Health Care Choices Research Articles

Differential effects of different delivery methods on progression to severe postpartum hemorrhage between Chinese nulliparous and multiparous women: a retrospective cohort study

BackgroundDelivery methods are associated with postpartum hemorrhage (PPH) both in nulliparous and multiparous women. However, few studies have examined the difference in this association between nulliparous and multiparous women. This study aimed to explore the difference of maternal and neonatal characteristics and delivery methods between Chinese nulliparous and multiparous women, and then examine the differential effects of different delivery methods on PPH between these two-type women.MethodsTotally 151,333 medical records of women who gave birth between April 2013 to May 2016 were obtained from the electronic health records (EHR) in a northern province, China. The severity of PPH was estimated and classified into blood loss at the level of < 900 ml, 900–1500 ml, 1500–2100 ml, and > 2100 ml. Neonatal and maternal characteristics related to PPH were derived from the same database. Multiple ordinal logistic regression was used to estimate associations.ResultsMedical comorbidities, placenta previa and accreta were higher in the nulliparous group and the episiotomy rate was higher in the multiparous group. Compared with spontaneous vaginal delivery (SVD), the adjusted odds (aOR) for progression to severe PPH due to the forceps-assisted delivery was much higher in multiparous women (aOR: 9.32; 95% CI: 3.66–23.71) than in nulliparous women (aOR: 1.70; 95% CI: 0.91–3.18). The (aOR) for progression to severe PPH due to cesarean section (CS) compared to SVD was twice as high in the multiparous women (aOR: 4.32; 95% CI: 3.03–6.14) as in the nulliparous women (aOR: 2.04; 95% CI: 1.40–2.97). However, the (aOR) for progression to severe PPH due to episiotomy compared to SVD between multiparous (aOR: 1.24; 95% CI: 0.96–1.62) and nulliparous women (aOR: 1.55; 95% CI: 0.92–2.60) was not significantly different. The (aOR) for progression to severe PPH due to vacuum-assisted delivery compared to SVD in multiparous women (aOR: 2.41; 95% CI: 0.36–16.29) was not significantly different from the nulliparous women (aOR: 1.05; 95% CI: 0.40–2.73).ConclusionsForceps-assisted delivery and CS methods were found to increase the risk of severity of the PPH. The adverse effects were even greater for multiparous women. Episiotomy and the vacuum-assisted delivery, and SVD were similar to the risk of progression to severe PPH in either nulliparous or multiparous women. Our findings have implications for the obstetric decision on the choice of delivery methods, maternal and neonatal health care, and obstetric quality control.

Characterising heterogeneity and the role of attitudes in patient preferences: A case study in preferences for outpatient parenteral intravenous antimicrobial therapy (OPAT) services

Choice modelling techniques have established themselves as a key analysis tool in health economics and have been used to understand patient and practitioner preferences across a wide variety of settings. A key interest in recent years has been the incorporation of ever more flexible levels of heterogeneity in preferences across individual decision makers, and in particular a growing interest in the potential role that attitudes and perceptions might play in healthcare choices. At the same time however, many applications simply apply these new tools without then investigating the resulting richness in the results. This paper not only presents a novel application of hybrid choice modelling in health, by looking at preferences for outpatient parenteral intravenous antimicrobial therapy (OPAT), but also carefully explores the findings in terms of sources of heterogeneity, disentangling the role of attitudes from other heterogeneity. We find that a large share of the heterogeneity can be attributed to two key underlying attitudinal constructs, related to the general attitude towards hospitals and whether responsibility for healthcare should lie with the patient or the practitioner. Especially the latter accounts for more than 60% of the overall heterogeneity in preferences for the type of treatment. These results may help design services that are suitable and appealing for a wide variety of patients as well as providing some insights into how nudging of attitudes and perceptions could help drive patients towards safer and more cost-effective treatment options.

