyses revealed consistent caregiver vs. non-caregiver differences, with the largest gaps in Southern and Eastern Europe. Discussion and Implications This is the first large-scale cross-national study that demonstrates a consistent association between older-adult caregiving and a wide range of environmentally sustainable behaviors. Results suggest the experience of caring for a vulnerable family member is closely related to a broader sense of social and environmental responsibility. Caregivers’ heightened engagement in sustainable consumption positions them as potential early adopters and change makers. Findings highlight new avenues for environmental education and caregiver support initiatives that synergistically promote interpersonal and environmental care.

Alloparental behaviour of an adult male Rhesus Macaque (Macaca mulatta)

We report an unusual case of caregiving by an adult male rhesus macaque (Macaca mulatta) at Sur Sarovar Bird Sanctuary, India. Observations from 7th June to 15th July, 2024 followed the adult male engaged in behaviors typically associated with female macaques, such as carrying, grooming, and protecting an infant male. Despite his aggressive interactions with other macaques, the adult male exhibited significant nurturing behaviors, including allowing the infant to suck from his nipple and maintaining close physical proximity for protection. These findings expand on previous research by demonstrating that male rhesus macaques can exhibit rare but impactful caregiving behaviors, underscoring the need for further investigation into such atypical male-infant interactions.

Exploring the Caregiver Experiences of Symptom Management in Children With Cancer: A Qualitative Systematic Review

ABSTRACTAlthough caregivers of children with cancer play an instrumental role in managing their child's symptoms, the impact of their own experiences or perspectives is under‐explored. Understanding these factors is essential as they influence caregiving behaviors and overall well‐being. This qualitative systematic review addresses this knowledge gap by synthesizing existing research on caregiver's experiences. The review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Two reviewers utilized Rayyan to screen titles and abstracts retrieved from comprehensive keyword searches of five databases including CINAHL, APA PsycINFO, Embase, and MEDLINE. Databases and bibliographies were hand‐searched for additional articles. One reviewer completed full text assessment and data were extracted into an Excel spreadsheet. The Quality Assessment with Diverse Studies tool was used to appraise included studies. Thematic content analysis was used to synthesize findings, which are presented narratively. Twelve articles are included, representing the experiences of 597 caregivers, most of which (83%) were undertaken in high‐income nations. Quality appraisal scores indicated all studies were of moderate to robust quality. Three main themes were identified including: (1) caregivers as protectors in their role, (2) normalization of symptoms yet they remain disrupting, and (3) communication between the caregiver and child. Findings emphasize the importance of formalized information provision and education to better support caregivers in managing their child's cancer‐related symptoms. Nurses are uniquely positioned to provide this essential support thereby improving the quality of life for both caregivers and children.

Child Fatalities Resulting From Caregiver Behavior: A Public Health Approach to Child Maltreatment Classification.

Limited research describes approaches for applying a public health lens to fatal child maltreatment classification. Specialized terminology and tools could help improve consistency in classifying deaths resulting from caregiver behavior. A six-criterion classification tool was developed via expert panel review of over 100 child deaths by the Alaska Division of Public Health's Child Death Review (CDR) program. Next, accuracy and acceptability were assessed by inviting staff from other CDRs using a national listserv to classify 21 brief case scenarios with the tool. Among the 47 respondents, sensitivity was 0.87, specificity 0.77, and accuracy 0.84. Variability by tool criterion ranged from 97% to 74% accurate. Most respondents (66%) reported the tool as being helpful for classifying deaths and moderate reliability was found. Study participants found it difficult to consistently apply specific criteria which resulted in a modification of the tool to improve the potential for universal adoption.

