Four Focus Group Discussions Research Articles

Job Satisfaction and Psychosocial Well-Being of COVID-19 Frontline Health Workers in Uganda

The COVID-19 pandemic exposed frontline healthcare workers (HCWs) to mental health problems and various challenges that impacted their job satisfaction. We explored the job satisfaction and psychosocial/mental well-being of COVID-19 frontline HCWs in Uganda. This was a mixed-methods study conducted at Mulago National Referral Hospital (MNRH), Entebbe Regional Referral Hospital (ERRH), and Uganda Virus Research Institute (UVRI). A pre-tested self-administered questionnaire and Four Focus Group Discussions (FGDs) were used for data collection. A five-point Likert scale was used for the quantitative data to measure mental well-being and job satisfaction. Bloom’s cut-off was used to categorize participants’ job satisfaction and mental well-being into good (≥80%), moderate (60% - <80%), and poor (<60%). FGDs were audio-recorded, transcribed, and analyzed thematically using NVivo version 12 software. 218 participants participated in the quantitative survey and 24 of them further participated in the FGDs. 51.4% ( n = 112) were males, aged 18 to 39 years (77.5%, n = 169) and 50.9% ( n = 111) were at MNRH. Overall, 54%, 28%, and 18% of the participants reported moderate, good, and poor job satisfaction respectively. Satisfaction with salary (2.6 ± 1.2) and compensation (risk) allowances (2.4 ± 1.3) was particularly low. Furthermore, 35%, 33%, and 32% of the participants reported moderate, good, and poor mental well-being respectively. Anxiety, burnout, stigma, and discrimination contributed to poor psychosocial/mental well-being. Less than half of the frontline HCWs reported good job satisfaction and psychosocial/mental well-being. There is a need for prioritization of the psychosocial well-being of frontline HCWs, in addition to improvement of remuneration systems.

Male circumcision perceptions among HIV vaccine trial participants in Soweto: Qualitative study

Background: Male circumcision has health benefits and cultural significance in South Africa and elsewhere. We sought to understand perceptions about male circumcision among participants enrolled in a preventive human immunodeficiency virus (HIV) vaccine efficacy trial in South Africa.Methods: We conducted a qualitative study with 28 consenting people aged 18–35 years old who self-reported that they were not living with HIV and who were participating in the HIV Vaccine Trials Network (HVTN) 702 vaccine efficacy trial in Soweto. Using a semi-structured guide, we facilitated four focus group discussions (FGDs) stratified by age, gender and sexual orientation. Focus group discussions were audio-recorded, transcribed verbatim, translated into English and thematically analysed.Results: Four main themes emerged: (1) accurate knowledge about what male circumcision is, with some participants stating that it partially reduces acquisition of HIV and sexually transmitted infections; (2) emerging distrust of cultural circumcision because of perceived lack of transparency and adverse events; (3) misperceptions that circumcision boosted masculinity and (4) the influenced of parents, family and female partners in circumcision decision-making.Conclusion: Young South African HIV vaccine trial participants accurately understand the HIV prevention benefits of male circumcision, but uptake decisions are embedded within a context informed by culture, sexuality, masculinity norms and values and the influence of women.Contribution: In this study, we showed that young South Africans participating in HIV vaccine trials instead embed their circumcision uptake decisions within a context informed by culture, sexuality and masculinity norms and values and influence of women.

Analysis of the factors influencing local employment in the mining sector in the Benishangul-Gumuz Regional state of Ethiopia

This article aims to analyze the factors that determine local employment in the mining sector and identify ways to improve the annual income of employed households in the Benishangul-Gumuz Regional State (BGR) of Ethiopia. The research design used for this study was cross-sectional. Quantitative data were collected from a sample of 162 households affected by mining operations, using systematic random sampling. Additionally, four focus group discussions (FGD) and eight key informant interviews (KII) were conducted to gather qualitative data. The quantitative data was analyzed using descriptive statistics and the Heckman two-stage model, while the qualitative data was analyzed using narrative analysis. The descriptive results indicate that most of the jobs created by the mining industries were temporary, and the small-scale mining sector employed more workers than the large-scale sector. Furthermore, migrant laborers benefited more from employment opportunities than indigenous households. The first result of the Heckman two-stage model reveals that the educational level of the household head, the size of the farmland, and membership in a farmer's organization have significant negative effects on local employment. On the other hand, the sex of the household head, the size of the nearest mining project, access to information, access to transport, and access to credit have significant positive effects on local employment. The second-stage results of the Heckman two-stage model show that the age of the household head, the dependency ratio, and membership in farmers' organizations have statistically significant negative effects on the annual income of employed households. Conversely, non-farm activities have statistically significant positive effects on the annual income of employed households. The findings of this study have implications for identifying the determinants and factors that need to be addressed to promote local employment. We suggest that both the Ethiopian and BGR regional governments should work towards increasing local employment opportunities for indigenous communities in the mining sector.