Strategies of Avoiding Medicolegal Problems

“Medicine is of all the arts the most noble, but owing to ignorance of those who practice it, and those who, inconsiderately form a judgment of them, it is at present far behind all other arts.” Hippocrates The provision of unnecessary health care is a serious problem and involves two key legal issues. First, doctors’ fear of litigation drives defensive practices – ordering tests and procedures, making referrals, and prescribing drugs to reduce perceived legal risks, rather than to advance patient care. Second, suboptimal communication and decision-making processes undermine a patient’s right to make informed health-care choices [1]. Information is available to judge and evaluate with limited knowledge in the field. Do we feel the same thing nowadays? Probably yes; and before consulting a patient, medicolegal implications are the first fear in our mind due to some of the facts such as decline in self-regulatory standards, rise in medical malpractices and commercialization, imbalance between service and business, and lack of an effective internal or external regulation. We must not forget the truth that there is a public outcry against medical profession due to some incidences, which is generally being applied to all healthcare professional community by media because of negative coverage. We should also remember that this is not the commonest issue in each doctor’s career; and media are not always negative, however, only a few incidences will imprint a general impression on the mindset of public and end up in to medicolegal consequences. We must come out of this fear and phobia and succeed in career if we maintain an acceptable standard of care and communication. If we discuss about the difference of medicolegal problems between physicians and surgeons, it is found that surgeons receive complaints twice as much as received by physicians [2]. This increased risk of litigation arises partly from involvement in surgical procedures and treatments but also reflects wider

The impact of code status simplification on end-of-life health care choices in gynecologic oncology

The impact of code status simplification on end-of-life health care choices in gynecologic oncology

Patient Experience Information: Streamlining and Harmonizing the Collection of Patient Preference and Patient-Reported Outcomes Data.

Patient-reported outcome (PRO) research is conducted to gather information on an individual's disease or treatment experiences. Patient preference (PP) research is conducted to gather an individual's evaluation of alternatives or choices among outcomes or other attributes. The fields of PRO and PP research have largely been kept separate, partly because the use and audience have been different; although both can influence health care choices. Recent initiatives on the generation of 'patient experience information' provide a regulatory framework for simultaneous consideration of PRO and PP data. This should act as an impetus for PRO and PP researchers to collaborate to generate scientifically robust information on patients' experiences, perspectives, needs, and priorities. This article discusses the similarities between PRO and PP research and proposes a streamlined and harmonized approach from which sponsors can provide regulators (and payers, clinicians, caregivers, and patients) with information derived using psychometrically robust and interpretable PRO and PP methodologies.

Understanding how the Australian vaccine-refusal movement perceives itself.

Public health responses to the vaccine-refusal (VR) movement are hindered by inadequate research about the movement's aims, identity and perceived value for its members. This study examined how members of the VR movement in Australia described the movement and what being part of it meant to them. Descriptions of the VR movement by 696 members from across Australia were collected between January and May in 2017 via an online survey. The data were analysed using thematic discourse analysis. Members' understandings of the movement and the beliefs underpinning these understandings were examined. Vaccine refusal was underpinned by distinct epistemic beliefs. Participants believed that mainstream vaccine promotion relies on dishonest communication of compromised research. They saw the VR movement as a science-based movement, researching both 'mainstream' and 'hidden' knowledge, promoting scientific values and advocating for better vaccine studies. Participants believed responsible parenting requires personally researching healthcare choices. Participants constructed the movement's identity in relation to common criticisms of vaccine refusal. These were discredited and repurposed to portray the movement as being brave and righteous. Participants believed people in the movement are astute, informed, responsible and courageous. They believed many members were impacted by vaccine-related harms, from which the movement now saves others. They saw themselves as fighting for an inconvenient truth that the mainstream ignores. Vaccine promotion needs to address the epistemic beliefs associated with vaccine refusal, yet these have been inadequately understood. Our findings contribute to understanding these beliefs. Furthermore, our findings suggest what messages targeting vaccine-refusing people should focus on. This may include acknowledging the significant effort that vaccine-refusing people invest in trying to protect their children, catering to vaccine-refusing people's high engagement and desire for detailed information, and avoiding stigmatising or confrontational vaccine-promotion strategies.

