Cross-sectional Mixed Methods Study Research Articles

Understanding adherence to self-isolation in the first phase of the COVID-19 pandemic in England: a cross-sectional mixed-methods study

BackgroundDuring the early “containment” phase of the COVID-19 response in England (January-March 2020), contact tracing was managed by Public Health England (PHE). Adherence to self-isolation during this phase and how people were making those decisions has not previously been determined. The aim of this study was to gain a better understanding of decisions around adherence to self-isolation during the first phase of the COVID-19 response in England.MethodsA mixed-methods cross sectional study was conducted, including an online survey and qualitative interviews. The overall pattern of adherence was described as never leaving home, leaving home for lower-contact reasons and leaving home for higher-contact reasons. Fisher’s exact test was used to test associations between adherence and potentially predictive binary factors. Factors showing evidence of association overall were then considered in relation to the three aspects of adherence individually. Qualitative data were analysed using inductive thematic analysis.ResultsOf 250 respondents who were advised to self-isolate, 63% reported not leaving home at all during their isolation period, 20% reported leaving only for lower-contact activities (dog walking or exercise) and 16% reported leaving for higher-contact, and therefore higher-risk, reasons. Factors associated with adherence to never going out included: the belief that following isolation advice would save lives, experiencing COVID-19 symptoms, being advised to stay in their room, having help from outside and having regular contact by text message from PHE. Factors associated with non-adherence included being angry about the advice to isolate, being unable to get groceries delivered and concerns about losing touch with friends and family. Interviews highlighted that a sense of duty motivated people to adhere to isolation guidance and where people did leave their homes, these decisions were based on rational calculations of the risk of transmission – people would only leave their homes when they thought they were unlikely to come into contact with others.ConclusionsUnderstanding adherence to isolation and associated reasoning during the early stages of the pandemic is essential to pandemic preparedness for future emerging infectious disease outbreaks. Individuals make complex decisions around adherence by calibrating transmission risks, therefore treating adherence as binary should be avoided.

Exploring the Lives of Women Rag Pickers in an Indian Metropolitan City: A Mixed-Methods Cross-Sectional Study on Social and Occupational Determinants Shaping Their Existence.

Globally, occupational hazards are a concern, especially in waste management. With 31.2% of its population in urban areas, India is confronted withescalating waste management challenges. People worldwide generate about two-thirds of a kilogram of waste daily. Effective solid waste management is crucial due to population growth, changing waste patterns, and rapid urbanisation. It profoundly impacts environmental, resident, and worker health. Rag picking is an informal profession undertaken by a marginalised population of the society, which involves collecting waste from trash cans, streets, and household waste. To assess the burden and the pattern of morbidity, and the occupational factors associated with it, as well as their health-seeking behaviour, the present study was carried out among women rag pickers in Mumbai, India. A cross-sectional descriptive study was conducted through a mixed-method approach in Mumbai's Chembur and Govandi areas, focusing on women rag pickers aged 15 to 49 years. The research was conducted over a period of three months, during which a total of 150 female rag pickers from individual familieswere identified and included in the study through purposive sampling.The structured questionnaires gathered quantitative data on socio-demographics, health-seeking behaviour, morbidity, and monthly expenses. The qualitative data were collected through focus group discussions with rag pickers, analysing themes related to rag picking as occupational preference and substance usage factors. Ethical approval from the institute and informed consentfrom each participant were obtained prior to data collection. Among the cohort of 150 women ragpickers, 67.3% were aged between 15 and 30 years, with 82% belonging to the lower socio-economic class. A notable 43.4% of these women engaged in significant tobacco use, primarily through oral consumption, while about 56.7% of their family members exhibited high substance use, including pan, tobacco, and alcohol. In terms of health-seeking behaviour, 51% refrained from seeking treatment for minor ailments, 29% resorted to home remedies or self-medication, and 20% sought care at hospitals. A morbidity analysis over the past three months revealed prevalent health issues, informing potential interventions. Examination of monthly expenditure patterns unveiled an average income of 9000 INR (130 USD), with a significant 61% allocation towards food and grocery expenses. Qualitative insights indicated that the preference for rag picking was driven by limited alternativesand substance use was influenced by peers and served as a means to cope with stress. These findings underscoredistinct health-seeking behaviours, and the unique needs of women rag pickers, providing valuable guidance for targeted policies to enhance their well-being. These findings underscore the need for targeted interventions to improve the well-being and socio-economic conditions of women rag pickers in India. Universal healthcare coverage, community-based initiatives,and social inclusion are vital for addressing their unique challenges and enhancing their quality of life.