NGOs' initiatives and grassroots approach for accessing to health care services for the slum people in Dhaka.

This study holds significant importance as it aims to delve into the impactful NGOs' initiatives and grassroots approaches instrumental in providing healthcare services to Dhaka's underserved slum people. It focuses on understanding how these factors influence the use and access to health services, which is a crucial aspect for researchers, policymakers, and healthcare professionals. This study was meticulously designed, utilizing a comprehensive cross-sectional mixed-methods design. By incorporating qualitative and quantitative data collection methods, we ensured a thorough understanding of NGOs' initiatives and grassroots approaches to providing healthcare services to slum dwellers in Dhaka, thereby instilling confidence in the validity of our research for the audience. A face-to-face interview was used to survey the participants (n = 722) using semi-structured questionnaires, following a systematic sampling technique. Four focus group discussions (FGDs) were also conducted with the slum people. Binary logistic regression was performed to know NGOs' initiatives, roles, and grassroots approach as predictors or independent variables and healthcare services as an outcome or dependent variable. The quantitative data were analyzed using SPSS version 23.0. At the same time, thematic analysis was conducted following Philip Adu's Qualitative data analysis process and Braun and Clarke's six steps of the thematic analysis system, integrating the 11 subthemes with the quantitative findings to highlight the interpretative findings of the qualitative data. Major findings revealed that NGOs' initiative roles and grassroots approach had a significant impact on slum dwellers' use and access to healthcare services. The initiatives included affordable health services (OR = 22.86, 95% CI = 3.87, 35.00, P = 0.01), special health services (OR = 5.63, 95% CI = 3.36, 9.42, P = 0.00), engagement of responsible community leaders (OR = 1.72, 95% CI = 1.14, 2.59, P = 0.01), distribution of health and medicine items (OR = 1.92, 95% 2 CI = 1.40, 2.63, P = 0.01), provision of updated information to slum dwellers (OR = 1.37, 95% CI = .99, 1.90, P = 0.05), telehealth and telemedicine (OR = 1.82, 95% CI = 1.55, 2.13, P = 0.01), BCC strategy (OR = 1.26, 95% CI = 1.00, 1.57, P = 0.05), and doorstep services as NGOs' grassroots approach (OR = 1.84, 95% CI = 1.00, 3.38, P = 0.05). Qualitative findings supported the quantitative findings through 2 main themes and 11 sub-themes, which were integrated with quantitative findings to highlight the interpretative findings of qualitative data. Health services and other facilities for urban slum people through NGOs' initiatives and grassroots approaches are highly affordable and practical, special health services with the involvement of special exceptional health professionals, community supportive services, BCC strategies, and doorstep health services may trigger the use and access to health services for slum dwellers. Results suggest and recommend capitalizing and investing in such initiatives and grassroots approaches from the government, policymakers, and donors with NGOs to find accessible, affordable health services for the unprivileged slum people.

Lived Experiences of Primary Caregivers of Children with Dyslexia: A Phenomenological Study

Background: Caregivers play an important role in children’s development. Therefore, they need to recognize the learning difficulties that their children face and support them to ensure learning gains and prevent secondary complications. Nevertheless, supporting a child with a learning disability can be challenging for caregivers in many ways. 1 This study investigated caregivers’ knowledge of dyslexia, their challenges when raising children with dyslexia, and the support they seek to raise such children. Methods: Ten individual in-depth interviews (IDIs) and four focus group discussions (FGDs) were conducted among 30 caregivers in Sri Lanka. Initial codes were generated using open coding from the transcripts, leading to sub-themes and themes. Results: Thematic analysis revealed a lack of knowledge of dyslexia-type difficulties among caregivers and in society, giving rise to misconceptions, leading to labeling and abuse of children. Caregivers feel emotionally pressured, helpless, stressed, and depressed in bringing up children with dyslexia, creating family disputes. Further, as a family, they have a sense of rejection and discrimination from school and society. Caregivers receive insufficient support from the education and health sectors due to multiple complexities such as myths, misbeliefs, inadequate knowledge and skills, unavailability of resources, and inaccessibility to services. Conclusions: Caregivers and families of children with learning disabilities demand more attention to improve their mental health and family harmony, which in turn improves children’s educational and health status. Sri Lankan health, educational, and social services should be optimized to reach the families of children with dyslexia-type difficulties.

