The rapid advancement of Artificial Intelligence (AI) has transformed the educational landscape, particularly in how students learn and engage with the English language. This study explores the perceptions of foundation students at UNITAR International University regarding the impact of AI on English language learning specifically, whether it serves as an aid or an obstacle. Employing a qualitative research design, data were collected through semi-structured interviews and focus group discussions with selected foundation students who have used AI-based tools such as ChatGPT, Grammarly, and Microsoft 365 Copilot in their learning process. The findings reveal that students generally perceive AI as a supportive learning aid that enhances vocabulary acquisition, grammar correction, and pronunciation practice. However, several participants expressed concerns about over-reliance on AI, reduced critical thinking, and diminished originality in writing. The study concludes that while AI can significantly facilitate English language learning, it should be integrated thoughtfully, with educators guiding students on ethical use and promoting self-directed learning. These insights highlight the need for balanced pedagogical approaches that harness AI’s benefits without compromising students’ language development and autonomy.

Aspirin Prophylaxis for Preeclampsia Prevention in Nigeria: An Explanatory Sequential Mixed Methods Study.

<p><em>Spelling competence is critical in academic writing, particularly for English student teachers who are expected to serve as role models of accurate language use in their future classrooms. At the South African university, many Level One English Student Teachers enter higher education with spelling challenges that affect both their academic performance and professional identity. This study investigates spelling problems and effective teaching strategies to overcome the problem. Employing a qualitative research approach, the study collected data through classroom observations, semi-structured interviews with lecturers, focus group discussions with students, and analysis of students’ written work. The findings revealed that spelling challenges were mainly influenced by phonological interference from learners’ home languages, limited familiarity with written English, and inadequate prior instruction in spelling rules. Effective interventions identified in the study include explicit spelling instruction, phonics-based approaches, fostering morphological awareness, peer-assisted learning, and the integration of digital tools. The study recommends incorporating structured spelling instruction into English Education modules to enhance student teachers’ writing accuracy, build their professional confidence, and equip them with the skills needed to teach spelling effectively in South African schools.</em></p>

This research explored the learning experiences of Pre-service Teachers during the gradual easing of social distancing mandates amidst the COVID-19 lockdowns. A mixed-method research design was employed, combining survey and thematic analysis, guided by the elements of the Community of Inquiry framework: social presence, cognitive presence, and teaching presence. A total of 251 PTs from three renowned universities in Maguindanao and Cotabato City, Philippines, participated in the surveys. Additionally, seven intern supervisors from these institutions served as key informants during interviews, while ten cooperating teachers from partner schools provided insights through focus group discussions. The analysis revealed that PTs perceived their experiential learning as excellent across all critical elements. Social presence was observed when they built harmonious relationships with students, peers, and mentors, expressed empathy and care in their communication, and created a comfortable, safe, and secure learning environment. Cognitive presence emerged through dynamic student participation in class sessions and reflective practices. Finally, their teaching presence was evident in their diverse teaching strategies, use of appropriate language, effective design and organization of instructional materials, facilitation of instruction, assessment, and feedback. However, further in-depth studies may be required to ascertain whether similar patterns emerge across diverse demographic groups.

Oral health remains a global health challenge. Rural communities are disproportionately affected by oral diseases due to inequitable access to oral health services and the absence of initiatives that promote oral health and quality of life. This study aimed to explore community members' perceptions of oral health in rural communities in Limpopo province, South Africa. A convenience sample of 50 participants was recruited to take part in five focus group discussions, each comprising 10 participants from five geographically distinct rural communities. Discussions were conducted using an interview guide, digitally recorded, transcribed verbatim, imported into ATLAS.ti, and thematically analyzed using an inductive approach. Three main themes emerged: (1) barriers to oral healthcare access, (2) inadequate oral health advocacy, and (3) intrinsic determinants of oral health, each with several related sub-themes and categories. Together, these factors were identified as key contributors to limited awareness of oral health and its potential impact, thereby increasing the prevalence of oral diseases in rural communities. Despite global initiatives to improve oral health, rural communities remain disproportionately affected by various oral health challenges. Improving oral health in these settings requires integrating oral health into PHC policy reform, equitable workforce distribution, implementation of oral health programs, expansion of mobile services, and the involvement of community healthcare workers to enhance access.