Influence of social inclusion and institutional culture on students’ interactions in clinical settings

Background: Decolonisation of the Speech-Language and Hearing (SLH) professions in South Africa to be Afrocentric is a current focus. These professions continue to hold white Eurocentric English and/or Afrikaans knowledges and practices, which are reflective of the minority. As diversity of students in higher education increases, the obvious incongruency between the language of learning and teaching (English) and institutional culture of the programmes and students who use English as an Additional Language (EAL) becomes heightened.Objectives: The study’s aim was to explore the learning and social experiences of EAL undergraduate students in a South African SLH training programme, with a specific focus on students’ experiences in patient, clinical supervisor and peer interactions in clinical situations.Method: A total of 24 participants recruited through purposive sampling were included in this cross-sectional mixed-method online survey design study. Data from the survey were analysed through descriptive and thematic analysis approaches.Results: Findings reveal a less than positive impression of EAL students in the current SLH training programme as far as their clinical experiences were concerned. The institutional culture of the SLH programme was reported to be disadvantageous to EAL students. These findings raise important implications for SLH training programmes, the regulator and the country’s SLH professions as a whole.Conclusion: This study sheds light on the significant incongruency between the existing institutional culture and the increasing diversity of students, particularly those who use EAL, in South African SLH training programmes.Contribution: Findings not only illuminate the challenges but also offer a path forward towards a more inclusive and representative SLH profession in South Africa, aligned with the principles of decolonization and Afrocentrism.

Mixed-methods cross-sectional study of the prevention of vertical HIV transmission program users unaware of male partner’s HIV status, in six South African districts with a high antenatal HIV burden

BackgroundElimination of vertical HIV Transmission (VHT) and maternal deaths are global health priorities. Male involvement is one of the most important factors that influences women’s decisions, including the uptake of Prevention of vertical HIV transmission (P-VHT). We sought to understand not knowing a male partner’s HIV status (MPHIVs) amongst women using services to prevent vertical HIV transmission in six South African districts with high antenatal HIV burden.MethodsA mixed-methods cross-sectional study was conducted in six South African districts, and data collected through face-to-face interviews with women and focus group discussions (FGDs) with women or male partners. The quantitative data were analyzed using STATA SE-17.0 and an inductive approach was used for qualitative data analysis.ResultsOverall, 28.7% of women were unaware of their MPHIVs, while 25.3% and 46.0% knew the MPHIVs was positive or negative, respectively. In multivariable logistic regression, single marital status and unplanned pregnancy increased the odds of not knowing a MPHIVs while a woman’s disclosure of her HIV status to the male partner reduced the odds. FDGs highlighted complexities around MPHIVs disclosure, e.g., reluctance to test for HIV and potential interventions including healthcare worker (HCW) assisted HIV disclosure.ConclusionUser-informed interventions to address MPHIVs non-disclosure amongst women of child-bearing age, particularly those at risk of unstable sexual partners and unplanned pregnancies, should be strengthened.

Delay in healthcare seeking for young children with severe pneumonia at Mulago National Referral Hospital, Uganda: A mixed methods cross-sectional study.