Healthcare Transparency in the Age of COVID-19

In addition to causing widespread morbidity and mortality, the COVID-19 pandemic has transformed everyday life and has placed an enormous burden on a US healthcare system for which rising costs were already a major concern. Well before the current crisis, there was wide recognition of the need for greater healthcare price transparency in the United States as a way to promote competition, reduced spending, and a more efficient allocation of resources. The additional demands of the COVID-19 pandemic have accentuated the need for policymakers to take this opportunity to advance healthcare transparency as well as give consumers incentives to use the newly available information to make better healthcare choices. There are short-term measures that can be taken even as the medical impact of COVID-19 is being brought under control. More importantly, longer-term structural reform of the current insurance-based financing system is needed in order to alleviate the stress on the healthcare system and obviate the need for government intervention.

Community-based Skill Building Intervention to Enhance Health Literacy Among Older Rural Adults.

The purpose of this article is to report the outcomes of a skill building intervention to improve general health literacy and health literacy about complementary and alternative therapies (CAM) among older rural adults. The intervention was implemented in eight rural communities. Descriptive statistics and general linear modeling were used for analysis. A total of 127 older adults completed the initial session and Time 1 questionnaire, 67 (51%) completed the intervention sessions and Time 2 questionnaire, and 52 (40.9%) completed the Time 3 questionnaire five months later. CAM health literacy scores and scores on one general health literacy measure were significantly higher at Time 2 compared to Time 1 and 3. The decline in scores over time suggests a need for continuing strategies to support older adults' health literacy. Assisting older adults to make safe health care choices is a critical role for investigators, nurses, and other health care providers.

Language proficiency and biologics access: a population study of psoriasis patients in the United States

Background Language proficiency plays an important role in healthcare choices and access. Differences in access to biologic medications exist, but it is unknown how much English proficiency influences access in US psoriasis patients. Objective To compare biologic medication use for psoriasis patients with differing English proficiency levels. Methods Population study of US psoriasis patients using the 2013–2017 Medical Expenditure Survey. Results Among a total of 4,470,820 US psoriasis patients (weighted), 4,028,119 (90.1%) had perfect English proficiency, and 442,700 (9.9%) had less than perfect English proficiency. Among the total population, 422,523 (9.5%) had access to biologics. Among those who received biologics, 411,411 (97.4%) of those had perfect English proficiency, and 11,112 (2.6%) of those had less than perfect English proficiency. Multivariate logistic regression found that patients with less than perfect English proficiency were significantly less likely to have access to biologics [OR 0.015 (95% CI: 0.001–0.179); p = .002], after adjusting for insurance status, income, education, healthcare utilization, and other sociodemographic and clinical factors. Limitations Psoriasis disease severity not specified. Conclusions Psoriasis patients with low English proficiency are significantly less likely to receive biologics than those with high English proficiency. Those with higher English proficiency are 61 times more likely to access biologics.

Genetic Variant Reinterpretation: Economic and Population Health Management Challenges.

Genetic Variant Reinterpretation: Economic and Population Health Management Challenges.

The value of three-dimensional ultrasound in identifying Mullerian anomalies at risk of adverse pregnancy outcomes

