Care Seeking Research Articles

Symptoms of depression and risk of emergency department visits among people aged 70 years and over.

Older people experiencing depression and anxiety have higher rates of health service utilisation than others, but little is known about whether these influence their seeking of emergency care. The aim was to examine the associations between symptoms of depression and the use of emergency health care, in an Australian context, among a population of people aged 70 years and over initially free of cardiovascular disease, dementia or major physical disability. We undertook secondary analyses of data from a large cohort of community-dwelling Australians aged [Formula: see text]70 years. Multivariable logistic regression was used to compare the association of symptoms of depression (measured using the Center for Epidemiological Studies Depression Scale 10 question version, CESD at baseline) with subsequent episodes of emergency care, adjusting for physical and social factors of clinical interest. Marginal adjusted odds ratios were calculated from the logistic regression. Data were available for 10,837 Australian participants aged at least 70 years. In a follow-up assessment three years after the baseline assessment, 17.6% of people self-reported an episode of emergency care (attended an ED of called an emergency ambulance) in the last 12 months. Use of emergency healthcare was similar for men and women (17.8% vs. 17.4% p = 0.61). A score above the cut-off on the CESD at baseline was associated with greater use of emergency health care (OR = 1.35, 95% CI 1.11,1.64). When modelled separately, there was a greater association between a score above the cut-off on the CESD and emergency healthcare for women compared with men. This study is unique in demonstrating how depressive symptoms among healthy older persons are associated with subsequent increased use of emergency healthcare. Improved understanding and monitoring of mental health in primary care is essential to undertake effective healthcare planning including prevention of needing emergency care.

(335) Motivation for Vasectomy Reversal Among U.S. Military Population

Abstract Introduction Vasectomy is a relatively common procedure performed for the purposes of sterilization; however, an estimated up to 6% of men that undergo vasectomy wish for reversal at some point. Few studies have examined the motivation behind vasectomy reversal, and very limited research within special populations, such as U.S. military members. Objective The aim of this study was to explore the motivations of U.S. military servicemen who opted for vasectomy reversal (VR) surgery, considering their unique access to this surgical care. Methods We conducted a retrospective review of patient records of microsurgical vasectomy reversal performed by a single surgeon (DJH) between 2020 and 2023. We evaluated the age at which vasectomy was performed, age at vasectomy reversal, reasons for seeking VR surgical care, number of children fathered before the vasectomy, and the age of the current partner. Results During the specified period, 106 patients underwent vasectomy reversal, and 102 of them had their medical records available for evaluation. The average age at the time of vasectomy was 31.3 years, while the average age at vasectomy reversal was 40.2 years. The average age of the partners they were with at the time of seeking care was 34.8 years. Before undergoing vasectomy, the subjects had fathered an average of 2.7 children. Among the patients, 73% (76) cited having a new partner after divorce as the primary motivation for seeking vasectomy reversal. Within this group, 57 mentioned remarriage, 3 were newly engaged, and 15 were in a new relationship. One individual mentioned seeking VR after their spouse's passing to explore the possibility of fertility with a potential future partner. Additionally, 20.6% (21) of the subjects sought vasectomy reversal to have more children with the same spouse as before vasectomy. Among them, 2 men mentioned an improvement in their financial status, and 2 cited an improvement in their wife's health condition as reasons for seeking VR. Two patients opted for vasectomy reversal due to non-fertility reasons, such as scrotal pain that affected their quality of life, and one patient cited religious beliefs as their motivation. Conclusions The primary driver for seeking VR surgical care among these men was the desire for fertility with a new partner, often after divorce. However, approximately 20% of the men cited the wish to have more children with the same partner as their motivation. Non-fertility reasons, such as religious beliefs and scrotal pain after vasectomy, were also observed as motivations for seeking VR, albeit less frequently. Disclosure No.

University Students’ Mental Health Services Need and Utilization, Telemental Health Awareness, and Barriers to Seeking Care During the COVID-19 Pandemic

ABSTRACT Telemental health services have become more pressing for higher education students since the onset of the COVID-19 pandemic. The extent of that need, and barriers to accessing care, remain uncertain – including demographic inequities. Between June 2020 and December 2021, public university students (N = 1441) were surveyed about demographic factors, history of mental healthcare, telemental health awareness, and perceived pandemic-time mental healthcare needs and barriers. Approximately one-third of the sample reported feeling an increased unmet need for mental health services, with connection to services being predicted by semester cohort, neighborhood income level, mental healthcare history, and level of telemental health awareness. A variety of barriers to seeking care were endorsed by a minority of participants. Results can inform outreach and capacity efforts in the post-vaccines era to improve access to care – including telemental healthcare – for historically marginalized groups, poorer students, and those unfamiliar with mental health services.