Globally, pneumonia is the leading infectious cause of under-five mortality, and this can be reduced by prompt healthcare seeking. Data on factors associated with delays in seeking care for children with pneumonia in Uganda is scarce. The study aimed to determine the prevalence, factors associated with delay, barriers, and facilitators of prompt healthcare seeking for children under five years of age with severe pneumonia attending Mulago National Referral Hospital (MNRH) Uganda. A mixed methods cross-sectional study was conducted among 384 caregivers of children with severe pneumonia at MNRH. Quantitative data was collected using interviewer-administered structured questionnaires and qualitative data through focus group discussions with caregivers. Descriptive statistics were used to determine the prevalence of delay in care seeking. Logistic regression analysis was used to determine the factors that were independently associated with delay in seeking healthcare. Content thematic analysis was used to analyze for barriers and facilitators of prompt healthcare seeking. The prevalence of delay in seeking healthcare was 53.6% (95% CI: 48.6-58.6). Long distance to a hospital (AOR = 1.94, 95% CI 1.22-3.01, p value = 0.003), first seeking care elsewhere (AOR = 3.33, 95% CI 1.85-6.01, p value = 0.001), and monthly income ≤100,000 UGX (28 USD) (AOR = 2.27,95% CI 1.33-3.86, p value = 0.003) were independently associated with delay in seeking healthcare. Limited knowledge of symptoms, delayed referrals, self-medication, and low level of education were barriers to prompt healthcare seeking while recognition of symptoms of severe illness in the child, support from spouses, and availability of money for transport were key facilitators of early healthcare seeking. This study showed that more than half of the caregivers delayed seeking healthcare for their children with pneumonia symptoms. Caregivers who first sought care elsewhere, lived more than 5 km from the hospital, and earned less than 28 USD per month were more likely to delay seeking healthcare for their children with severe pneumonia. Limited knowledge of symptoms of pneumonia, self-medication, and delayed referral hindered prompt care-seeking. Key facilitators of prompt care-seeking were accessibility to health workers, support from spouses, and recognition of symptoms of severe illness in children. There is a need for programs that educate caregivers about pneumonia symptoms, in children less than five years.

Preferences for oral PrEP dosing among adolescent boys and young men in three sub-Saharan African countries.

HIV remains a leading contributor to the disease burden in sub-Saharan Africa, with adolescents and young people disproportionately affected. Optimising pre-exposure prophylaxis (PrEP) uptake has predominantly focused on women and adult men who have sex with men. We explore adolescent boys and young men's PrEP uptake preferences in South Africa, Uganda, and Zimbabwe. A cross-sectional sequential exploratory mixed-methods study amongst males aged 13-24 years was conducted between April and September 2019 as part of the CHAPS trial. Group discussions (GDs) and In-Depth Interviews (IDIs) focused on motivations and hindrances for HIV testing, PrEP preference, and reasons for the uptake of PrEP. A thematic approach was used to analyse the qualitative data. A quantitative survey following the qualitative work covered questions on demographics, HIV risk and PrEP preferences (on-demand vs. daily). For quantitative analysis, we fitted logistic regression models to determine factors associated with on-demand vs daily PrEP preference. Overall, 647 adolescent boys and young men (median age 20, IQR: 17-22) were enrolled. Of these, 422 (65.22%) preferred on-demand PrEP (South Africa 45.45%, Uganda 76.80%, Zimbabwe 70.35%; p<0.001). Factors independently associated with on-demand PrEP included country (South Africa, adjusted odds ratio (aOR) = 0.19 [95%CI:0.1-0.3] compared to Uganda) and advanced planning of sex [>24 hours in advance aOR = 1.4 (0.9-2.3) compared to <2 hours]. Qualitatively, participants commonly believed they were not at risk of HIV acquisition most of the time and thought that on-demand PrEP would be suitable as they tend to plan sexual activity in advance. Preference for on-demand PrEP is high in young males. The qualitative data support a preference for on-demand PrEP in those who plan sex in advance. HIV intervention programs should offer both on-demand and daily PrEP to engage more adolescent boys and young men in HIV prevention practices.

COVID-19 Impact on Children’s Social Work Practice and Social Worker Well-being: A Mixed Methods Study from Northern Ireland and Great Britain during 2020–2022

Abstract Social workers were heavily impacted by the COVID-19 pandemic. In this study, we examined the well-being, burnout and work conditions of UK children’s social workers at five time points of the COVID-19 pandemic. This was a cross-sectional mixed methods study analysing data from 1,621 social workers who worked in children’s services in the UK in 2020–2022. Data were collected using anonymous online surveys which included both quantitative and qualitative questions. The mental well-being of participants decreased as the pandemic progressed and work-related burnout increased. In the later stages of the pandemic, children’s social workers in Northern Ireland fared better than their Great Britain counterparts in relation to their well-being and levels of burnout. Thematic analysis of qualitative data revealed four major themes: Changes in service demand and referrals, Adapted ways of working, Staff shortages and Emotional impact. The findings highlight the challenges that the children’s social workers encountered during the COVID-19 pandemic and have implications for policy, practice and research.