Education is a powerful tool for driving development and transformation in society. Higher Education Institutions (HEIs) in the Philippines mandate State Universities and Colleges (HEIs) to engage in research and extension activities that contribute to nation building and improvement of the quality of life. Initiatives of academic institutions to conduct impact studies of extension programs implemented in partnership with communities are vital sources of information about the success of community-based extension programs. This study focused on evaluating the impact of Project CARES (Child Advocacy and Responsive Extension Services), a research-based extension project for Child Development Workers implemented in the locality of Kapangan, Benguet, Northern Philippines for the past five years. Combining quantitative and qualitative research approaches by gathering data through survey, interviews, focus group discussions and narrative analyses, the study assessed the impact of the project to 36 purposively selected Child Development Workers, beneficiaries of the extension project, and willingly participated the impact assessment by external assessors. The participants agreed that they gained knowledge and information; acquired child-centered pedagogical skills; imbibed positive attitudes towards early childcare and development; and they benefited from their engagements through the various activities of Project CARES which greatly contributed to their professional growth and development.

This study aimed to explore the life experiences of City Jail Officers as stewards of persons deprived of liberty amidst the Covid-19 pandemic. Specifically, sought to the following specific problems: the experiences of the informants in the performance of their duties during the Covid-19 pandemic, coping with the challenges encountered in the performance of duties, and aspirations of the informants to improve the quality of jail service. The phenomenological and qualitative approach in this study was utilized through interviews as the key process in the gathering of data. There were ten (10) selected city jail officers. Four (4) of them were individually interviewed while the other six (6) were included in the Focused Group Discussion (FGD). They were selected randomly but met the minimum qualifications. The research location is at Tagbilaran City Jail – Cabawan District, Tagbilaran City. A validated interview guide aided with the voice recorder for the basis of transcribing the responses of the informants. Utilization of Colaizzi's method, a phenomenological analysis procedure in analyzing the responses of the informants during the conduct of the interview. For the experiences of the informants as Jail Officers amidst the Covid-19 pandemic, the themes generated were: Triumph through Unity, Collegial Harmony Initiative, Scarcity of Supplies, and PDL’s Misbehavior. In coping with the challenges encountered in the performance of duties, the following themes were created: Resilience Amidst Scarcity, Synergistic Wellness Renewal, and Virtual Family Reconnection, for the aspirations of the informants, themes created were: Adherence to Protocol and Training for Safety and Security in Innovation. For the Tagbilaran City Jail Personnel, the implementation of several suggestions is recommended to inspire and encourage jail officers for relevant improvements. Firstly, the development of specialized training programs tailored to address challenges unique to the pandemic, emphasizing the significance of humane treatment and effective guidance, is crucial. Introducing mental health support services for jail officers can aid in coping with the stresses associated with their roles during the pandemic. Establishing open communication channels within the jail facility is another key recommendation, fostering dialogue among personnel and creating a supportive work environment. The implementation of recognition programs to acknowledge and appreciate the efforts of jail officers can significantly boost morale and motivation. As for the Local Government Unit (LGU), the following suggestions are proposed to make informed decisions based on the comprehensive overview. In addition, the Department of Interior and Local Government (DILG) to effectively address challenges through education and training, the following suggestions are recommended. Organizing workshops and seminars on relevant topics such as crisis management and adapting to new challenges can equip jail officers with the necessary skills.