Improving access to pediatric hydrocephalus care for all: the role of maternal health literacy and socioeconomic status.

Limited research has addressed the barriers impeding access to surgical care for pediatric patients with hydrocephalus. To identify priorities for enhancing access to pediatric hydrocephalus surgical care and to address healthcare disparities, it is essential to understand the level of access to care and the influence of socioeconomic status (SES) and maternal health literacy. In this study, the authors aimed to assess the level of access to surgical care; determine the frequency of more than a 2-week delay in seeking, reaching, and receiving care; and investigate the influence of parental SES and maternal health literacy on these delays. This observational prospective cohort study involved data collection from a sample of 100 pediatric patients aged ≤ 5 years with hydrocephalus and their mothers, including information on family SES (education, occupational, and economic status). Maternal health literacy was assessed using the Brief Health Literacy Screen (BHLS) questionnaire. The Three Delays framework from the Lancet Commission on Global Surgery, categorizing delays in seeking care, reaching care, and definitive care, provided a structured approach for analyzing access delays. Statistical significance was set at p < 0.05. Among the pediatric patients, there was a male-to-female ratio of 1.7:1, with a median age of 1.5 months. None of the patients had insurance coverage that included surgical treatment. A significantly low number of patients accessed care within 2 weeks for seeking care duration (34%), reaching care duration (15%), and definitive care duration (1%). The median time to definitive surgical treatment for the entire study population was 14 weeks (upper SES: median 6.3 weeks, middle SES: median 9.8 weeks, lower SES: median 16.7 weeks). Through Cox proportional hazards regression, a hazard ratio of 0.046 (95% CI 0.010-0.210) was obtained. Multiple linear regression analysis identified BHLS Brief D (β = -0.335, p = 0.001) and SES (β = 0.389, p < 0.001) as predictor variables for delays in seeking care and definitive care, respectively. SES (β = 0.446, p < 0.001) and Evans index (β = 0.233, p = 0.010) were predictor variables for delays in reaching care. Maternal health literacy and SES were identified as factors associated with delays in accessing neurosurgical care for pediatric patients with hydrocephalus. To reduce disparities in pediatric hydrocephalus care, it is essential to implement strategies that promote education, improve healthcare infrastructure, and provide support to families encountering challenges related to low SES and limited maternal health literacy.

Women's experiences of receiving antenatal and intrapartum care during COVID-19 at public hospitals in the Sidama region, Ethiopia: A qualitative study using the combination of three delay and social-ecological framework (hybrid framework).

The COVID-19 pandemic, drought and internal conflict have worsened Ethiopia's already weak healthcare system. Antenatal and intrapartum care are especially prone to interruption under these circumstances. To explore women's experiences receiving antenatal and intrapartum care during the pandemic. A descriptive qualitative approach was utilised. We conducted in-depth interviews with 17 women and held 4 focus group discussions with women who gave birth at 4 public hospitals during the pandemic. A study was conducted at four public hospitals in the Sidama region of Ethiopia, during which data were collected from 14 February to 10 May 2022. Thematic analysis was performed to generate themes. The peak of the COVID-19 pandemic in Ethiopia presented several barriers to access and uptake of antenatal and intrapartum care at public hospitals. Four themes and 10 subthemes emerged from the thematic analysis. The themes were 'Barriers to maternity care uptake during COVID-19', 'Shortage of resources during COVID-19', 'Delays in maternity care uptake during COVID-19' and 'Mistreatment of women during maternity care during COVID-19'. The subthemes included 'Fear of contracting COVID-19', 'People in the hospital neglecting COVID-19 prevention', 'Women losing their job during COVID-19', 'Shortage of beds in the labour ward', 'Shortage of medical supplies', 'Delays in seeking care', 'Delays in receiving care', 'Complications during childbirth', 'disrespectful' and 'suboptimal care'. The findings of this study underscore the impact of COVID-19 on antenatal and intrapartum care, leading to delays in seeking and receiving care due to reduced rapport, resource shortages, companion restrictions, disrespectful care and suboptimal care. These factors contribute to increased obstetric complications during COVID-19. It is imperative for policymakers to prioritise essential resources for antenatal and intrapartum care in the present and future pandemics. Moreover, healthcare providers should maintain respectful and optimal care even amid challenges.