Objective To examine the reliability of three-dimensional ultrasound (3 D-US) in the differentiation between subseptate and arcuate uteri, due to the different associated pregnancy outcomes; refine the existing 3 D-US parameters and evaluate the concordance between 3 D-US and MRI in diagnosing these anomalies. Study design This was a prospective cohort study of 455 women suspected of having a Mullerian anomaly. The diagnosis of subseptate, bicornuate or arcuate uterus was made by 3 D-US in 55 women. Two independent examiners manipulated the 3 D-US volume datasets and recorded the internal intercornual distance, indentation length, indentation tip angle, and myometrial wall thickness in the coronal plane of the uterus. Subsequently, 48 women underwent MRI which was used as the reference test for diagnosis. We calculated the degree of correlation between the two ultrasound assessors’ 3 D-US measurements using interclass correlation coefficient and as well as a Bland-Altman plot. The mean values of the four parameters were used to create receiver operating characteristic curves for determining the best cutoff values for differentiation between subseptate and arcuate uterui. We used the Cohen’s Kappa test to measure the level of agreement between 3 D-US and MRI. Results There was good interobserver agreement between the two 3 D-US assessors for all four parameters. There was a substantial level of agreement between 3 D-US and MRI in differentiating between bicornuate, subseptate and arcuate uteri with a kappa value of 0.727 (95% CI 0.443–0.856). Distinction between subseptate and arcuate uterus was improved when using an indentation length ≥12.5 mm (AUC 0.99) and indentation tip angle ≤89.25 degrees (AUC 0.97) as cutoffs for diagnosis but not the internal intercornual distance or myometrial wall thickness. Conclusion 3 D-US evaluation of the coronal view of the uterus can be relied upon to make a noninvasive, accurate differentiation between subseptate and arcuate uteri. The fundal indentation length and indentation tip angle cut offs of ≥12.5 mm and ≤88 mm, respectively were found to be most accurate for distinction. Thus, allowing for individualizing pre-pregnancy management plans and patient-informed healthcare choices. Highlights There are no agreed upon criteria for differentiating arcuate from subseptate uteri. Such differentiation is critical for counseling and management due to the substantial difference in pregnancy outcome. We aimed to propose cut off values for ultrasound measurements standardized against MRI diagnostic criteria for accurate differentiation between arcuate and subseptate uteri. We demonstrated substantial agreement between 3D-US and MRI in differentiating between bicornuate, subseptate and arcuate uteri. 3D-US evaluation of the coronal view of the uterus is reliable to make an accurate differentiation between subseptate and arcuate uteri. Using the indentation length ≥12.5 mm and indentation tip angle ≤89.25 degrees as parameters to be measured on the coronal view by 3D-US increases its diagnostic accuracy for distinction between arcuate and subseptate uteri.

Health and culture: National and individual drivers of preference for professional medical help

Abstract Background Preferences for professional medical healthcare in case of non-acute medical situations influence a major amount of healthcare use, and vary strongly across countries. Personal values and country culture have been shown to be important predictors of human preferences in many areas. We therefore investigated the impact of both individual and country-level characteristics across Europe on individual healthcare preferences related to non-acute medical conditions. Methods Data from 17,710 individuals from 16 European countries were analysed using a multi-level approach, simultaneously including individual- and country level predictors. Results Healthcare preferences were explained by both human values (Conservation γ = 0.097, p &amp;lt; .01, Self Enhancement γ = 0.038, p &amp;lt; .05) and trust in the doctor (γ 0.054, p &amp;lt; .01). Socio-demographics played a minor role. Societal tightness-looseness (TL) strongly predicted healthcare use preferences on the country level (γ 0.109, p &amp;lt; .05). Also TL enhanced the relation between conservation and preference (γ 0.024, p &amp;lt;.05), and decreased the relation between self-enhancement and preference (γ -0.021, p &amp;lt;.01). Conclusions Our results suggest that healthcare behavior is related to people's motivations and the extent to which the society they live in is more tight or loose. Stronger conservation values increase preference for professional medical care, while self-transcendence- and openness-to-change values decrease preference. Societal tightness is positively related to preference on the country level. Furthermore, in tight societies the effect of conservation is enhanced and the effect of self enhancement is suppressed, related to an additional higher preference for professional medical help. Our results may help key actors within the health system to predict and channel healthcare choice behavior across and within nations. Key messages Culture plays an important role in developing a preference for medical help, on both individual as well as country level. Personal values the as well as cultural tightness looseness are fruitful tools for the analysis of national and international health care research.

Wellness among nursing students: A qualitative study

Nursing students typically experience high levels of stress and anxiety in nursing schools, and this is often compounded by having to combine complex classroom theories with practice. Healthy behaviors are subsequently neglected, diminishing academic efficiency and personal wellbeing. Student nurses need to adopt healthy lifestyles since wellness has been shown to promote positive health outcomes. Nonetheless, studies on the perception of wellness, and descriptions of its facilitators and barriers in wellness promotion among nursing students remain limited. This qualitative descriptive study aimed to explore facilitators and barriers to promote wellness among nursing students in Thailand. Data was gathered using focus groups with 80 undergraduate third and fourth-year nursing students, comprising 64 females and 16 males. Four themes emerged from content analysis regarding the facilitators of promoting wellness: healthy living; belief in animism; self-optimism; and receiving support. Barriers to wellness were three themes of stressors involved in students’ lives: pressure from instructors; behaviors of staff nurses; and being perceived as untrustworthy. It is vital to promote wellness among nursing students to encourage their health care choices and to support them through their studies.