Background: The interplay between community-based mental health literacy (MHL) and the specific barriers faced by low-wage Filipino workers within the unique socio-cultural context of the UAE is underexplored. The United Arab Emirates (UAE), as a major economic hub in the Gulf Cooperation Council (GCC) region, hosts one of the largest expatriate populations globally, with Filipino nationals constituting a significant portion. Purpose: This study aimed to investigate the relationship between mental health literacy (MHL) and perceived barriers to seeking psychological help among low-wage Filipino migrant workers in the United Arab Emirates (UAE). It sought to provide a nuanced understanding of the cultural, social, and structural factors influencing their help-seeking behaviours. Methods: A concurrent triangulated mixed-methods design was employed. Quantitative data were collected via a survey administered to 200 participants, measuring demographics, MHL, and help-seeking barriers. Simultaneously, qualitative data were gathered through four focus group discussions with 28 participants to explore lived experiences. Quantitative data were analysed using descriptive statistics, Pearson correlation, and multiple regression, while qualitative data were analysed using thematic analysis. Results: Quantitative analysis revealed a significant, strong negative correlation between MHL scores and perceived help-seeking barriers (r(198) = -.62, p < .001). Stigma and financial constraints were the most highly rated barriers. Thematic analysis of focus group data yielded three primary themes: (1) 'Bawal Magkasakit': The Unaffordability of Being Unwell, highlighting economic precarity as a primary deterrent; (2) The Double-Edged Sword of Community, which explores the dual role of the community as both a source of support and stigma; and (3) Faith as a First and Final Resort, indicating a strong reliance on spiritual coping mechanisms over formal mental health services. A joint display of the data demonstrated strong convergence between the quantitative and qualitative findings. Conclusion: The findings underscore that enhancing mental health support for low-wage Filipino workers in the UAE requires a multi-level approach. Interventions must move beyond simple psychoeducation to address deep-seated cultural norms, pervasive stigma, and formidable economic barriers. Culturally-attuned, community-based models that integrate spiritual support and address financial accessibility are crucial for fostering a supportive environment where seeking help is viewed as a sign of strength, not a liability.

Constitutional Court Decision No. 69/PUU-XIII/2015 has brought about a significant paradigm shift in Indonesian marriage contract law, allowing for the creation of such contracts during the course of a marriage. This change necessitates a shift in the role of notaries from mere document creators to active and responsive legal educators. However, implementation in the city of Pekanbaru shows that the optimization of this role has not been fully achieved, marked by low legal literacy among the public, structural barriers, and the lack of integration between the notarial service system and regulations and technology. The main problem is the passive attitude of Notaries, who only respond to requests without proactively providing legal education. This empirical legal research aims to analyze and formulate a concept for optimizing the role of notaries in the creation of authentic marriage agreements following the Constitutional Court's decision in Pekanbaru. Using a sociological-legal approach with qualitative methods, this research is descriptive-analytical and exploratory in nature. Data collection was conducted through in-depth interviews, participatory observation, and focus group discussions, as well as document and literature studies. The research results indicate an increase in the creation of marriage agreement deeds following the Constitutional Court ruling, but the number remains low compared to the total number of marriages. The majority of clients come from highly educated groups and have economic-business motivations. The main challenges include inconsistent technical regulations, insufficient socialization, variations in notarial practices, and ineffective third-party protection mechanisms. As an innovation, this study proposes a model for transforming the role of notaries into a proactive-educational, inter-institutional collaborative, and digitally adaptive role. This model is expected to strengthen the position of notaries as an essential legal profession in protecting marriage law in Indonesia.

Objective To explore secondary school students' perceptions of a metaverse platform called Meta-OHE (metaverse for oral health education).Methods Focus group discussions (FGDs) were conducted with purposively sampled 16-year-old secondary school students from semi-government schools in Malaysia. Participants engaged with the Meta-OHE platform on Mitoworld for one week before the FGDs sessions on https://mitoworld.io/world/w/2808/meta-ohe . The FGDs, conducted in both English and Malay, each lasted between 30-60 minutes and were guided by a semi-structured topic guide until data saturation was achieved. The data were analysed through framework analysis, using NVivo 14.0 to systematically code and develop themes.Results A total of 81 students participated in 16 FGDs. Emerging themes in their perceptions of the metaverse platform Meta-OHE included freedom and exploration, interactive features, access to oral health information, and immersive learning experiences. Participants favoured visually appealing environments, customisable avatars, diverse oral health education content, and the integration of augmented reality and virtual reality technologies. Desired platform features from the participants also included gamification, reward systems, up-to-date information, diverse environments, social features, short videos, educational simulations, and age-appropriate content.Conclusion The study revealed positive perceptions of Meta-OHE for oral health education, suggesting its potential as an innovative tool for engaging secondary school students in oral health promotion and education. However, frequent updates, maintenance and expansions to content, technical diversity and features were emphasised to maintain interest and relevance.