Determinants of Intention to Disclose Musculoskeletal Injury in Adolescent Athletes.

Although research indicates that the key to minimizing the effect of musculoskeletal injury, improving care, and mitigating long-term effects is to improve early injury care seeking, little is known about barriers to early musculoskeletal injury disclosure and care seeking. To identify which determinants predicted sport-related musculoskeletal (MSK) injury disclosure by adolescent athletes. Cross-sectional study. Online survey. A total of 564 adolescent athletes (58% male, age = 15.81 ± 1.8 years). Online survey exploring determinants of age, gender, race, socioeconomic status, injury knowledge, attitudes, perceived social norms, and perceived behavioral control surrounding MSK injury disclosure, intention to disclose MSK injury, and actual behavior of disclosing MSK injury. Of the respondents, 457 (80.2%) reported having sustained ≥1 (mean = 3.2 ± 2.2; range = 1-10) MSK injuries related to sport. Those who endorsed having experienced an MSK injury disclosed not reporting or purposefully hiding 77% of their suspected MSK injuries. Several factors influenced a high intention to disclose MSK injury. Specifically, for each unit increase in total MSK injury knowledge (Exp[β]= 1.061, β=0.054, P = .020, 95% CI = 1.031, 1.221) and attitude (Exp[β]= 1.070, β = 0.064, P < .001, 95% CI = 1.027, 1.115) score, 6% and 7% increases in the likelihood of a high intention to disclose an MSK injury, respectively, were observed. Moreover, for each unit increase in the social norm score (Exp[β]= 1.178, β=0.164, P < .001, 95% CI = 1.119, 1.241), an 18% increase in the likelihood of a high intention to disclose an MSK injury was noted. Designing interventions geared toward increasing the knowledge of signs and symptoms of MSK injury, improving attitudes surrounding disclosure, and better understanding the social context of disclosing MSK injuries may improve MSK injury disclosure behavior and reduce the associated social and economic burdens of these injuries.

Barriers to Timely Seeking of Breast Cancer Care Among Palestinian Women: A Cross-Sectional Study.

Examining the association of breast cancer (BC) symptom awareness with time to help seeking and exploring barriers to timely presentation may enhance the effectiveness of BC awareness campaigns and early detection efforts. This study aimed to assess the anticipated time for seeking medical advice when experiencing a potential BC symptom among women in Palestine and to identify their barriers to early presentation. A convenience sampling method was used to recruit adult women from hospitals, primary health care facilities, and public areas across 11 governorates in Palestine. A translated-into-Arabic version of the validated BC Awareness Measure was used. The questionnaire consisted of three sections: sociodemographic information, recognition of 13 BC symptoms and reporting time for seeking medical advice, and barriers to early presentation. A total of 5,257 questionnaires were included. The proportion of participants who would seek medical advice immediately varied on the basis of the nature of BC symptoms. For symptoms related to the breast, the proportion ranged from 25.7% for redness of the breast skin to 53.5% for a lump or thickening in the breast. For symptoms related to the nipple, the proportion ranged from 30.7% for nipple rash to 48.0% for discharge or bleeding from the nipple. Exhibiting good BC symptom awareness was associated with a higher likelihood of seeking medical advice within a week for all BC symptoms. Emotional barriers were the most frequently reported barriers. There was no association between increasing levels of BC awareness and reporting fewer or more barriers. The nature of BC symptoms had an impact on help-seeking behaviors. Participants with good BC symptom awareness were more likely to seek medical advice earlier.

Navigating antenatal care: The lived experiences of adolescent girls and young women and caregiver perspectives in Zambia.