Perceptions of Relationships with Kinship Caregivers Among Parents Following State-Detected Psychoactive Substance Use

SYNOPSIS Objective. This study sought to better understand parent relationships with kinship caregivers, with an eye toward parents’ perceptions of how kinship caregiver mindsets and behaviors surrounding substance use may have impacted parents. Design. Data came from transcripts of in-depth, semi-structured interviews with 16 parents in the United States, who had substantiated child welfare cases related to substance use. Transcripts were dual-coded, and analysis was guided by the reflexive thematic analysis framework. Results. Parents described two different experiences with kinship caregivers. For some families, parents reported fragmentation of their support system; parents described caregivers as undermining their parental authority, disrupting attachment bonds, and communicating with children in ways that perpetuated stigma around substance use. Other parents reported increased cohesion among family members; parents described caregivers as supportive and empowering, particularly as they navigated mandated “recovery.” Conclusions. Findings offer insights to help inform decision-making by both practitioners and policymakers by giving a voice to parents as they navigate the complex systems of child welfare services and drug court programming.

Caregivers' cognitions about infants' mental and emotional states

AbstractGiven the relevance of caregivers' perceptions, cognitions, and emotions about their child's mental states for caregiving behavior and children's development, researchers from multiple theoretical perspectives have developed constructs to assess caregivers' cognitions, resulting in a large but scattered body of literature. In this article, we highlight the conceptual overlap among and uniqueness of six constructs assessing caregivers' cognitions about their child at 36 months and younger: infant intentionality, mental representations, mind‐mindedness, parental embodied mentalizing, parental empathy, and parental reflective functioning. We define constructs, present approaches to measurement, and propose elements of importance that fall under the umbrella of caregivers' cognitions and that may be associated differentially with children's early cognitive and social–emotional development. We conclude with recommendations for researchers aiming to capture caregivers' cognitions about their child's mental states, whether focusing on one of the six reviewed constructs or on specific elements (e.g., awareness of the child's mind or accuracy of caregivers' perceptions of their child) under the umbrella of caregivers' cognitions.

Prenatal representations link pregnancy intention to observed caregiving

ABSTRACT Aims/Background Children from unintended pregnancies are at an increased risk of experiencing less positive parenting practices as well as abuse and neglect. Thus, identifying factors that may explain the association between pregnancy intention and caregiving behaviours is critical, as well as identifying if these associations can be assessed during pregnancy. Design/Methods In a sample of 297 pregnant people (Mage = 31.17, SD = 4.89; gestational age range 9.71–35.14, M = 23.55, SD = 5.54) and, later, their 6-month-old infants, this prospective study examined the degree to which two facets (i.e. acceptance and richness of perceptions of the child and their role in being a parent for that child) of caregivers’ prenatal mental representations of the child explained the association between pregnancy intention and the caregiver behaviour observed during caregiver – child interactions in infancy. Results Results indicated that caregiver–child interactions following pregnancies that were intended, relative to those non-intended, were rated as higher in caregiving sensitivity and warmth. These relations were explained, in part, by a greater richness of perceptions, but not through acceptance. Conclusion Findings suggest richness of perceptions as a potential target for exploration in interventions to support pregnant people who were not intending to become pregnant as a means to promote positive caregiver – child relationships.

Information seeking behaviour of informal caregivers at the premier tertiary teaching hospital in Nigeria

This study was conducted to examine the information behaviour of informal caregivers in a university college hospital in Ibadan, Nigeria. Informal caregivers in the teaching hospitals constitute critical pubic health care players whose information behaviours have not been studied. Data was collected from 208 caregivers using a questionnaire that consisted of structured and open-ended questions. The study found that healthcare providers were the primary source of health for caregivers, with 34.1% actively seeking information from them. The caregivers seldom utilised sources like the internet, community organizations, books, family, and friends. The preference for healthcare providers as sources is due to their accessibility and ability to provide prompt and accurate answers. Caregivers have diverse information needs, including medication-related information, first aid techniques, nutrition, exercise, mental health, and lifestyle choices. They seek this knowledge to make informed decisions that improve their loved ones’ well-being. The study also revealed that caregivers heavily rely on information technology for health information due to its accessibility and reliability. The study highlights the need for ongoing training and proactive information sharing by healthcare providers to better support informal caregivers in Nigeria, emphasizing the importance of integrated support systems within healthcare facilities. To meet diverse information needs, healthcare institutions should diversify dissemination strategies, including culturally sensitive materials and digital literacy programs, while developing tailored mobile applications and online support communities for caregivers. Policymakers must focus on creating supportive healthcare policies, funding caregiver programs, and expanding insurance coverage to alleviate financial burdens, ensuring that caregivers have access to necessary resources and information.

