Health Experiences Research Articles

Entering civic space: youth experiences in sexual and reproductive health and rights advocacy in Ethiopia, Mali and Mozambique

ABSTRACT Young people are increasingly involved in advocacy on sexual and reproductive health and rights (SRHR), but research documenting their experiences remains limited. This article explores how young people advocate for SRHR in Ethiopia, Mali and Mozambique, what motivates them, what barriers they face, and how they overcome them. Building on in-depth interviews and focus group discussions, the findings show that across the three countries, youth are motivated to advocate for SRHR because it resonates with their direct realities, but experience challenges throughout. This is linked to a need for accessible and flexible funding for youth initiatives, trust from established organisations acting as allies, and freedom to establish advocacy agendas. Young people furthermore recommended more diverse youth perspectives should be represented in initiatives. Insights from this study are relevant to youth-led organisations, non-governmental organisations and governments interested in equal partnerships with young people in decision-making, and funders supporting international development aid.

A scoping review of the impact of eco-distress and coping with distress on the mental health experiences of climate scientists.

In the face of a future predicted to be one defined by an increase in the Earth's surface temperature, and the associated extreme weather events, distressing emotional responses are understandable. Climate scientists comprise a unique group, in that they are deeply and consistently faced with the current reality, and consequences of, climate change. 'Ecological distress', a term to describe climate-related emotional experiences, can include feelings of grief, anxiety, and hopelessness proportionate to the existential threat of climate change. This review sought to scope the current literature into how ecological distress is experienced by this population, factors that mitigate or exacerbate these experiences, and the coping strategies that are used. This review used Interpretive Content Analysis to code the data and employed a narrative synthesis of the findings. This paper demonstrates the significant emotional impacts associated with working as a climate scientist, along with an associated set of coping strategies. Climate scientists share experiences of emotional distress, involving both intra- and interpersonal processes, highlighting how people working in this profession may be vulnerable to unique pressures and psychological burdens related to their work. Climate scientists have an essential role to play in helping society and policy makers understand the implications of climate change and identifying the most useful responses. As such, it is integral that the psychological wellbeing of this group is understood and cared for. This review is the first step in synthesising current knowledge, in preparation for developing helpful methods and strategies for keeping our climate scientists well, motivated, and engaged.

Exploring mental health experiences and supports among international engineering undergraduate students – insights to inform university support

ABSTRACT This study explores the mental health perceptions, expectations for mental healthcare, and use of existing mental health services among international engineering students at a Western Canadian university. Employing a phenomenological qualitative approach, semi-structured interviews were conducted with 18 international undergraduate engineering students to understand their mental health challenges and service usage. The thematic analysis revealed three significant themes: students’ understanding of mental health; their experiences within the engineering programme, and recommendations to enhance and facilitate a positive mental health experience at the university. Findings suggest that mental healthcare for international engineering students should be responsive to the students’ unique needs, providing support and accessible services during their transition from their home countries and recognising the impact of the environmental and cultural factors on their experiences as members of the Faculty of Engineering and the broader university community.

Hidden in plain text: Uncovering hidden heterogeneity and social stratification in Ireland AD 1150-1800.

Between the Irish late medieval (AD 1150-c.1550) (LMP) and post-medieval (AD c.1550-1800) (PMP) periods, colonial practices changed land ownership. Contextualizing these periods within a biocultural political economy framework supports increasing social inequality in the PMP, which we expect to be reflected in different skeletal markers of longevity and stress. Therefore, we hypothesized that widespread exposure to stressors and resource deprivation contributed to lower longevity in the PMP compared to the LMP, and that there would be greater variation between sites in the frequency of linear enamel hypoplasias (LEH) in the PMP. We estimated age and counted matched pairs of LEH on 526 adult skeletons from the Irish counties of Dublin, Kildare, Louth, and Meath. Age-at-death was compared through Kaplan-Meier survival functions and non-parametric tests. Linear enamel hypoplasias prevalences were analyzed with Mann-Whitney U tests and Generalized Linear Models. Age-at-death distribution changed between the LMP and PMP for males, with males experiencing an increase in median-age-at-death. The same was untrue for females, who show no changes in median age-at-death. Analysis of LEH frequency per individual showed that variation between sites was significant in the post-medieval period but not in the late medieval period. These results suggest that social organization contributed to embodied health experiences that varied across time periods. Specifically, populations from the PMP appear to have embodied greater social inequality in their more varied susceptibility to stress. Our work demonstrates the strength of pairing historical texts with the analysis of skeletal remains to evaluate the impact of social structures on biological frailty.