Adolescent pregnancy remains a global concern, especially in low- and middle-income countries. Sub-Saharan African nations, including Zambia, bear a disproportionate burden of adolescent pregnancies, contributing to high rates of maternal and child mortality. Despite efforts to improve antenatal care (ANC) services, utilization rates remain suboptimal, especially among adolescent girls and young women (AGYW). To explore the barriers and facilitators to ANC services among AGYW and how these factors might differ by age and HIV status. This qualitative study employs a combination of in-depth interviews (IDIs) and focus group discussions (FGDs) to gather comprehensive insights into the experiences of AGYW regarding ANC services. The study design follows a socio-ecological framework (SEF) to identify multiple levels of influence on ANC utilization. We conducted 40 IDIs with AGYW aged 15-24; and 2 FGDs with caregivers of AGYW (n = 16). IDIs explored AGYWs barriers and facilitators to accessing and utilizing healthcare services during pregnancy, as well as social support and HIV treatment and prevention. FGD topics included social support, barriers and facilitators to ANC, and HIV services. We developed a codebook based on the SEF and coded transcripts using Dedoose software. Results showed that early pregnancy knowledge did not always translate to AGYW seeking ANC services right away or within the first trimester. More than half of the AGYW did not initiate ANC until well into the second trimester. Factors including lack of motivation, denial of pregnancy, desires to terminate pregnancies, social norms, policies, clinic environment, and financial constraints contributed to delays in ANC initiation. Social support from family, partners, peers, and the community were crucial motivators for early ANC. Lastly, challenges to ANC continuation included lack of transportation, long clinic waiting times, perceived provider indifference, and stigma at both community and clinic levels. In conclusion, gaining insights from qualitative data is essential for comprehensively understanding the barriers and challenges to accessing ANC among this specific age group. By identifying and addressing these barriers while enhancing facilitators, effective programs can be developed and implemented to improve the health and well-being of young mothers and their children.

How do Cancer Patients in Economically Marginalized Neighborhoods Decide Where to Seek Care: Perspectives From Cancer Patients and Healthcare Professionals.

The quality of cancer care affects patient outcomes. It is therefore important to understand what factors and/or barriers shape a cancer patient's decision about where to seek care. We sought to understand factors influencing decision-making for historically marginalized communities in a large metropolitan area with multiple options for cancer care, including a National Cancer Institute (NCI)-designated comprehensive cancer center. We conducted semi-structured interviews with cancer patients from economically marginalized neighborhoods in Washington D.C., and with healthcare professionals who work with patients from these areas. Participants were recruited through flyers, social media posts, and word of mouth. Two researchers analyzed the data using a combination of inductive and deductive approaches supported by the ATLAS. ti software. A total of 15 interviews were conducted. Analysis revealed 3 major factors influencing where patients decide to seek care: health insurance, transportation, and prioritization of needs. Participants repeatedly identified navigating the bureaucracy of insurance enrollment and high medical costs as prohibitive to seeking care. Transportation was often mentioned in terms of convenience of use and proximity to the care center. Prioritization of needs refers to circumstances such as unstable housing, poverty, and mental illness, that some patients prioritize over seeking quality cancer care. Across these themes 2 findings arose: a discrepancy between stated and actual factors in choosing an oncologist, and the extent to which a cancer patient is able to choose their oncologist. This study helps explain some of the factors that influence how cancer patients in urban settings choose an oncology center, and the barriers which prohibit access. This study aimed to understand how cancer patients decide where to seek treatment.

Non-communicable disease care in Sierra Leone: a mixed-methods study of the drivers and barriers to retention in care for hypertension

ObjectiveTo retrospectively analyse routinely collected data on the drivers and barriers to retention in chronic care for patients with hypertension in the Kono District of Sierra Leone.DesignConvergent mixed-methods study.SettingKoidu Government...

MORBIDITY PROFILE AND RISK FACTORS AMONG UNDER-FIVES AND HEALTH CARE SEEKING BEHAVIOURS OFTHEIR PARENTS

The present study investigated the morbidity profile and its risk factors amongunder-fivesand the health care seeking behavioursof their parents in a selectedPanchayat,Ernakulam.Theobjectivesofthestudyweretoassessthemorbidityprofileand its risk factors among under-fives and health care seeking behaviours of parentsand to find the association between morbidity and selected demographic variables andselectedriskfactors.Across-sectionalcommunity-baseddescriptivesurveydesignwasemployed.Thesamplewereselectedusingconveniencesamplingtechnique.Thetoolsweremorbidityprofileassessmentchecklist,riskfactorassessmentchecklistandhealthcare seeking behaviour checklist tool. The findings showed that 81% children hadmorbidityand19%hadnomorbidity.Themost commonmorbidconditionswerecoldand running nose (76%),followed by cough (73%),fever (64%) and hand foot andmouth disease(8%).With regard to a risk factors leading to morbidity, 27% were notgiven exclusive breast feeding, 25% did not start complimentary feeding at the end ofsix months, 14% did not wash their hands before feeding the children, 28% had nofamily history of respiratory tract infection, 20% had no proper ventilation at home,34% had no proper waste disposal, 67% were exposed to passive smoking, 52% ofchildrenweregoingtoAnganwadiand4%hadcongenitaldisorders.Presentstudyalsoshowsthat52%ofmothersreliedonallopathicsectorandequalpercentage(12%)usedAyurvedaandprevious medicationand14%madeuseofhomeremedyduringdiseaseconditions of their children. The findings also showed that there was no associationbetweenmorbidityandselecteddemographicvariables.Thefindingsshowedtherewasassociation between morbidity and using boiled water for drinking (p = 0.038), familyhistoryofrespiratory infections(p=0.05),child goingto day-care/Anganwadi.