Maternal alexithymia and caregiving behavior: the role of executive functioning -A FinnBrain Birth Cohort study.

The growing interest in parental cognition calls for research clarifying how cognition interacts with other parenting determinants to shape caregiving behavior. We studied the interplay between executive functioning (EF; cognitive processes that enable goal-directed thinking and behavior) and alexithymic traits (characterized by emotion processing/regulation difficulties) in relation to emotional availability (EA; the dyad's ability to share an emotionally healthy relationship). As EF has been reported to shape parents' ability to regulate thoughts and emotions during caregiving, we examined whether EF moderated the association between maternal alexithymic traits, and EA. Among 119 mothers with 2.5-year-olds drawn from the FinnBrain Birth Cohort, EF was measured with Cogstate tasks, alexithymic traits with the Toronto Alexithymia Scale (TAS-20), and caregiving with the Emotional Availability Scales (EAS). More alexithymic traits on the TAS-20 subscale Externally Oriented Thinking (EOT) were associated with poorer caregiving in a hierarchical regression analysis (ΔR2 = 0.05, p = .01). A marginally significant moderation effect was found when adding the EOTxEF interaction term to the model (ΔR2 = 0.03, p = .06). These associations weakened slightly when controlling for education level. Estimation of simple slopes and a Johnson-Neyman figure indicated a significant association between higher EOT and lower EAS, that increased in strength as EF decreased from the group mean level. The influence of cognitive alexithymic traits on EA could be especially pronounced among low EF parents, but further studies are needed to support and extend the findings. The potential role of parental reflective functioning in this context is discussed.

Maternal contingent responsiveness moderates temperamental risk to support adaptive infant brain and socioemotional development across the first year of life.

In the first few months of life, infants display intriguing individual differences in how they react to novel stimuli in their environment. Infant "negative reactive" tendencies have been robustly linked to resting brain activity profiles that confer risk for maladaptive socioemotional outcomes. The present study examines whether and how caregiver behavior in early infancy may interact with infant negative reactivity to alter the extent to which such tendencies predict risk-related brain activity profiles. In the present study, 51 mothers (all White; age M = 32 years, SD = 3; 70.8% monthly household income > 3,400 U.S. dollars) and their infants (39.2% female at birth) participated. We measured infant negative reactivity and maternal contingent responsiveness to infant's gaze during mother-infant interactions at age 4 months. At 10-11 months, we assessed infants' resting electroencephalographic (EEG) 6-9 Hz frontal asymmetry (a marker of risk for maladaptive regulatory behaviors and withdrawal), infant fearful withdrawal, and infant empathic behavior. We found that maternal contingent responsiveness to 4-month-old infant's gaze in naturalistic interactions moderated the relation between 4-month infant negative reactivity and 11-month resting EEG asymmetry. Results suggest that maternal contingent responsiveness alters the extent to which early reactive tendencies end up "embedded" in infant brain activity profiles. Exploratory analyses revealed that the interaction between maternal contingent responsiveness and infant reactivity predicting infant resting EEG asymmetry, in turn predicted infants' fearful withdrawal and empathic behaviors also assessed at 10-11 months. Findings demonstrate the critical buffering role of maternal contingent responsive behaviors in reducing potential maladaptive neural and socioemotional outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Maternal childhood trauma, caregiving behavior, and child cognitive development in the context of drug addiction.