"Hanging on by a Thread": The Lived Experience of Parents of Children with Medical Complexity.

Families with children with medical complexity endure high levels of chronic and toxic stress, impacting the overall health and wellbeing of all family members and the system as a whole. The purpose of this study was to examine the lived experiences of parents/caregivers with children with medical complexity. The lived experiences of 15 parents of children with complex medical needs were explored using focus group discussions. Focus group discussions were recorded, transcribed, and analyzed using van Manen's 6-step process for hermeneutic phenomenology. Aligned with the research questions, the analysis draws on van Manen's four lived existential analytical categories. Themes include: (1) lived body, the psychological and physiological effect; (2) lived time and space, the immediate impact on the there, now, and then; (3) lived relationships, social life and family relational effect; (4) risk factors; and (5) protective factors. Caregivers of children with medical complexity have a unique experience of trauma and resilience. This study will inform interdisciplinary medical providers about the mental health and resiliency experiences of this population to support more effective healthcare practices.

Substance use recovery: Global health perspectives and experiences

Addictive behavior treatment networks comprise harm-reduction services and recovery programs. Recovery is an approach toward interventions for addictive behavior that focuses on the individual’s empowerment, abilities, and life skills. Rehabilitation-oriented programs have evolved from traditional therapeutic communities to comprehensive services that are integrated into social and health networks and delivered by multidisciplinary professionals. This paper aims to analyze the development of recovery programs, drawing from quantitative and qualitative data from an action research approach. It also presents theoretical models and best practices for recovery. In summary, recovery-oriented programs must be integrated with harm-reduction networks, social and employment services, and health systems. Furthermore, as recovery is based on empowerment and peer social support, there is an urgent need to develop structured programs to address these issues. Moreover, there is a need to design and implement specific interventions for a broad range of populations and develop evaluation systems to assess the effectiveness and relevance of recovery-oriented programs.

Pandemic scars: long-term impact of COVID-19 on work stress among healthcare workers in China.

This study mainly focused on the long-term effect of different risk exposure levels and prior anti-epidemic experience of healthcare workers in mitigating COVID-19 on their work stress in the post-COVID era. The study sample included 359 physicians, 619 nurses, 229 technicians and 212 administrators, for a total of 1,419 healthcare workers working in the Lanzhou area during the investigation. Data were analyzed by multivariate regression models. Our findings indicated that the interaction between pandemic effect mitigation experience and high-risk exposure significantly affected healthcare workers in the post-COVID era by increasing their work stress (p<0.001) and reducing their rest time (p<0.001). Healthcare workers may have experienced worse outcomes in the long term if they had higher levels of risk exposure and more experience in fighting epidemics. Furthermore, poor mental health (p<0.001) and prior experience with SARS (p<0.001) further amplified these adverse effects. However, surprisingly, we did not observe any effect of prior anti-epidemic experience or high-risk exposure on the mental health of healthcare workers in the post-COVID era (p>0.1). The adverse impact of COVID-19 may have left long-lasting effects on Health professionals (HPs), particularly those with high Risk exposure (RE) and more mitigation experience. Poor Mental health (MH) and previous experience in mitigating previous similar outbreaks (such as SARS) are risk factors that should be considered. Support programs must be designed and promoted to help HPs respond and improve their performance. Our study presents compelling evidence that the COVID-19 pandemic will have long-term detrimental effects on the work stress of healthcare workers.