Evaluating High-performance Female Athletes’ Knowledge and Awareness of Atrial Fibrillation

Background: Atrial fibrillation (AFib) is a common cardiac arrhythmia with emerging evidence suggesting a high risk in athletes may exist, especially those engaged in vigorous physical activity. While substantial research has examined male athletes, limited data exists for female athletes, despite their growing presence in elite sports. AFib poses a health risk as it can progress without symptoms, potentially leading to severe complications, including heart failure and stroke. Athletes, accustomed to discomfort in their competitive pursuits, may delay seeking care even after retiring from sport, compounding the issue. Objectives: Therefore, we investigated the level of AFib-related knowledge in Canadian females, defined as high-performance athletes who had or were competing at a national or international level. Methods: Our online cross-sectional survey employed the 21-question Atrial Fibrillation Knowledge and Assessment Tool (AFKAT), with an additional question to assess awareness of an AFib diagnosis. Results: Participants were recruited through research websites and were mostly over 40 years old (45/52), Caucasian (50/52), university educated (39/53), from the sport of curling (41/52), and 62% (32/52) had competed at an international level. The mean knowledge score was 12.63 ± 5.79 out of 21 and was significantly different between international-level athletes (14.22 ± 4.38) when compared to national-level athletes (10.10 ± 6.91; p = 0.011). Conclusions: Varying levels of AFib knowledge were observed within this population, and our results importantly identified a discrepancy based on competition level, with international-level female athletes demonstrating higher AFib knowledge levels. This highlights the necessity for targeted educational interventions, to inform and increase athletes’ cardiovascular awareness of the potential risk of AFib.

Impact of the Sars-Cov-2 outbreak on the initial clinical presentation of new solid cancer diagnoses: a systematic review and meta-analysis

BackgroundThe COVID-19 pandemic might have delayed cancer diagnosis and management. The aim of this systematic review was to compare the initial tumor stage of new cancer diagnoses before and after the pandemic.MethodsWe systematically reviewed articles that compared the tumor stage of new solid cancer diagnoses before and after the initial pandemic waves. We conducted a random-effects meta-analysis to compare the rate of metastatic tumors and the distribution of stages at diagnosis. Subgroup analyses were performed by primary tumor site and by country.ResultsFrom 2,013 studies published between January 2020 and April 2022, we included 58 studies with 109,996 patients. The rate of metastatic tumors was higher after the COVID-19 outbreak than before (pooled OR: 1.29 (95% CI, 1.06-1.57), I2: 89% (95% CI, 86-91)). For specific cancers, common ORs reached statistical significance for breast (OR: 1.51 (95% CI 1.07-2.12)) and gynecologic (OR: 1.51 (95% CI 1.04-2.18)) cancers, but not for other cancer types. According to countries, common OR (95% CI) reached statistical significance only for Italy: 1.55 (1.01-2.39) and Spain:1.14 (1.02-1.29). Rates were comparable for stage I-II versus III-IV in studies for which that information was available, and for stages I-II versus stage III in studies that did not include metastatic patients.ConclusionsDespite inter-study heterogeneity, our meta-analysis showed a higher rate of metastatic tumors at diagnosis after the pandemic. The burden of social distancing policies might explain those results, as patients may have delayed seeking care.

Assessment of Various Factors Contributing to Unfavourable Oral Health Care Seeking Behaviour: A Cross-Sectional Study.