Legalization of marijuana or not? Opinions from over 38,000 residents in Taiwan

BackgroundMarijuana is legal in many Western countries and Thailand. In Taiwan, Marijuana remains a category-2 narcotic; however, some legislative candidates recently advocated legalization of medical marijuana. This study surveyed a large sample of Taiwanese to gain a better understanding of the public’s knowledge and attitudes towards legalizing marijuana.MethodsThis cross-sectional mixed-methods study included demographic data and responses to a survey questionnaire, “Knowledge and Attitudes of Legalizing Marijuana” (KALM). The survey included 15 statements about four categories: public health, social impact, medical applications of THC (Δ9-tetrahydrocannabinol), and legal and tax consequences; and two yes/no questions about medical use and legalization of marijuana. Knowledge was scored as disagree = 0, no knowledge = 2, or agree = 4; attitude was scored from 0 = very unimportant to 4 = very important. Responses to an open-ended question asking for additional comments/concerns were analysed with content analysis. The survey was conducted from February 15 to March 1, 2023.ResultsData were analysed from 38,502 respondents, aged 15 to > 56 years. Most were female (67.1%) and parents (76.4%). Scores were higher for respondents who were parents, religious, ≥ 36 years of age, had a high-income status, no history of substance abuse, knowledge of medical marijuana, and did not support legalization of marijuana. Medical personnel had greater knowledge of marijuana, but their attitude indicated they viewed legalization as less important. In the open-ended question, many respondents requested more information about marijuana be provided to the public before considering legalization.ConclusionsTaiwanese respondents considered legalization of marijuana a significant concern, especially as it relates to impacts on public health.

Understanding Sociodemographic Factors and Reasons Associated with COVID-19 Vaccination Hesitance among Adults in Tanzania: A Mixed-Method Approach.

Although studies on COVID-19 vaccine hesitancy are being undertaken widely worldwide, there is limited evidence in Tanzania. This study aims to assess the sociodemographic factors associated with COVID-19 vaccine hesitancy and the reasons given by unvaccinated study participants. We conducted a mixed-method cross-sectional study with two components-health facilities and communities-between March and September 2022. A structured questionnaire and in-depth interviews were used to collect quantitative and qualitative data, respectively. A total of 1,508 individuals agreed to participate in the survey and explained why they had not vaccinated against COVID-19. Of these participants, 62% indicated they would accept the vaccine, whereas 38% expressed skepticism. In a multivariate regression analysis, adult study participants 40 years and older were significantly more likely to report not intending to be vaccinated (adjusted odds ratio [AOR], 1.28; 95% CI, 1.01-1.61; P = 0.04) than youth and middle-aged study participants between 18 and 40 years. Furthermore, female study participants had a greater likelihood of not intending to be vaccinated (AOR, 1.51; 95% CI, 1.19-1.90; P = 0.001) than male study participants. The study identified fear of safety and short-term side effects, and lack of trust of the COVID-19 vaccine; belief in spiritual or religious views; and belief in local remedies and other precautions or preventive measures as the major contributors to COVID-19 vaccine hesitancy in Tanzania. Further empirical studies are needed to confirm these findings and to understand more fully the reasons for vaccine hesitancy in different demographic groups.

Validation and Clinical Utility of the PHQ-9 and CES-D as Depression Screening Tools in Collegiate Student-Athletes.

The National Athletic Trainers' Association recommends including mental health screening measures as part of the pre-participation exam (PPE) for all student-athletes. Despite this recommendation, most mental health screening tools have not been validated in the student-athlete (SA) population. To validate and examine clinical utility of two depression screening tools in the collegiate SA population. Cross-sectional mixed methods design. Two Northeastern United States university athletics programs. A total of 881 (male = 426, 48.4%; females = 455, 51.6%; mean age 19.7 ± 1.4 years old) NCAA Division-II collegiate SAs completed the PHQ-9 and CES-D; 290 SAs participated in a MINI clinical interview. Depression symptoms were measured using two self-reported depression screening tools, the PHQ-9 and CES-D, during the fall PPE. SAs were selected using a random stratified sampling technique to participate in a MINI Structured Clinical Interview, as the reference standard comparison for the ROC analysis. A cut-off score of 6 on the PHQ-9 corresponded to 78% sensitivity, 75% specificity, 17.3% PPV, 98.1% NPV, 3.2 LR+, and 0.3 LR-. A cut-off score of 15 on the CES-D corresponded to 83% sensitivity, 78% specificity, 19.7% PPV, 98.6% NPV, 3.7 LR+, and 0.22 LR-. This was the first study to validate depression screening tools in the collegiate SA population. The results suggest cut-off scores on the PHQ-9 and CES-D in SA may need to be lowered when compared to those recommended for the general population and provide strong evidence for use as screeners to rule out depression. Referral and confirmatory testing should be implemented to confirm the presence of depression for SA scoring at or above cutoff thresholds. Given its brevity, inclusion of a suicidality/self-harm question, and evidence of LR-/NPV strength, the PHQ-9 is a practical and effective screener for the SA population.