Work Disparities and the Health of Nurses in Long-Term Care: A Scoping Review.

Work disparities, such as unfairness in pay or unequal distribution of work experienced by nurses in long-term care (LTC), can impact the retention and health of this workforce. Background: Despite the significant impact of disparities on nurses' health in LTC, a literature review on work disparities of nurses in LTC has not been conducted. Method: This scoping review aimed to explore the nature and extent of research on meso-level work disparities experienced by nurses in LTC and its links with nurse health and well-being. Five databases were searched: MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), SCOPUS, and CINAHL (EBSCO host). Results: Of the 5652 articles retrieved, 16 studies (14 quantitative and 2 qualitative) published between 1997 and 2024 met the inclusion criteria. A total of 53 work disparities were identified. Only four articles investigated the association of a work disparity with a variable of health (e.g., physical, mental, or poor general health). Conclusions: The results suggest that more attention to how disparities impact nurses' health and lived experiences is warranted. Meso-level disparities from this review provide an initial basis to consider possibilities in the workplace, especially in supporting equity and opportunities for health and well-being at work (e.g., through fair access to professional growth opportunities and a more equitable balance of work expectations and demands of nursing staff). Future studies of the intersection of macro- and meso-level factors are needed to inform better workplace practices and social and economic policies to support the well-being, health, and safety of nurses at work in LTC.

Investigating College Student Mental Health Needs and Barriers Using Natural Language Processing

College students’s mental health has been declining, despite efforts by universities to improve outreach and programming. Though a variety of resources are available, students, especially those who experience marginalization, often do not engage with them. LGBTQ+ students in Florida, in particular, may face unique challenges. To understand marginalized college students’s mental health experiences, we conducted ten focus group interviews (N = 65) with students with various marginalized identities. Using Natural Language Processing (NLP) techniques, we conducted sentiment analysis with respect to students’s responses on interview questions (e.g., mental health needs, how needs are met/not met) among LGBTQ+ and other minority groups. Overall, LGBTQ+ students yielded a more negative sentiment than the other groups, with a marginally significant (at 0.1 level) difference suggested by Wilcoxon rank sum test. This project presents a novel approach to leveraging traditional qualitative methods and AI, provides deeper understanding of the mental-health-related needs of marginalized college students, and practical implications for prevention and intervention efforts to promote college students’s mental health.

Contributory Injustice, Epistemic Calcification and the Use of AI Systems in Healthcare

AI systems have long been touted as a means to transform the healthcare system and improve service user outcomes. However, these claims frequently ignore the social context that leaves service users subject to epistemic oppression. This paper introduces the term “epistemic calcification” to describe how the use of AI systems leads to our epistemological systems becoming stuck in fixed frameworks for understanding the world. Epistemic calcification leads to contributory injustice as it reduces the ability of healthcare systems to meaningfully consider alternative understandings of people’s health experiences. By analysing examples of algorithmic prognosis and diagnosis, this paper demonstrates the challenges of addressing contributory injustice in AI systems and the need for contestability to focus on more than the AI system and on the underlying epistemologies of AI systems.

Women’s exposure to intimate partner violence and its association with child stunting: findings from a population-based study in rural Rwanda

ABSTRACT Background Child stunting is a significant challenge for most districts in Rwanda and much of sub-Saharan Africa and persists despite multisectoral efforts. There is a notable lack of population-based studies examining the correlation between violence against women and child stunting in Rwanda. Objective We aimed to investigate the association between Rwandan women’s exposure to intimate partner violence (IPV) and child stunting in children under 3 years of age. Methods In December 2021, a population-based cross-sectional study was conducted in the Northern Province of Rwanda, including 601 women and their children <3 years of age. The World Health Organization (WHO) Women’s Health and Life Experiences Questionnaire for IPV research was utilized. Child stunting was assessed using the WHO criteria for low height for age. Multivariable logistic regression was used to examine the association between IPV and child stunting before and during pregnancy. Results Of 601 women, 47.4% (n = 285) experienced any form of IPV during pregnancy. The prevalence rates of the types of IPV associated with child stunting varied: 33% for psychological, 31.4% for sexual, and 25.7% for physical violence. Exposure to physical violence before pregnancy and sexual violence during pregnancy was associated with higher odds of child stunting; the adjusted odds ratios were 1.29 (95% CI, 1.01–2.03) and 1.25 (95% CI, 1.04–2.01), respectively. Conclusion Women’s exposure to physical and psychological violence is associated with an increased risk of child stunting. Urgent targeted interventions and support systems are needed to address the complex relationship between women’s exposure to IPV and adverse effects on child growth.