Access to effective oral health care is crucial for a good quality of life. Unfortunately, many individuals face barriers in accessing the necessary oral health care services. By examining various factors, we can gain a better understanding of the challenges faced by the population and work towards improving oral health care outcomes. This study aims to assess the various factors contributing to unfavorable oral healthcare-seeking behavior in Chennai city. A cross-sectional study was conducted in Chennai city involving six hundred and twenty-four individuals from the general population from 12 wards by lottery method. The data collection process involved interviews using a pre-designed questionnaire, through which demographic information was gathered. The Penchansky and Thomas model was employed to assess barriers in service utilization. All completed questionnaires were included in the data analysis, which was performed using SPSS version 20. In the present study, among the various dimensions of access suggested by Penchansky and Thomas, the major reason for unfavorable oral healthcare-seeking behavior was accommodation (54.8%), followed by affordability (20.2%), accessibility (5.6%), acceptability (4.4%), and availability (1.1%). The other reasons that contributed were sociocultural factors (26.4%), lack of awareness (20.8%), and psychosocial factors (11.8%). The present study highlights lack of time as the major factor contributing to unfavourable oral healthcare-seeking behaviour in an urban population. This finding contrasts with previous studies that have focussed on the lack of awareness about dental diseases and the high cost of dental treatment in rural areas.

Access to quality care after injury in Northern Malawi: results of a household survey

BackgroundMost injury care research in low-income contexts such as Malawi is facility centric. Community-derived data is needed to better understand actual injury incidence, health system utilisation and barriers to seeking care following injury.MethodsWe administered a household survey to 2200 households in Karonga, Malawi. The primary outcome was injury incidence, with non-fatal injuries classified as major or minor (> 30 or 1–29 disability days respectively). Those seeking medical treatment were asked about time delays to seeking, reaching and receiving care at a facility, where they sought care, and whether they attended a second facility. We performed analysis for associations between injury severity and whether the patient sought care, stayed overnight in a facility, attended a second facility, or received care within 1 or 2 h. The reason for those not seeking care was asked.ResultsMost households (82.7%) completed the survey, with 29.2% reporting an injury. Overall, 611 non-fatal and four fatal injuries were reported from 531 households: an incidence of 6900 per 100,000. Major injuries accounted for 26.6%. Three quarters, 76.1% (465/611), sought medical attention. Almost all, 96.3% (448/465), seeking care attended a primary facility first. Only 29.7% (138/465), attended a second place of care. Only 32.0% (142/444), received care within one hour. A further 19.1% (85/444) received care within 2 h. Major injury was associated with being more likely to have; sought care (94.4% vs 69.8% p < 0.001), stayed overnight at a facility (22.9% vs 15.4% P = 0.047), attended a second place of care (50.3% vs 19.9%, P < 0.001). For those not seeking care the most important reason was the injury not being serious enough for 52.1% (74/142), followed by transport difficulties 13.4% (19/142) and financial costs 5.6% (8/142).ConclusionInjuries in Northern Malawi are substantial. Community-derived details are necessary to fully understand injury burden and barriers to seeking and reaching care.

P693 Care needs and reasons for (not) seeking care among fatigued patients with Inflammatory Bowel Disease: A qualitative study

Abstract Background Fatigue is one of the most prevalent and burdensome symptoms experienced by patients with inflammatory bowel disease (IBD), even when the disease is in remission. Many patients report dissatisfaction towards fatigue-related care and uptake of available interventions is often low. This study aims to explore reasons why IBD patients do or do not engage in professional fatigue-related care and their needs regarding type of care and how to offer care. Methods We conducted a qualitative study, taking a phenomenological methodological approach. Sixteen adult IBD patients with disease in remission and severe fatigue (i.e., Checklist Individual Strength – subjective fatigue ≥ 35) were recruited from an academic hospital. We performed semi-structured interviews. Data were analysed using template analyses. Results We identified six themes regarding reasons why to (not) seek care for fatigue: 1) cognitions about fatigue and coping (e.g., a need to deal with fatigue alone), 2) perceptions of fatigue-related care and previous care experiences (e.g., perceiving that nothing can be done about fatigue), 3) knowledge and behaviour of the healthcare provider (e.g., fatigue complaints are not taken seriously), 4) somatic factors (e.g., physical symptoms of IBD), 5) social factors (e.g., feeling misunderstood by others) and 6) practical factors (e.g., time and money). Furthermore, we identified needs regarding how to offer care, i.e., proactive screening and active offer of care by healthcare providers, a holistic and person-centred approach and practical needs taken into account. Finally, regarding what care to offer, patients suggested a broad range of options, including information provision on fatigue management, eliminating physical causes of fatigue, discussing medication options, lifestyle support, psychological support, peer support and practical support. Conclusion IBD patients’ perceptions, coping and knowledge, as well as healthcare professionals’ behaviours play a major role in seeking fatigue-related care. Findings emphasize the importance of discussing IBD-related fatigue actively and taking a holistic and patient-centred approach to treat fatigue, targeting a broad range of physical- and psychological factors. These findings yield a better understanding of factors that hinder and facilitate care seeking in fatigued IBD patients and hereby provide ways to optimize the uptake of care.