Assessing Dietary Practices of Children with Avoidant Restrictive Food Intake Disorder (ARFID) - A Cross-Sectional Study

OBJECTIVE: The current study aimed to find children's dietary patterns with Avoidant Restrictive Food Intake Disorder (ARFID) and its characteristics in children. METHODOLOGY: This mixed-method cross-sectional study was conducted in April 2021 among children with Avoidant Restrictive Food Intake Disorder. Thirty participants of the age group (5-12 years) were selected from the Pediatrics and Children Ward of Ittefaq Hospital, Lahore, with a purposive sampling technique. Outpatient children aged between 5 and 12 years were included, whereas the children who had any congenital disabilities and were diagnosed with any other eating disorder were excluded. A focus group discussion was held for the formulation of the questionnaire. A diagnostic criteria questionnaire for ARFID was taken from the Canadian Pediatric Surveillance Program 2017, including anthropometric data and general characteristics/behavioral features. A self-structured food frequency questionnaire was used. Informed consent was taken from all participants. Qualitative interviews were reported as thematic analysis, and Quantitative data were analyzed using SPSS version 25 as statistical analysis for data visualization, simple statistics to generate summary charts, and customized graphs. RESULTS: Patients with ARFID were primarily female and relatively young, with a mean age of 8.35±0.46. Most of the participants were underweight (77%). The mean BMI (kg/m2) of the children was 13.7±0.26. Most patients with ARFID also reported a lack of interest in eating, loss of appetite, aversion due to sensory characteristics and avoidance of certain foods. CONCLUSION: ARFID is prevalent in all populations, but the lack of awareness among healthcare professionals and the general population makes the diagnosis difficult. KEYWORDS: ARFID, Eating Disorders, Food aversions, Food Frequency Questionnaire, Loss of appetite, Underweight

Task-Shifting Immunization Activities to Community Health Workers: A Mixed-Method Cross-Sectional Study in Sahel Region, Burkina Faso.

Faced with the frequent disruptions to the health care system and provision of immunization services caused by terrorist attacks that began in 2015, the Sahel region in Burkina Faso initiated resilience strategies, including the task-shifting of immunization activities to community health workers (CHWs). This strategy was designed to involve more CHWs in the vaccination delivery process and ultimately to improve the performance of the health care system. The task-shifting strategy began as a pilot in Djibo health district in 2019 and then extended to all 4 districts of the Sahel region. CHWs included both personnel recruited through the Ministry of Health and Public Hygiene processes at the national level and other community members who support the operation of health facilities. They were trained on standardized immunization modules and provided with vaccines by functional health facilities teams. Implementation initiated with the administration of oral antigens by CHWs. Subsequently, their service delivery was expanded to include injectable vaccines in the context of the worsening terrorist attacks and the urgent need to protect the health of local populations affected by the security and humanitarian crisis. The intervention was evaluated through an internal programmatic review conducted as a descriptive cross-sectional study implemented from August 1 to October 28, 2022, in the Sahel region, including a survey in Dori health district. CHWs involved in implementing the strategy were considered for interviews. Performance indicators for all antigens have shown an upward trend since the strategy's inception in 2019. The task-shifting of immunization activities to CHWs has been implemented successfully in a region seriously affected by terrorism-related insecurity. It holds the promise of maintaining or even improving performance if institutionalized and scaled up while improving the monitoring of adverse events following immunization by the CHWs.

Project Respect: experiences of seriously ill LGBTQ+ patients and partners with their health care providers.