The process of developing an augmented reality (AR) tool for knowledge translation on climate change-related experiences among youth in Kenya

This report details a qualitative methodological approach of developing an Augmented Reality (AR) tool which integrates digital storytelling for context-specific, accessible, scalable participatory research knowledge translation on climate-related sexual health experiences among youth (aged 16-25 years) in Kenya. AR, which engages audiences through virtual images overlayed on the real world in real-time, enhances learning and knowledge retention. This suggests the potential for using this increasingly accessible technology in knowledge translation, despite such use being understudied. Our AR tool meaningfully incorporates seven digital storytelling videos made by youth in Kenya through a study in 2023, to amplify youth voices while illustrating complex pathways between four climate-related factors (drought, floods, extreme heat, and excess winds) and three HIV vulnerabilities (gender-based violence, early marriage, and transactional sex). The aim of this paper is to describe the design of an AR tool for knowledge translation, youth empowerment, and health promotion, and to outline how it can be harnessed for sexual health and climate change education to inform future knowledge translation approaches with youth climate-affected issues.

Determining unmet need: clinical relevance of suspected neurodivergence in first-episode psychosis.

We explored the prevalence of autism and attention-deficit hyperactivity disorder in first-episode psychosis. Through service evaluation involving 509 individuals, detailed analyses were conducted on neurodevelopmental traits and patterns of service utilisation. Prevalence of neurodivergence in first-episode psychosis was 37.7%. Neurodivergent individuals used urgent mental health services more frequently (Mann-Whitney U = 25925, Z = -2.832, P = 0.005) and had longer hospital stays (Mann-Whitney U = 22816, Z = -4.886, P ≤ 0.001) than non-neurodivergent people. Neurodivergent people spend more than twice as long in mental health hospitals at a time than the non-neurodivergent people (Mann-Whitney U = 22 909.5, Z = -4.826, P ≤ 0.001). Mediation analysis underscored indirect impact of neurodivergence on hospital stay durations through age at onset of psychosis and use of emergency services. Prevalence of neurodevelopmental conditions in first-episode psychosis is underestimated. Neurodivergent individuals show increased utilisation of mental health services and experience psychosis earlier. Early assessment is crucial for optimising psychosis management and improving mental health outcomes.

Evaluating the impact of the Health Access for Refugees Project on people who are refugees or seeking asylum in Northern England.

Evidence demonstrates that people who are seeking asylum and refugees face individual, institutional and system-level barriers when accessing health services. Health Access for Refugees' Project (HARP) is a UK initiative increasing access to health care within this community through a series of interventions. This study explored the impact of HARP on health service access, experiences and outcomes for clients, and how volunteers and staff addressed institutional and system-level barriers. In summer 2020, we conducted qualitative telephone interviews with four HARP clients, eight clients who became volunteers, seven further volunteers and three staff members. The educational aspect of the interventions supported clients navigating the complex UK health care system while promoting independence in accessing health care. Advocacy by volunteers and staff was important in challenging barriers at individual and institutional levels. Staff challenged the asylum system, by improving information around entitlement to health care and addressing barriers to registering with a General Practitioner (GP). Interventions such as those provided by HARP can address different levels of barriers to support people accessing health care provision. This can be achieved through training health professionals and working with peers to support access to care and to develop self-advocacy. However, stable long-term funding is essential to ensure the sustainability of these initiative.