Monitoring and evaluation of breast cancer screening programmes: selecting candidate performance indicators

BackgroundIn the scope of the European Commission Initiative on Breast Cancer (ECIBC) the Monitoring and Evaluation (M&E) subgroup was tasked to identify breast cancer screening programme (BCSP) performance indicators, including their acceptable and desirable levels, which are associated with breast cancer (BC) mortality. This paper documents the methodology used for the indicator selection.MethodsThe indicators were identified through a multi-stage process. First, a scoping review was conducted to identify existing performance indicators. Second, building on existing frameworks for making well-informed health care choices, a specific conceptual framework was developed to guide the indicator selection. Third, two group exercises including a rating and ranking survey were conducted for indicator selection using pre-determined criteria, such as: relevance, measurability, accurateness, ethics and understandability. The selected indicators were mapped onto a BC screening pathway developed by the M&E subgroup to illustrate the steps of BC screening common to all EU countries.ResultsA total of 96 indicators were identified from an initial list of 1325 indicators. After removing redundant and irrelevant indicators and adding those missing, 39 candidate indicators underwent the rating and ranking exercise. Based on the results, the M&E subgroup selected 13 indicators: screening coverage, participation rate, recall rate, breast cancer detection rate, invasive breast cancer detection rate, cancers > 20 mm, cancers ≤10 mm, lymph node status, interval cancer rate, episode sensitivity, time interval between screening and first treatment, benign open surgical biopsy rate, and mastectomy rate.ConclusionThis systematic approach led to the identification of 13 BCSP candidate performance indicators to be further evaluated for their association with BC mortality.

The Three CCCs of Dysphagia Management: Culturally Competent Care

Purpose Patient-centered care is a healthcare approach that values an individual's right to make health care choices. For patients with dysphagia, honoring choices that carry significant health risks is challenging. This article presents strategies adapted from the multicultural literature to enhance patient engagement and help balance choices for quality of life while mitigating potential negative health consequences. The goal is to provide clinicians with knowledge gleaned from multicultural resources to deliver optimal care that considers both cultural and ethical factors. Method The authors use a hypothetical case of an older adult woman with dysphagia whose family is disagreeing with diet recommendations to introduce the concepts of culture, cultural humility, cultural competence, and ethical considerations. The authors present strategies for working with culturally diverse patients to show that these strategies can be adapted for use with any patient, regardless of cultural background. Conclusion Adopting a perspective that every patient presents with many cultural variables that can influence dysphagia management encourages the speech-language pathologist to approach each patient through a multicultural lens. Strategies and approaches for working with culturally and linguistically diverse patients can be adapted and inform the speech-language pathologist on ways to establish a dynamic of shared decision making for successful outcomes.

Sociocultural determinants and patterns of healthcare utilization for epilepsy care in Uganda