Healthcare seeking behavior and delays in case of Drug-Resistant Tuberculosis patients in Bangladesh: Findings from a cross-sectional survey.

The emergence of Drug-Resistant Tuberculosis (DR-TB) has become a major threat globally and Bangladesh is no exception. Delays in healthcare seeking, proper diagnosis and initiation of treatment cause continuous transmission of the resistant tubercule bacilli through the communities. This study aimed to assess the different health care-seeking behaviors and delays among DR-TB patients in Bangladesh. A prospective cross-sectional study was conducted from November to December 2018, among 92 culture positive and registered DR-TB patients in four selected hospitals in Bangladesh. Data were collected through face-to-face interviews with survey questionnaire as well as record reviews. Among the 92 study participants, the median patient delay was 7 (IQR 3, 15) days, the median diagnostic delay was 88 (IQR 36.5, 210), the median treatment delay was 7 (IQR 4,12) days, and the median total delay among DR-TB patients was 108.5 (IQR 57.5, 238) days. 81.32% sought initial care from informal healthcare providers. The majority (68.48%) of the informal healthcare providers were drug sellers while 60.87% of patients sought care from more than four healthcare points before being diagnosed with DR-TB. The initial care seeking from multiple providers was associated with diagnostic and total delays. In Bangladesh, DR-TB cases usually seek care from multiple providers, particularly from informal providers, and among them, alarmingly higher healthcare-seeking related delays were noted. Immediate measures should be taken both at the health system levels and, in the community, to curb transmission and reduce the burden of the disease.

Factors associated with non-urgent presentations in the paediatric emergency department using Andersen's behavioural model: A cross-sectional descriptive study.

To explore the rate of NUPs and associated factors in the PED of the 'Hospital Universitario y Politécnico La Fe' in Valencia (Spain) using Andersen's Behavioural Model. We conducted a descriptive cross-sectional study using Andersen's Behavioural Model in parents visiting the PED with their children at the 'Hospital Universitario y Politécnico La Fe' in Valencia (Spain). The study involved a total of 530 participants, of whom 419 (79%) had made an NUP. The predisposing factors identified were: (I) paediatric patients brought in by their fathers (OR = 0.460; p = 0.005), (II) lower educational attainment (OR = 3.841; p = 0.000), (III) first-time parenthood (OR = 2.335; p = 0.000) and (IV) higher parental stress (OR = 1.974; p = 0.023). The enabling factors included: (I) responsibility for a significant part of the childcare shared with others (OR = 0.348; p = 0.041) and (II) the perception that PEDs provide better care than primary care (PC) services (OR = 1.628; p = 0.005). The need factors were: (I) existing chronic illness in the child seeking care (OR = 0.343; p = 0.000) and (II) the perceived severity of the urgency (OR = 0.440; p = 0.031). The NUP rates found in this study are similar to those found internationally. In accordance with Andersen's Behavioural Model, we identify predisposing, enabling and need factors to explain the multifactorial nature of NUPs in PEDs. Identifying the factors associated with NUPs enables interventions to be targeted at those groups most likely to engage in NUPs, thereby optimising the functioning of the PED and improving the well-being of children and families. These interventions should focus on improving parental health literacy, providing education on making appropriate decisions about accessing health services and recognising severe symptoms in children, as well as improving access to high-quality PC services. Providing support to parents during the transition to parenthood would also be beneficial. This paper adheres to the STROBE initiative guidelines. Participants, who voluntarily agreed to take part, contributed to the study by completing a paper-based questionnaire containing all the study variables as prepared by the research team.

Health system assessment for access to care after injury in low- or middle-income countries: A mixed methods study from Northern Malawi.