Discrimination against lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons in health care creates barriers to serious illness care, including patients avoiding or delaying necessary care, providers disrespecting wishes of surrogates, and adverse outcomes for patients and families. A cross-sectional mixed-methods study using an online survey was used to determine the extent to which LGBTQ+ patients and spouses, partners, and widows experienced disrespectful or inadequate care due to sexual orientation or gender identity. A total of 290 LGBTQ+ patients and partners reported high levels of disrespectful and inadequate care, including 35.2% stating their provider was insensitive to them because of their identity; 30% reporting their provider was unaware of LGBTQ+ health needs; 23.1% feeling judged; 20.7% experiencing rudeness; 20.3% stating providers did not use their correct pronouns; and 19.7% reporting their treatment decisions were disregarded. Black and Hispanic patients were 2-4 times more likely than non-Hispanic White patients to report discrimination. This study demonstrated high levels of disrespectful and inadequate care towards patients and partners due to being LGBTQ+, which was especially problematic for Black and Hispanic patients and those living in politically conservative regions. Recommendations include federal and state civil rights laws to prohibit LGBTQ+ discrimination and institutional practices to address discrimination, including cultural sensitivity training for staff.

Nurses' Experiences and Perspectives of the Telehealth Working Environment and Educational Needs.

The continuing evolution of health care and the nursing profession includes the exponential growth of telehealth platforms. The goal of this study was to describe nurses' experiences with and perspectives on their practice with and future need for telehealth. A cross-sectional descriptive mixed methods study was conducted with nursing graduates from a single university. Completed survey questions focused on demographics, current work status, plans for employment participation, and tele-health experience. Descriptive analysis was conducted with statistical software, with directed content analysis for narrative responses. A total of 305 of 5,080 participants completed the survey (6% response rate). Nurses described perceived benefits and barriers to working in a telehealth environment. Nurses identified continuing education needs that could form the basis for a telehealth continuing education program to increase confidence in telehealth delivery. The identified telehealth educational needs will positively influence the formation of continuing education opportunities for practicing nurses. [J Contin Educ Nurs. 202x;5x(x):xx-xx.].

HIV destigmatization: perspectives of people living with HIV in the Kumasi Metropolis in Ghana.

Human immunodeficiency virus (HIV)-related stigma has been identified as one of the principal factors that undermines HIV prevention efforts and the quality of life of people living with HIV (PLWH) in many developing countries including Ghana. While studies have been conducted on HIV-related stigma reduction, very few have sought the views of PLWH on how this might be done. The purpose of the study was to (i) identify factors that cause HIV-related stigma in Ghana from the perspective of PLWH, (ii) identify challenges that HIV-related stigma poses to the treatment and care of PLWH, and (iii) to obtain recommendations from PLWH on what they think various groups (community members, health care providers, and adolescents) including themselves should do to help reduce HIV-related stigma in Ghana. A mixed methods cross-sectional study design was used to collect data from 404 PLWH at the Suntreso Government Hospital in the Kumasi Metropolis of Ghana across six domains using Qualtrics from November 1-30, 2022. Quantitative data was analyzed using the Statistical Package for Social Sciences (SPSS) version 26 and the Statistical Analysis System (SAS) version 9.4. Qualitative data was analyzed using a thematic approach. Most of the study participants (70.5%) said HIV-related stigma in Ghana is due to ignorance. Of this population, 90.6% indicated that they had experienced stigma because they have HIV, causing them to feel depressed (2.5%), ashamed (2.2%), and hurt (3.0%). Study participants (92.8%) indicated that the challenges associated with HIV-related stigma has affected their treatment and care-seeking behaviors. Recommendations provided by study participants for HIV destigmatization include the need for PLWH not to disclose their status (cited 94 times), community members to educate themselves about HIV (96.5%), health care providers to identify their stigmatizing behaviors (95.3%), health care providers to avoid discriminating against PLWH (96.0%), and the need for adolescents to be educated on HIV and how it is transmitted (97.0%). It is important for the government and HIV prevention agencies in Ghana to target and address co-occurring HIV-related stigma sources at various levels of intersection simultaneously This will help to shift harmful attitudes and behaviors that compromise the health and wellbeing of PLWH effectively.

Hesitancy in COVID-19 Vaccine Uptake and Its Correlated Factors Using Multi-Theory Model among Adult Women: A Cross-Sectional Study in Three States of Somalia.