ObjectiveEpilepsy is a global public health concern, with the majority of cases occurring in lower- and middle-income countries where the treatment gap remains formidable. In this study, we simultaneously explore how beliefs about epilepsy causation, perceived barriers to care, seizure disorder characteristics, and demographics influence the initial choice of healthcare for epilepsy and its impact on attaining biomedical care (BMC). MethodsThis study utilized the baseline sample (n = 626) from a prospective cohort study of people with epilepsy (PWE) attending three public hospitals in Uganda (Mulago National Referral Hospital, Butabika National Referral Mental Hospital, and Mbarara Regional Referral Hospital) for epilepsy care. Patient and household demographics, clinical seizure disorder characteristics, and sociocultural questionnaires were administered. Logistic regression and principal component analyses (PCA) were conducted to examine associations with the choice of primary seizure treatment. ResultsThe sample was 49% female, and 24% lived in rural settings. A biomedical health facility was the first point of care for 355 (56.7%) participants, while 229 (36.6%) first sought care from a traditional healer and 42 (6.7%) from a pastoral healer. Preliminary inspection of candidate predictors using relaxed criteria for significance (p < 0.20) identified several factors potentially associated with a greater odds of seeking BMC first. Demographic predictors included older caredriver (decision-maker for the participant) age (odds ratio [OR]: 1.01, 95% confidence interval [CI]: [0.99, 1.02], p-value: 0.09), greater caredriver education level (OR = 1.21, 95% CI: [1.07, 1.37], p-value = 0.003), and lower ratio of sick to healthy family members (OR = 0.77 [0.56, 1.05], P = 0.097). For clinical predictors, none of the proposed predictors associated significantly with seeking BMC first. Self-report causation predictors associated with a greater odds of seeking BMC first included higher belief in biological causes of epilepsy (OR = 1.31 [0.92, 1.88], P = 0.133) and lower belief in socio-spiritual causes of epilepsy (OR = 0.68 [0.56, 0.84], P < 0.001). In the multivariate model, only higher caredriver education (OR = 1.19 [1.04, 1.36], P = 0.009) and lower belief in socio-spiritual causes of epilepsy (OR = 0.69 [0.56, 0.86], P < 0.01) remained as predictors of seeking BMC first. Additionally, PCA revealed a pattern which included high income with low beliefs in nonbiological causes of epilepsy as being associated with seeking BMC first (OR = 1.32 [1.12, 1.55], p = 0.001). Despite reaching some form of care faster, individuals seeking care from traditional or pastoral healers experienced a significant delay to eventual BMC (P < 0.001), with an average delay of more than two years (traditional healer: 2.53 years [1.98, 3.24]; pastoral care: 2.18 [1.21, 3.91]). ConclusionsCoupled with low economic and educational status, belief in spiritual causation of epilepsy is a dominant determinant of opting for traditional or pastoral healing over BMC, regardless of concurrent belief in biological etiologies. There is a prolonged delay to eventual BMC for PWE who begin their treatment seeking with nonallopathic providers, and although nonallopathic healers provide PWE with benefits not provided by BMC, this notable delay likely prevents earlier administration of evidence-based care with known efficacy. Based on these findings, initiatives to increase public awareness of neurobiological causes of epilepsy and effectiveness of biomedical drug treatments may be effective in preventing delays to care, as would programs designed to facilitate cooperation and referral among traditional, faith-based, and biomedical providers.This article is part of the Special Issue “The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda”

National Evaluation of Patient Preferences in Selecting Hospitals and Health Care Providers.

Patient utilization of public reporting has been suboptimal despite attempts to encourage use. Lack of utilization may be due to discordance between reported metrics and what patients want to know when making health care choices. The objective of this study was to identify measures of quality that individuals want to be presented in public reporting and explore factors associated with researching health care. Patient interviews and focus groups were conducted to develop a survey exploring the relative importance of various health care measures. Interviews and focus groups conducted at local outpatient clinics. A survey administered nationally on an anonymous digital platform. Likert scale responses were compared using tests of central tendency. Rank-order responses were compared using analysis of variance testing. Associations with binary outcomes were analyzed using multivariable logistic regression. Overall, 4672 responses were received (42.0% response rate). Census balancing yielded 2004 surveys for analysis. Measures identified as most important were hospital reputation (considered important by 61.9%), physician experience (51.5%), and primary care recommendations (43.2%). Unimportant factors included guideline adherence (17.6%) and hospital academic affiliation (13.3%, P<0.001 for all compared with most important factors). Morbidity and mortality outcome measures were not among the most important factors. Patients were unlikely to rank outcome measures as the most important factors in choosing health care providers, irrespective of age, sex, educational status, or income. Patients valued hospital reputation, physician experience, and primary care recommendations while publicly reported metrics like patient outcomes were less important. Public quality reports contain information that patients perceive to be of relatively low value, which may contribute to low utilization.

Community pharmacists' professional practices for complementary medicines: a qualitative study in New Zealand.