Hypertension is a leading non-communicable disease in Nepal, with a rising burden among older adults and persistently low rates of blood pressure control. While several studies have explored healthcare-seeking behavior in the general population, little is known about the specific challenges faced by older adults with hypertension. In particular, the perspectives of older adults with hypertension, family caregivers and healthcare providers-key actors in the care process are rarely explored. Therefore, this study aims to explore challenges to healthcare-seeking among older adults with hypertension in Nepal from the perspective of older adults, family caregivers, and healthcare providers. We adopted a qualitative study design to collect the required information. Trained researchers conducted 24 In Depth Interviews (IDIs) with older adults, healthcare providers, and facilitated 2 Focus Group Discussions (FGDs) with 18 caregivers. Interviews and FGDs were held in private settings using a semi-structured guideline based on the socio-ecological model. The interviews and FGDs were conducted in the Nepali language. The audio-recorded sessions were then transcribed verbatim and subsequently translated into English before analysis, to then apply both inductive and deductive coding. We then analyzed the data using thematic analysis with Taguette software. Applying the Socio-Ecological Model, we explored multi-level challenges to seeking care as perceived by older adults with hypertension, family care givers and healthcare providers in Central Nepal. At the individual level, perceived physical and cognitive decline, low health autonomy, and competing priorities as limiting their ability to seek care, while healthcare providers viewed these same factors as major challenges to timely service utilization. Interpersonal challenges were perceived in terms of limited family support and poor communication between older adults with hypertension and health care providers. At the community level, inadequate infrastructure and transportation difficulties restrict access. Organizational challenges were perceived as insufficient geriatric services, fragmented care pathways, and shortages of health staff, with providers particularly emphasizing these system constraints. Finally, at the policy level, perceived exclusion from health insurance, lack of structured programs, and inefficiencies in medication supply and enforcement as significant challenges. To improve hypertension management, a coordinated response is needed by investing in geriatric-friendly services, empowering older adults with hypertension, strengthening family and community support, and closing the policy-to-practice gap. As Nepal's population ages, addressing these issues is vital to achieving equitable, age-inclusive healthcare.

Resilience, the capacity to adapt positively in adversity, is a key protective factor for adolescent well-being, particularly for depression and anxiety, which are highly prevalent among adolescents in Nepal. Accurate measurement across cultural contexts is essential to identify at-risk adolescents and understand protective mechanisms. This study culturally adapted and evaluated the psychometric properties of the Child and Youth Resilience Measure-Revised (CYRM-R) and Rugged Resilience Measure (RRM) in Nepal to ensure cultural relevance, reliability, and validity. This mixed-method study focused on poverty-affected adolescents in Kathmandu, using focus group discussions, cognitive interviews, pilot assessments, and a cross-sectional survey. The findings indicated Nepali versions of CYRM-R and RRM were acceptable, comprehensible, and relevant based on qualitative feedback. Most items showed item-total correlations between 0.2 and 0.5, indicating good discrimination, and internal consistency was satisfactory (α and ω > 0.7). Exploratory and confirmatory factor analyses supported a unidimensional structure, with an alternative two-factor solution explored for CYRM-R. Test-retest reliability was moderate overall, with some subscales less consistent. Both tools demonstrated strong psychometric properties, including face, content, convergent, and known-groups validity. The Nepali CYRM-R and RRM provide culturally robust tools for assessing adolescent resilience, supporting researchers, educators, and policymakers in designing targeted interventions.