Spiritual Healing: Ragam Bahasa Balian Sebagai Salah Satu Pelestarian Tradisi Lokal di Bali

This research aims to identify the language varieties of Balian and the factors that influence these language varieties. This research is descriptive qualitative with a linguistic and pragmatic theory approach used by Balian. Data collection was done by in-depth interviews with Balians in the hotel. The collected data were then transcribed and thematically coded to identify patterns in language use, such as the use of language, the use of metaphorical language styles, and the sentence structure used. The results found that the balian language variety when communicating with clients is the use of affirmative language, the use of spiritual metaphor style, and the use of imperative sentence structure to direct the client's experience and emotional response during the healing process. Meanwhile, the factors that influence balian language varieties are cultural, spiritual, social, economic, and personal factors. An understanding of these factors helps explain how balians navigate between local traditions and the needs of their clients, as well as how they integrate different elements of language to create effective and meaningful healing experiences. Future studies go more in-depth into analyzing balian language use when viewed pragmatically and therapeutically.

Perspectives and experiences of health sciences academics regarding ChatGPT: A qualitative study

Purpose This study aimed to explore the perspectives and experiences of healthcare academics regarding the impact of ChatGPT, an artificial intelligence (AI)-supported language model, on education and research. Sample and methods This qualitative study employed a phenomenological analysis approach. The study sample consisted of nine academics from the Faculty of Health Sciences at a university in Türkiye, selected through purposive sampling method. Data were collected through semi-structured interviews, coded using the MAXQDA software, and analyzed using content analysis. Results The participants highlighted that while ChatGPT offers rapid access to information, it occasionally fails to provide current and accurate data. They also noted that the students’ misuse of ChatGPT for assignments and exams has a negative effect on their critical thinking and information retrieval skills. The academics reported that there is a need for expert oversight and verification of the data generated by ChatGPT. Conclusion While ChatGPT offers significant benefits such as enhanced efficiency in academic research and education, it also presents challenges, including accuracy and ethical concerns. Institutions should integrate ChatGPT with clear guidelines to maximize its benefits while maintaining academic integrity. Future studies should explore the long-term impacts of AI tools, such as ChatGPT, on educational outcomes and their application across various disciplines.

Report of Unfair Discipline at School and Associations with Health Risk Behaviors and Experiences - Youth Risk Behavior Survey, United States, 2023.

Relatively little is known about the association between school discipline and student health and well-being. Using CDC's 2023 Youth Risk Behavior Survey, CDC analyzed the prevalence of report of unfair discipline at school and associations with experiences at school, mental health, suicidal thoughts and behaviors, and health risk behaviors among high school students overall and stratified by race and ethnicity. Prevalence estimates, prevalence differences, and prevalence ratios adjusted for race (in overall models), grade, and sex were calculated. Overall, 19.3% of students reported receiving unfair discipline during the previous 12 months; Black or African American students had a higher prevalence (23.1%) compared with Hispanic or Latino students (18.4%) and White students (18.1%). Unfair discipline was reported among a majority of students who describe their sexual identity in some other way (besides gay, heterosexual, lesbian, bisexual, or questioning) for American Indian or Alaska Native (81.7%) and multiracial (57.1%) subgroups. Overall, report of unfair discipline was associated with every health risk behavior and experience examined, including being bullied at school or electronically, skipping school due to feeling unsafe, carrying a weapon at school, prescription opioid misuse, poor mental health, persistent feelings of sadness or hopelessness, seriously considered attempting suicide, and attempted suicide. This pattern of association was similar among most student groups in models stratified by race and ethnicity. This analysis is the first to demonstrate, among a nationally representative sample of high school students, that reports of unfair discipline are associated with various health risk behaviors and experiences. With these findings, public health and education practitioners can create interventions that equitably promote safe, supportive, and inclusive school environments for student health.

Adult Caretaker Engagement and School Connectedness and Association with Substance Use, Indicators of Emotional Well-Being and Suicide Risk, and Experiences with Violence Among American Indian or Alaska Native High School Students - Youth Risk Behavior Survey, United States, 2023.