Background Complementary medicines are a popular healthcare choice among patients/consumers, and most pharmacies sell these products. Pharmacists are well-placed to advise on complementary medicines, but their training and practices for these products are not optimal. Pharmacists' professional practices for complementary medicines ought to be influenced by professional codes of ethics and standards. Objective To examine community pharmacists' perspectives on complementary medicines in New Zealand, including motivations and justifications for selling these products, and professional and ethical issues complementary medicines raise for pharmacists. Setting Community pharmacists in New Zealand. Method Qualitative, semi-structured interviews with 27 New Zealand practising community pharmacists identified through purposive and convenience sampling. Main outcome measure Participants' views, experiences, and professional practices for complementary medicines. Results Participants struggled to clearly describe products they considered complementary medicines. Perspectives towards these products ranged from strongly supportive to somewhat sceptical; none was strongly opposed. Participants had several motivations for selling complementary medicines, particularly consumer demand and profits. Participants acknowledged ethical issues concerning complementary medicines, including lack of evidence of efficacy and pharmacists' limited training/knowledge. Few referred explicitly to complementary-medicines-related statements in the Pharmacy Council of New Zealand's Code of Ethics, or indicated these guided their practice. Conclusion Participants sold complementary medicines despite having limited knowledge on these products and concerns about efficacy; participants justified this as they believe they are providing an holistic option for patients, and/or ensuring complementary medicines do no harm. Participants were mindful of ethical/professional issues regarding complementary medicines, but were not necessarily aware of, or guided by, explicit statements in the Pharmacy Council of New Zealand's Code of Ethics.

Exploring Genetic Literacy in a Small Hispanic Population.

Introduction: Genetic literacy recognizes one's ability to gather, understand, and apply genomic information to make informed health care choices and social decisions. A limited understanding of genomic literacy carries the potential for poor health outcomes. The aim of this pilot study was to determine the usefulness of an assessment tool to ascertain genetic literacy in a small Hispanic clinic population. Methodology: Mixed-method, cross-sectional pilot study requiring forward-back translation of an established questionnaire. Twenty Spanish-speaking adults were recruited through purposive and convenience sampling. Results: Forward-back translation provided a comparable questionnaire. Participants indicated information was relevant. Qualitative feedback uncovered regional differences. Quantitative results reported descriptive statistics, frequencies, and Cronbach alphas. Discussion: Findings from this study reveal the need for genetic literacy assessment tools that are attuned to the linguistic, ethnic, and cultural differences within the Hispanic population.

Health care options and factors influencing health seeking behavior in a rural community in Nigeria: A cross-sectional study

Introduction: Health care resources are disproportionately distributed between urban and rural areas in many developing countries, including Nigeria. Barriers to health care like cultural beliefs, poor education, and financial constraints make many rural dwellers seek other options of health care available to them. This paper aimed to determine the sociodemographic factors that influence health-seeking practices in a rural community setting. Methods: A sample of 380 rural community dwellers in Southern Nigeria was recruited in a cross-sectional study. An interviewer-administered questionnaire was used to collect socio-demographic, healthcare access, and utilization data. Data were analyzed with SPSS version 25.0 software. A chi-square test was used to find the association between sociodemographic characteristics and their health-seeking practices. Results: Equal proportions (43.4%, 42.9%) of the respondents fell within the younger age categories of 10–29 and 30–49 years. Self-reported factors influencing the choice of health care were: promptness of care (41.8%), cost (22.4%), professionalism (16.8%), distance (15.8%), and cultural belief (3.2%). The patent medicine store was the most utilized source of health care (42.1%), and 36.8% of respondents sought health care in the hospital. The hospital was utilized by 41.8% of respondents with secondary education, 34.9% with tertiary education, 31.7% with primary education, and 26.1% with no formal education. Females tended to seek health care from hospitals (40.2%) and patent medicine store (43.7%) compared to males (33.3% and 41.0%, respectively). There was a statistically significant association between education and health care options utilized (P&lt;0.05). Conclusion: This study draws attention to the suboptimal utilization of standard health care in a rural community setting mainly due to perceived influences of promptness of health care service (41.8%) and cost (22.4%). It revealed that rural dwellers mainly seek healthcare from patent medicine stores. The health authorities should, therefore, prioritize the eradication of delays at the point of care and expand financial access to health care. These would enable rural dwellers to optimize the minimum standard of health care available within their various communities.