Exposure to childhood trauma confers intergenerational risk on child development. However, the mechanism linking a mother's childhood trauma with her child's cognitive development remains poorly understood. This study recruited 71 mother-child dyads affected by substance use disorder from local, community-based, outpatient substance use treatment programs. Maternal exposure to childhood trauma, caregiving behavior, and child cognitive development were assessed in each mother-child dyad. These were measured through a comprehensive biopsychosocial interview, an observed dyadic interaction coded using the Coding Interactive Behavior system, and the Bayley Scales of Infant and Toddler Development, Screening Test, respectively. We hypothesized that compromised caregiving behavior would mediate a negative relationship between maternal childhood trauma and child cognitive development. Analyses did not support this hypothesis. Specifically, maternal childhood trauma was not significantly associated with child cognitive development nor the four dimensions of maternal caregiving behavior. However, caregiving behavior (specifically maternal sensitivity and limit setting) was associated with child cognitive development, when controlling for maternal childhood trauma and child age. The lack of associations observed suggests that protective factors may buffer the intergenerational impact of childhood trauma. Furthermore, the relationship between quality of caregiving and child cognitive development highlights the importance of interventions which foster sensitive caregiving behaviors that may bolster child cognitive development in the context of maternal substance use disorder and maternal childhood trauma. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Selective Feeding-An Under-Recognised Contributor to Picky Eating.

Background: Amongst children presenting to an interdisciplinary clinic with complaints of picky eating, we aim to identify the proportion who have underlying selective feeding and to describe its implications on growth and nutrition, as well as parental coping responses. Methods: We conducted a retrospective chart review of first-visit consults from January 2020 to July 2022. Caregiver and child mealtime behaviours were assessed using the standardised Caregiver's Feeding Styles Questionnaire (CFSQ) and by direct observation. Caloric intake and oromotor skills were assessed by dietitians and speech therapists, respectively. Medical concerns were addressed by the doctor. Results: Out of 152 children referred for concerns of "picky eating", 128 (84.2%) were diagnosed as having selective eating, while the rest were diagnosed with delayed oromotor skills, poor appetite, oral aversion and 4 were deemed to have normal feeding behaviour for their age. Of the 128 selective eaters, 67 (52%) children had comorbidities such as autism spectrum disorder (ASD) (n = 59), attention-deficit/hyperactivity (ADHD) (n = 2) and underlying medical conditions (n = 6). The remaining 61 children were "otherwise well". Of the "otherwise well" children, 47.5% had inadequate caloric intake and 31% had failure to thrive. The commonest feeding style among caregivers of "otherwise well" picky eaters was authoritarian (36%). The majority (80%) of these caregivers also experienced helplessness. Conclusions: We conclude that picky eating in young children is a symptom with several possible underlying aetiologies. It is associated with nutritional consequences for the child and significant stress on caregivers. Being able to recognise those who need referral for specialist intervention and multidisciplinary management (such as selective feeding and delayed oromotor skills) would be important.

Caregiver burden, religious coping, and spiritual well-being among caregivers of elderly stroke patients and predictors affecting spiritual well-being.

Stroke is a disease that affects the arteries leading to and within the brain. Stroke usually creates a range of disabilities such as physical deficits and difficulty in performing daily activities. These long-term needs and the continuous caregiving sequence affect the care burden and spiritual well-being of caregivers. The correlational study population consisted of caregivers of stroke older patients (N = 100). Burden Interview Scale, Spiritual Well-Being Scale and Religious Coping Scale were used. Descriptive analyses, independent sample t-test, one-way analysis of variance, correlation, regression analyses were used to evaluate the data. The mean age of caregivers was 48.38 ± 13.52 years. The score of Burden Interview Scale was 31.41 ± 15.13 (light/moderate), Negative Religious Coping was 7.39 ± 3.17 (moderate), Positive Religious Coping was 24.30 ± 4.34 (high), and Spiritual Well-Being was 21.65 ± 6.73 (low). There is a significant relationship between Burden Interview and Negative Religious Coping (r = 0.274; P = 0.006), Burden Interview and spiritual well-being (r = -0.563; P = 0.000), and spiritual well-being and positive religious coping (r = 0.228; P = 0.026). The predictors that affect the spiritual well-being of caregivers were found to be Burden Interview (β = -0.571) and Positive Religious Coping (β = 0.181) (P < 0.05). Nurses play an important role in increasing the spiritual well-being levels and religious coping behaviours of caregivers. Nurses should communicate empathically with caregivers, understand their feelings, and provide emotional support.