BackgroundDigital mental health interventions (DMHIs) offer a scalable approach to address adolescent depression and anxiety. User-centered coproduction can optimize acceptability and engagement, but it is often resource-intensive. Advances in generative artificial intelligence (GenAI) create new opportunities for involving adolescents in co-design, yet research on its feasibility and acceptability, particularly in low-resource settings, remains underexplored.ObjectiveThis study aimed to explore adolescents’ experiences and perspectives of using GenAI to co-design stories, images, and music for the Kuamsha app (Sea Monster), a gamified DMHI that teaches behavioral activation through interactive narratives and peer support.MethodsOverall, 2 participatory workshops and focus group discussions were conducted with 23 adolescents (aged 15‐19 years) in rural Mpumalanga, South Africa. Participants were guided to use 3 GenAI tools—ChatGPT (OpenAI), text-to-story; MidJourney (MidJourney Inc), text-to-image; and Soundful (Soundful Inc), music generation—to create digital content. Data were audio-recorded, translated, transcribed, and triangulated with the facilitator’s observation notes. Thematic analysis was used to explore key themes.ResultsAlmost all participants (22/23, 96%) had no prior exposure to GenAI. The majority (20/23, 87%) described the creative process as enjoyable and engaging, with most (21/23, 91%) reporting that creating music improved their mood. Adolescents expressed autonomy and ownership of the process, with more than half (14/23, 61%) personalizing outputs to reflect their identities and aspirations. All participants (23/23, 100%) preferred artificial intelligence (AI)–generated images over the cartoon-like illustrations of the Kuamsha app, and most (19/23, 83%) preferred AI-generated music. Story preferences were more mixed, with about a quarter of participants (6/23, 26%) recalling that Kuamsha’s narratives contained embedded lessons that were not integrated into the ChatGPT outputs. Most adolescents (18/23, 78%) required support with prompt construction, and more than half (13/23, 57%) noted cultural biases in AI outputs, particularly in images. Most participants (17/23, 74%) expressed interest in using AI for schoolwork and creative projects, while a minority (6/23, 26%) preferred to limit use to personal applications. Concerns about fairness and the displacement of human creativity were also raised.ConclusionsGenAI shows promise for enhancing adolescent engagement in the coproduction of DMHIs and enabling culturally relevant and personalized content. However, reliance on human support and persistent algorithmic biases remain limitations. Further research should explore the integration of therapeutic principles into AI-generated media and strategies to mitigate bias.

The transition from student to teacher can be a challenging journey. This article explores how perceived unpreparedness – experienced as a disorienting dilemma – influences final-year student teachers’ self-efficacy and overall well-being. Using an interpretive paradigm and a qualitative approach, data were generated through questionnaires, visual representations, and focus group discussions with twelve student teachers at a South African higher education institution. A conceptual framework is developed by merging Mezirow’s transformative learning theory and Bandura’s self-efficacy theory. The case study reveals that while most student teachers initially felt prepared to teach English, self-examination of their preparedness based on teaching practice experiences exposed feelings of anxiety, low self-confidence, and self-doubt, impacting their self-efficacy. The findings reveal that enhancing student teachers’ self-efficacy is essential for their well-being, as higher self-efficacy promotes resilience, confidence, and preparedness for teaching. Emotional health and psychological support are critical for fostering student teachers’ sense of hope, resilience and self-efficacy. Addressing these challenges can help higher education institutions foster self-efficacy development, ensuring that student teachers transition from uncertainty to confidence. This article advocates for a holistic approach to teacher preparation, highlighting the role of higher education institutions, student affairs, and counselling services in strengthening self-efficacy and reducing anxiety through targeted support.

The REBAHS LPSP II action launched in May 2022 by International Medical Corps (IMC) and Première Urgence Internationale (PUI) in Lebanon is a continuation of previous initiatives implemented in Primary Healthcare Centers (PHCCs) with the key aim to support service provision in PHCCs. This study aims to present a multi-faceted impact evaluation approach, quantifying the outcomes of the action and identifying areas for improvement. A mixed-method approach was adopted, including quantitative and qualitative tools to assess the impact of the initiative’s health sector. Indicators of PHCC service utilization were extracted from the National Health Information System (PHENICS) and analyzed through descriptive analysis, interrupted time series analysis, and cost-effectiveness analysis. Key-informant interviews (KII) were conducted with donors and stakeholders, and Focus Group Discussions (FGDs) were implemented with PHCC staff members to gain a deeper understanding of the impact, challenges, and areas for improvement of the initiative. The action resulted in an overall increase in the proportion of children being screened for malnutrition, women being screened for breast cancer via mammogram testing, and a high number of antenatal care visits. Improved access to care, patient satisfaction, quality of care, and disease detection and management among other positive impacts have been highlighted. Barriers to implementation including administrative burdens, staff turnover, and financial constraints among others have been suggested. Lessons learned and recommendations for future program design have been highlighted. This study may serve as a model for enhancing healthcare systems globally by enhancing global funding models, optimizing resource allocation, and improving program impact, specifically in conflict-affected settings and countries with limited resources, thereby enhancing healthcare access, health service delivery, and program sustainability.