The strength of American Indian and Alaska Native (AI/AN) communities comes from generations of Indigenous traditions, language, culture, and knowledge. These strengths have been challenged by a complex set of systemic, structural, and social factors related to historical and intergenerational trauma that affects the health of AI/AN communities. Furthermore, AI/AN population health data often are inaccurate because of analytic coding practices that do not account for multiracial and ethnic AI/AN identification and inadequate because of statistical suppression. The 2023 national Youth Risk Behavior Survey included a supplemental sample of AI/AN high school students. Coding of race and ethnicity was inclusive of all AI/AN students, even if they also identified as another race or as Hispanic or Latino, providing comprehensive data on health behaviors and experiences among AI/AN high school students nationwide. Adult caretaker engagement and school connectedness and their association with 13 health behaviors and experiences were examined, including five types of current substance use, four indicators of emotional well-being and suicide risk, and four types of violence. Pairwise t-tests and adjusted prevalence ratios from logistic regression models identified significant associations between exposure and outcome variables. Among AI/AN students, having an adult who always tried to meet their basic needs, high parental monitoring, and high school connectedness were associated with lower prevalence of certain measures of substance use, poor emotional well-being and suicide risk, and violence. Compared with non-AI/AN students, the prevalence of current electronic vapor product use, current marijuana use, attempted suicide, and experience of sexual violence was higher among AI/AN students.This report presents the most comprehensive, up-to-date data on substance use, indicators of emotional well-being and suicide risk, and experiences with violence among AI/AN high school students nationwide. The findings suggest the importance of engaged household adults and school connectedness in promoting emotional well-being and preventing substance use, suicide-related behavior, and experiences of violence among AI/AN students. Understanding the historical context and incorporating Indigenous knowledge when developing interventions focused on AI/AN youths are critical to ensure such interventions are successful in improving AI/AN health and well-being.

Disparities in School Connectedness, Unstable Housing, Experiences of Violence, Mental Health, and Suicidal Thoughts and Behaviors Among Transgender and Cisgender High School Students - Youth Risk Behavior Survey, United States, 2023.

Transgender high school students (those whose gender identity differs from their sex assigned at birth) experience disparate health outcomes and challenges in school, including violence and discrimination, compared with cisgender students (those whose gender identity aligns with their sex assigned at birth). Until recently, population-based data describing the experiences of transgender students and students questioning whether they are transgender (questioning) have been limited. In 2023, the national Youth Risk Behavior Survey assessed transgender identity, providing the first nationally representative data about transgender students. This report describes the demographic characteristics of transgender and questioning high school students and examines differences in the prevalence of experiences of violence, poor mental health, suicidal thoughts and behaviors, school connectedness, and unstable housing among transgender, questioning, and cisgender high school students nationwide. In 2023, 3.3% of U.S. high school students identified as transgender, and 2.2% identified as questioning. Transgender and questioning students experienced a higher prevalence of violence, poor mental health, suicidal thoughts and behaviors, and unstable housing, and a lower prevalence of school connectedness than their cisgender peers. Compared with 8.5% of cisgender male students, 25.3% of transgender students and 26.4% of questioning students skipped school because they felt unsafe. An estimated 40% of transgender and questioning students were bullied at school, and 69% of questioning students and 72% of transgender students experienced persistent feelings of sadness or hopelessness, a marker for experiencing depressive symptoms. Approximately 26% of transgender and questioning students attempted suicide in the past year compared with 5% of cisgender male and 11% of cisgender female students. Intervention opportunities for schools to create safer and more supportive environments for transgender and questioning students can help address these disparities. The findings of this report suggest that more effort is necessary to ensure that the health and well-being of youths who are socially marginalized is prioritized.

“Consistent Support Is Good for My Mental Health”—Exploring the Lived Experience of Autistic Mental Health

“Consistent Support Is Good for My Mental Health”—Exploring the Lived Experience of Autistic Mental Health