In developing countries, access to information, awareness, and availability of COVID-19 vaccines are key challenges. Somalia launched the COVID-19 vaccination in March 2021; however, the uptake of the vaccination is slow, which creates fear of further loss of life in the country unless intentional and organized campaigning and efforts are made to improve both the availability of the vaccine and its acceptance by the community. This study aimed to understand the current level of awareness, accessibility, trust, and hesitancy toward the COVID-19 vaccine among women in Somalia. To assess COVID-19 vaccine uptake, acceptance, community awareness, and hesitancy rates in Somalia, we carried out a cross-sectional mixed methods study in three regions of Somalia that were selected randomly out of the 18 regions of Somalia. A multi-theory model (MTM) was developed to identify correlated factors associated with the hesitancy or non-hesitancy toward COVID-19 vaccination among women of all ages (18 years and above). A total of 999 eligible women (333 in each district) of 18-98 years old were interviewed in March 2022. About two-thirds (63.76%) of participants reported hesitancy about receiving the COVID-19 vaccine. The theory model initiation construct indicated that behavioral confidence in the vaccine (b = 0.476, p < 0.001), participatory dialogue (at b = 0.136, p < 0.004), and changes in the physical environment (b = 0.248, p = 0.015) were significantly associated with COVID-19 vaccine acceptance among women who were not hesitant to take the vaccine. The availability of COVID-19 vaccines may not translate into their uptake. The decision to get the vaccine was determined by multiple factors, including the perceived value of the vaccination, previous experience with the vaccine, perceived risk of infection, accessibility and affordability, and trust in the vaccine itself. Public health education programming and messaging must be developed to encourage vaccine uptake among women with varying levels of vaccine hesitancy.

Relationship Between Asthma Control Status and Health-Related Quality of Life in Japan: A Cross-Sectional Mixed-Methods Study.

There is limited information regarding multidimensional relationships between asthma control and health-related quality of life (HRQoL), work productivity, and asthma symptom burden in Japan. Furthermore, systematic qualitative investigations about asthma burden have not been performed. This cross-sectional, mixed-methods study included Japanese patients (≥ 20years) with asthma adherent to inhaled corticosteroids/long-acting β2-agonists (ICS/LABA). The primary endpoint was impact of asthma on HRQoL, measured using the Asthma Health Questionnaire-33 (AHQ-33). Secondary endpoints were cough burden (Japanese-adapted Leicester Cough Questionnaire [J-LCQ]) and impact of asthma on work/activities (asthma-specific Work Productivity and Activity Impairment Questionnaire [WPAI:Asthma]). Quantitative data were assessed for the overall population and for well-controlled (WC) and not well-controlled (NWC) asthma subgroups. Qualitative verbal interviews further assessed the impact of NWC asthma on patients' HRQoL; emergent themes were extracted using thematic analyses. Of 454 patients, 45.2% (n = 205) had NWC asthma. Patients with NWC asthma had significantly worse asthma- and cough-related HRQoL across all AHQ-33 and J-LCQ domains and significantly greater work and activity impairment versus patients with WC asthma, across all assessed WPAI:Asthma domains. AHQ-33 total score was highly correlated with J-LCQ total and domain scores (r = -0.8132 to r = -0.7407). Nine themes emerged from qualitative interviews and confirmed that patients with NWC asthma had considerable HRQoL impairment due to asthma symptoms. Patients with NWC asthma had higher symptom burden and worse HRQoL than patients with WC asthma, despite ICS/LABA adherence. Cough burden correlated with HRQoL, suggesting cough may be one of the key markers to inform treatment strategy for patients with asthma.

Determinants of male involvement in partner's cervical cancer screening in Makueni County, Kenya

Background: Cervical cancer is the fourth cause of cancer deaths globally and is ranked in Kenya as the second cause of cancer-related deaths among females. Men are crucial in minimizing cervical cancer burden. This study sought to establish the socio-cultural and economic factors determining male involvement in their partner's cervical cancer screening in Makueni County, Kenya. Methods: A mixed-method cross-sectional study was used to obtain quantitative and qualitative data from men using questionnaires. Participants were married men aged 18-64 who sought services at three mid-level rural hospitals in Makueni County. Three key Informant face-to-face interviews were conducted. Quantitative data were analyzed using descriptive statistics and inferences. Qualitative data was analyzed through codes and themes. Results: The study included 291 men. Men's involvement in their partner's cervical cancer screening was low. Only 18% of the participants showed high involvement. The participants' mean age was 38.59 (SD±10.51). Younger men (median age=33 years) were significantly more involved than their older counterparts (median age=38 years) (U=4363, p=0.020). The level of male involvement was strongly linked to the rural area of residence (p=0.001) and the hospital where the respondents were interviewed (p=0.012). Other determining factors included employment status (p=0.004), educational level (p=0.000, and spousal screening history (p=0.000). The odds of male involvement were higher in men who understood their role in cervical cancer screening than those who did not (OR=4.550, 95% CI [1.307, 15.844], p=0.017). Conclusions: Male involvement in their partner’s cervical cancer screening remains significantly low, and demographics and sociocultural factors are key to these poor trends.