Injuries represent a vast and relatively neglected burden of disease affecting low- and middle-income countries (LMICs). While many health systems underperform in treating injured patients, most assessments have not considered the whole system. We integrated findings from 9 methods using a 3 delays approach (delays in seeking, reaching, or receiving care) to prioritise important trauma care health system barriers in Karonga, Northern Malawi, and exemplify a holistic health system assessment approach applicable in comparable settings. To provide multiple perspectives on each conceptual delay and include data from community-based and facility-based sources, we used 9 methods to examine the injury care health system. The methods were (1) household survey; (2) verbal autopsy analysis; (3) community focus group discussions (FGDs); (4) community photovoice; (5) facility care-pathway process mapping and elucidation of barriers following injury; (6) facility healthcare worker survey; (7) facility assessment survey; (8) clinical vignettes for care process quality assessment of facility-based healthcare workers; and (9) geographic information system (GIS) analysis. Empirical data collection took place in Karonga, Northern Malawi, between July 2019 and February 2020. We used a convergent parallel study design concurrently conducting all data collection before subsequently integrating results for interpretation. For each delay, a matrix was created to juxtapose method-specific data relevant to each barrier identified as driving delays to injury care. Using a consensus approach, we graded the evidence from each method as to whether an identified barrier was important within the health system. We identified 26 barriers to access timely quality injury care evidenced by at least 3 of the 9 study methods. There were 10 barriers at delay 1, 6 at delay 2, and 10 at delay 3. We found that the barriers "cost," "transport," and "physical resources" had the most methods providing strong evidence they were important health system barriers within delays 1 (seeking care), 2 (reaching care), and 3 (receiving care), respectively. Facility process mapping provided evidence for the greatest number of barriers-25 of 26 within the integrated analysis. There were some barriers with notable divergent findings between the community- and facility-based methods, as well as among different community- and facility-based methods, which are discussed. The main limitation of our study is that the framework for grading evidence strength for important health system barriers across the 9 studies was done by author-derived consensus; other researchers might have created a different framework. By integrating 9 different methods, including qualitative, quantitative, community-, patient-, and healthcare worker-derived data sources, we gained a rich insight into the functioning of this health system's ability to provide injury care. This approach allowed more holistic appraisal of this health system's issues by establishing convergence of evidence across the diverse methods used that the barriers of cost, transport, and physical resources were the most important health system barriers driving delays to seeking, reaching, and receiving injury care, respectively. This offers direction and confidence, over and above that derived from single methodology studies, for prioritising barriers to address through health service development and policy.

Knowledge of Postnatal Danger Signs and Associated Factors among Mothers in Nepal

BACKGROUND: The postpartum period is crucial, and it is essential to recognize warning signs. Unfortunately, maternal mortality rates remain high due to postpartum complications, especially in developing countries like Nepal. Many mothers are not aware of postnatal warning signs, which can delay them from seeking necessary medical care and increase the risk of maternal mortality. The main objective of study to identify mothers' knowledge of postnatal danger signs and the relevant factors. METHOD: A study was conducted in Chitwan, covering three municipalities: Madi, Rapti, and Ratnanagar. A stratified proportionate-based simple random sampling technique was used to recruit 527 mothers for the study. Data was collected through face-to-face interviews using a structured questionnaire, and statistical analysis was conducted using SPSS version 21. A multivariate logistic regression was used to determine the factors associated with the knowledge of postnatal danger signs. RESULT: Out of the total respondents, only 209 (39.7%) demonstrated good awareness regarding postpartum danger signs. To be considered informed, a woman must be able to list at least three common warning signs. However, the majority of respondents consistently identified vaginal bleeding as a dangerous sign postpartum. The study found that modern health care seeking behavior (AOR=1.63, 95% CI:1.04-2.55), occupation in service (AOR=3.19, 95% CI:1.39-7.29), and time to reach the health facility (AOR=1.96, 95% CI:1.18-3.25) were significantly associated with knowledge of postnatal danger signs. Of these, 67 (12.7%) faced postnatal danger signs during their postpartum period. Among those, the majority (39 or 7.4%) had a good practice of seeking a health facility for care and treatment. CONCLUSION: It is encouraging that mothers become more aware of postnatal danger signs despite their initial low level of awareness. Factors such as the mother's age, occupation, educational background, age of marriage and first childbirth, number of ANC visits, and healthcare-seeking behavior are significantly associated with their awareness of postnatal danger signs. Therefore, healthcare providers should focus on these factors to improve the mothers' knowledge of postnatal danger signs.