Changes in healthcare seeking behaviors among caretakers of children in the previously occupied ISIS territory: Hadeetha, Anbar, Iraq: a cross-sectional survey of 415 households.

The western province of Anbar, and the district of Hadeetha, have suffered direct impacts from the second United States led invasion (2003) through the ISIS invasion (2014-2017). With the primary health care centers being closed or inaccessible, the remaining population experienced changes in health seeking. The area of Anbar, Iraq remains largely remote from the discourse of health system recovery post-conflict. The objective of this study was to describe changes in health seeking behaviors of caregivers of children ages 12-72months of age in Hadeetha, Anbar, Iraq from the conflict period of ISIS (Islamic State of Syria and Iraq), 2014-2017, to the post-conflict period, 2021. This was a mixed-methods study composed of a cross-sectional 415 household survey and focus groups in Hadeetha, Anbar, Iraq. Caretakers of children were interviewed from February to April 2021. Children were sampled from a list of children who missed at least one vaccination appointment without a return for follow-up from the birth cohorts of 2014 to 2020. Healthcare workers focus groups and key informant interviews occurred from 2019 to 2021 centered around experiences from the 2014 to 2021 period. In the post-conflict period, there were no differences in health seeking based upon provider type between respondents. Physicians were primary healthcare providers in the post-conflict period for 79% of respondents versus only 47% in the conflict period. Healthcare workers described major barriers to delivering services in Hadeetha during the ISIS occupation due to infrastructure damage, threats of violence, decreased medical personnel, lack of compensation and disruptions in medical supplies from 2014 to 2017. This study provides insight into health seeking challenges among the many individuals who remained in Hadeetha during the ISIS occupation. Health use patterns by provider type mirror the concerns the healthcare providers shared: limited availability, efflux of professional workers, limited resources and security challenges to providing care. Positive trends toward increased access to physicians during periods of peace are an encouraging marker for continued population resilience during the post-conflict period. Recovery efforts continue to be hampered by internal sectarian discord within Iraq as well as insufficient resources to maintain health services as well as provide catch-up health services, such as immunizations.

Cat Caring Behaviors and Ownership Status of Residents Enrolling a Cat in a Free Sterilization Program.

Most cats entering animal shelters in Australia are less than 12 months old and emanate from low socioeconomic areas. Many are unidentified and may be either owned or semi-owned cats (cats cared for by someone who does not consider themselves the owner). In Australia, approximately 33% of cats entering shelters and pounds are euthanized annually, adversely affecting the mental health of staff involved. Our study investigated cat ownership and caregiving behaviors of cats enrolled in the Australian Pet Welfare Foundation's Community Cat Program, which included free sterilization, microchipping, and preventive healthcare. The suburbs targeted in Ipswich, Australia had a high per capita cat intake into animal shelters. We surveyed 1094 cat owners and semi-owners. Most cats were under 12 months old (79%), primarily domestic short-haired (69%), and acquired through informal channels such as friends, family, or as strays. Veterinary care was limited, with only 15% of cats having visited a veterinarian and 28% being vaccinated. Prior to hearing about the free sterilization program, 88.5% of participants identified as owners, while 11.5% were semi-owners. Before completing the survey, these semi-owners transitioned from an informal caregiving relationship to becoming owner of the cat/s. Of the semi-owners, 93% indicated that their transition to ownership was driven by feelings of responsibility, emotional attachment, and access to free sterilization services. These findings suggest that targeted interventions, such as accessible veterinary care and sterilization programs, are crucial in encouraging semi-owners to take full ownership of cats, improving cat welfare, and reducing unplanned breeding. Supporting this transition helps curb overpopulation and fosters improved caregiving, benefiting both cats and communities.