Physical, mental and social status after COVID-19 recovery in Nepal: A mixed method study.

Nepal has been devastated by an unprecedented COVID-19 outbreak, affecting people emotionally, physically, and socially, resulting in significant morbidity and mortality. Approximately 10% of COVID-19 affected people have symptoms that last more than 3-4 weeks and experience numerous symptoms causing an impact on everyday functioning, social, and cognitive function. Thus, it is vital to know about the recovered patient's health status and undertake rigorous examinations to detect and treat infections. Hence, this study aims to assess the health status of COVID-19 post-recovery patients in Nepal. A descriptive cross-sectional mixed-method study was conducted in all seven provinces of Nepal. A total of 552 interviews were conducted for the quantitative study, and 25 in-depth interviews were conducted for the qualitative study among above 18 years COVID-19-recovered patients. The data was gathered over the phone through the purposive sampling method The results of a descriptive and thematic analysis were interpreted. The majority (more than 80%) of the recovered patients could routinely perform household duties, activities outside the home, and financial job accounting. However, a few of them required assistance in carrying out all of those tasks. Prior and then after COVID-19 infection, smoking habits reduced by about one-tenth and alcohol intake decreased by a twelve percent. A qualitative finding revealed that the majority of COVID-19 symptomatic patients experienced a variety of physical symptoms such as fever, headache, body pain, fatigue, tiredness, sore throat, cough, loss of taste, loss of smell, sneezing, loss of appetite, and difficulty breathing, while others felt completely fine after being recovered. Furthermore, there was no variation in the daily functional activities of the majority of the recovered patients, while a few were found conducting fewer activities than usual because they were concerned about their health. For social health, quantitative data indicated that more than half of the participants' social health was severely impacted. According to the IDI, the majority of the interviewees perceived society's ignorance and misbehavior. Family members were the most often solicited sources of support. Some participants got care and assistance, but the majority did not get affection or love from their relatives. Moreover, regarding mental health, 15 percent of participants had repeated disturbing and unwanted thoughts about COVID-19 after being recovered, 16 percent tried to avoid information on COVID-19 and 7 .7 percent of people had unfavorable ideas or sentiments about themselves. More than 16 percent of participants reported feeling some level of stress related to the workplace and home. While in-depth interviews participants revealed that COVID-infected patients who were asymptomatic didn't experience any emotional change in them but recovered patients who are symptomatic symptoms had anxiety and still being conscious of COVID-19 in fear of getting infected again Additionally, it was discovered that participants' mental health is influenced by ignorance of society, as well as by fake news posted to social media. COVID-19 infection has had an impact on physical, mental, and social well-being. Hence, to aid in the early recovery of COVID-19 patients, provision of evaluating and reporting the clinical features, early detection and management of long COVID case is needed from the local and provincial and central government of Nepal.

Factors associated with COVID-19 vaccination status: A cross-sectional study of California students in higher education

To examine the factors associated with coronavirus vaccine hesitancy among students in higher education, we conducted a cross-sectional mixed-methods study between June and August 2021 among California students in higher education (n = 4444). We collected information on vaccination status, socio-demographics, and attitudes towards coronavirus vaccination.After adjusting for social demographics and social network characteristics, compared to those with household members who were vaccinated, those who had household members who were unvaccinated had 0.11 (95% CI 0.09 – 0.14) times the odds of being vaccinated. Political identification was related to vaccination status: compared to those who did not identify with any particular party, those who identified as progressive had 12.5 (95% CI 3.70 – 50.0) times the odds of being vaccinated. Asians had higher odds (OR = 1.54; 95% CI 1.08 – 2.04) of being vaccinated compared to whites and men were marginally less likely to be vaccinated (OR = 0.79; 95% CI 0.61 – 1.00). However, age, parental education, and educational status were unrelated to vaccination status. Social and demographic factors may be associated with the decision to remain vaccinated among young adults. Public health messages shouldutilize social networks to encourage vaccination uptake among young adults.