It is unknown whether Female Community Health Volunteers' (FCHVs) can counsel for hyperlipidemia in rural Nepal. Using the Health Belief Model, we evaluated FCHV's knowledge, self-efficacy, and barriers to counsel for hyperlipidemia in two phases eleven months apart among 28 FCHVs from rural mid-Western Nepal. In each phase, we conducted four Focused Group Discussions (FGDs), hyperlipidemia-related training and two similar surveys before and after the training. We used inductive and deductive codes for thematic analysis and descriptive statistics for quantitative analysis. We integrated the results for complementarity and convergence using concurrent embedded design (Qual + quan). FCHVs' mean age was 48 years and 21 out of 28 had worked for > 10 years. We found four themes in FGDs. In Phase 1, despite having interest, FCHVs had limited knowledge and confidence in counseling for hyperlipidemia. However, with sufficient training, they believed they could counsel. In Phase 2, FCHVs conveyed improved knowledge and self-efficacy. They expressed community might be concerned about their expertise, which improved in Phase 2. Quantitatively, FCHVs' knowledge improved immediately after the initial training, which was stable in Phase 2. Inadequate training was identified less as a barrier in Phase 2, but inadequate time and incentive were identified more often, and community's perception of FCHVs' skills remained unchanged. FCHVs want to provide hyperlipidemia counseling. Despite our trainings and FCHV's perceived self-efficacy, knowledge gap persisted. FCHVs' workload, inadequate incentives and knowledge were important barriers. Balanced workload, regular trainings and adequate incentives are important to engage FCHVs in hyperlipidemia management.

Despite considerable progress in expanding and improving maternal, newborn, and child health (MNCH) globally, gaps remain in low- and middle-income countries (LMICs), particularly in sub-Saharan African countries, including Somalia. According to theWorld Health Organization (WHO), Somalia is among the countries facingvery high alert levelsfor maternal, newborn, and under-five deaths. The maternity continuum of care (CoC) throughout pregnancy, childbirth, and the postnatal period is essential for the health and survival of mothers and their babies. This study aimed to explore the gaps in Somalia's maternity continuum of care. This qualitative study included 5 focus group discussions (44 childbearing mothers) purposively sampled from urban, rural, internally displaced people (IDPs), agro, and nomadic pastoralists, and 19 in-depth interviews (IDIs) from healthcare providers, policymakers, recently delivered and childbearing mothers, community leaders, and traditional birth attendants in 6 regions of Somalia in January 2024. We used thematic analysis to analyze the data. Five key themes and twelve subthemes emerged from the analysis: service availability, access to care, decision-making, quality of care, and traditional beliefs. The maternity continuum of care gaps varies across different community categories, such as urban areas, rural areas, IDPs, agro-pastoralists (beeraley-baadiye), and nomadic pastoralists (reer-guuraa), due to diverse reasons, including service availability, access to care (financial, distance, and transportation), socioeconomic disparities, infrastructure, climate-related issues, and security issues. The maternity continuum of care gaps varies across different community categories, such as urban, rural, IDPs, agro-pastoralists (beeraley-baadiye), and nomadic pastoralists (reer-guuraa), due to a combination of diverse reasons, such as service availability; access to care, including financial, distance, and transportation; socioeconomic disparities; infrastructure; climate-related issues; and security issues.

Corporate Social Responsibility (CSR) has evolved globally from philanthropic acts to strategic initiatives with social, environmental, and economic implications. In Kenya, CSR is often applied philanthropically, with limited integration into long-term development strategies, especially in rural areas. This study investigates the social impacts of Rabai Power Company’s (RPL) CSR initiatives on sustainable rural development and corporate reputation in Kilifi County, Kenya. It aims to assess how CSR activities influence community beneficiaries and shape the company's legitimacy and stakeholder perceptions. A qualitative case study approach was used. Data were collected through four key informant interviews and one focus group discussion. The study was guided by Stakeholder Theory, Legitimacy Theory, and the Triple Bottom Line (TBL) framework. The data were thematically analyzed to identify recurring patterns related to CSR impacts. The CSR initiatives by RPL significantly contributed to education, healthcare, water provision, socio-cultural development, and youth empowerment. Beneficiaries reported enhanced well-being and greater trust in the company. However, challenges such as the sustainability of services, equitable resource distribution, and governance issues were identified. Strategic CSR, when aligned with local needs and supported by participatory governance, enhances both community development and corporate legitimacy. Communities perceive RPL not merely as a business entity but as a development partner. The study recommends institutionalizing CSR through cross-sectoral partnerships, capacity building, and sustainable funding. The research contributes to CSR theory by contextualizing its application in a rural African setting and reinforces its relevance to the Sustainable Development Goals (SDGs).

Sleep disturbances are a common yet often overlooked challenge for people living with dementia and their caregivers, significantly affecting daily functioning and well-being. Existing interventions frequently prioritise pharmacological treatments, which may not align with the cultural values and preferences of ethnically diverse communities. This study explored how older adults with mild dementia and their caregivers from white British, Caribbean, Chinese, and South Asian backgrounds in the UK understand and manage sleep difficulties using culturally meaningful, non-pharmacological strategies. A qualitative, cross-cultural design was adopted using focus group discussions with 12 dementia dyads (older adults and their caregivers) recruited from community organisations in a city in Southern England. Four focus groups were conducted using a topic guide to elicit participants' lived experiences and culturally informed coping practices. Transcripts were analysed using reflexive thematic analysis with NVivo 14, generating four overarching themes that captured shared and culturally specific perspectives. Analysis revealed four key themes: (i) Sleep as a holistic and relational experience, (ii) The importance of routine, ritual, and physical engagement, (iii) Emotional calm and non-drug coping with night-time worry, and (iv) Cultural fit and practical accessibility shape participation. Participants viewed sleep through a holistic lens, closely linked to emotional, spiritual, and relational harmony. Gentle, non-invasive approaches such as calming evening rituals, light physical activity, spiritual reflection, and mindfulness-like practices were described as culturally rooted and preferable to medication. Participants valued familiar routines, trusted facilitators, and flexible, community-based delivery. Practical barriers, such as time constraints and caregiving demands, were highlighted alongside a strong desire for co-designed, culturally adaptive interventions. This study underscores the potential of culturally grounded, mind-body approaches to address sleep disturbances in dementia care. By aligning interventions with communities' daily routines, spiritual beliefs, and emotional needs, non-pharmacological strategies can improve acceptability and relevance. Critically, these findings show that ethnicity and cultural background should not be overlooked in research and intervention design, as they shape how people experience and manage sleep. Community-embedded, participatory models can foster trust, sustain engagement, and ultimately support better sleep and well-being for people living with dementia and their caregivers.

BackgroundIn Uganda, 22% of all women of reproductive age have an unmet need for family planning services. Access to contraceptive services, especially long-term reversible contraceptives such as implants, remains a challenge. The number of trained health providers is also not sufficient to address the needs for contraception. The Uganda Ministry of Health implemented a community-based implant provision pilot project where community health extension workers (CHEWs) were trained and accredited to insert implants at community level.ObjectiveThis study aims to evaluate the implementation and acceptability of stakeholders toward task shifting the provision of family planning implants to CHEWs in Uganda.MethodsThe evaluation will use a cross-sectional design using both quantitative and qualitative methods. The quantitative component will use a noninferiority design, whereas the qualitative component will use a descriptive approach. The noninferiority design involves a comparison of the competence of the currently authorized cadre to offer the service to the proposed cadre (CHEWs). Compared with a randomized controlled trial, the noninferiority design is more appropriate for this evaluation because the CHEWs and the authorized cadre are not comparable in terms of level of training and competencies. The authorized cadre has gone through formal training, which is not comparable with the training the CHEWs have received, and so the comparison is such that the competencies of the CHEWs are noninferior or at most equal to the competencies of the authorized cadre. Quantitative data will be collected among 92 CHEWs and 92 qualified health workers using performance assessment checklists and practice-based questionnaires that were developed based on the training manuals. Competency will be measured on a continuous scale and summarized as mean (SD) scores. Qualitative data will be collected through key informant interviews (n=23), in-depth interviews (n=24), and focus group discussions (n=18). Qualitative data will be analyzed using thematic analysis following the framework method for the analysis of qualitative data using ATLAS.ti (version 9).ResultsPreliminary findings indicate improved confidence and capacity of community health workers to provide implants despite challenges such as poor waste disposal, record keeping, and data management. By August 2025, training of research assistants had been concluded, and data collection had started. We anticipate that the data collection will be completed by the end of October 2025, the data analysis will be completed by November 2025, and the final results will be published by December 2026.ConclusionsThis pilot will generate contextual information that can be used to improve access to family planning services at the community level.