Perspectives of healthcare practitioners on environmental sustainability in healthcare: A qualitative study.

To explore the perspectives of Kazakhstani healthcare professionals on environmental sustainability in healthcare. An exploratory qualitative design. Four focus group discussions (FGDs) on environmental sustainability in healthcare were conducted among healthcare professionals (nurses, physicians, midwives and physical therapists) from June to August 2023 in three cities of Kazakhstan. Each FGD consisted of at least 6 to 11 participants and lasted between 60 and 90 minutes. The collected data were analysed using the thematic analysis. A total of 137 initial codes were identified and further organized into 22 sub-themes based on similarities in codes and meanings, and then 5 significant themes were identified. The five main themes are 'Environmental Sustainability Practices in Healthcare', 'Purposes of Environmental Sustainability in Healthcare', 'Impact of Environmental Sustainability in Healthcare in Patients', 'Challenges in Implementing Environmental Sustainability in Healthcare' and 'The Role of Healthcare Leadership in Improving Environmental Sustainability in Healthcare'. The findings highlighted the perceptions and practices of healthcare professionals on environmental sustainability's purposes in healthcare, its impacts on patients and its implementation challenges. The study also underscored the critical role of strong and active leadership in ensuring a sustainable implementation of green policies in healthcare facilities and achieving successful results of environmentally conscious healthcare practices. The findings provide invaluable information that can be used by policymakers and healthcare organization leaders to create a sustainable healthcare system. Implementing environmental sustainability practices in healthcare should be widespread, intentional, and sustainable, entailing strong leadership and unwavering personal and organizational commitment. No patient or public contribution. We adhered to relevant EQUATOR guidelines, specifically the Consolidated Criteria for Reporting Qualitative Research.

Teaching through integration - Action research at a private nursing institution in Karachi, Pakistan.

This research aims to explore the outcome of teaching through integration, on nursing students learning using Harden model (1984) of curriculum strategy. The study used action research as a methodology. Two modules of Year II BScN curriculum were taught through integration to 120 students at a private nursing institute in Karachi, Pakistan. The Data was collected from February to May 2018. Four focus group discussions (FGD) of six students each were conducted, before and after module implementation. The data were analysed using Creswell method. The study findings consist of three themes "integration adds to contentment", "integration carries challenges and "integration supplements teaching learning strategies" with their respective subthemes as Complete connected and comprehensively concise" Integration carries challenges, added burden, and lacked creativity and logistics. The findings show that teaching through integrated modules help students to become focused and responsible learner, optimize understanding of concepts, and strengthen theory practice integration for delivering holistic care. The study recommends to use integration strategy as a step towards enhanced student learning and better patient outcome.

Understanding referral of patients with cancer in rural Ethiopia: a qualitative study

BackgroundCancer incidence is increasing in Ethiopia mainly due to increased life expectancy, while oncological capacities remain limited. Strong referral linkages between different levels of the healthcare system are key to provide timely access to cancer care. In this qualitative study, we assessed limitations and potential of cancer patient referral in the rural Southwest of Ethiopia.MethodsWe held four focus group discussions (FGD) with health professionals at one primary and three secondary hospitals and conducted eight in-depth interviews (IDI) with the hospitals´ medical executives and local health bureau representatives. Data was analysed inductively using thematic analysis and emerging themes were categorized within the revised concept of access by Penchansky and Saurman.ResultsThe inevitable referral of patients with cancer in the rural Southwest of Ethiopia is characterized by the absence of clear communication protocols and the lack of formal referral linkages. The newly implemented hub-system has improved emergency referrals and could be expanded to non-emergency referrals, sensitive to the needs of advanced oncological care. Liaison officers can pave the way but need to be trained and equipped adequately. Referred patients struggle with inadequate transportation systems, the lack of accommodation close to specialized facilities as well as the inability to navigate at those sites due to language barriers, illiteracy, and stigmatization. Few Non-Governmental Organizations (NGOs) help but cannot compensate the limited governmental support. The shortage of medications at public hospitals leads to patients being directed to costly private pharmacies. In the light of those challenges, cancer remains to be perceived as a “death sentence” within the rural communities.ConclusionsStandardized referral linkages and a multi-faceted support network throughout the cancer care continuum are necessary to make oncology care accessible to Ethiopia´s large rural population.

Social determinants of health and long-term conditions in people of Black African and Black Caribbean ethnicity living with HIV in London: Aqualitative study.

People living with human immunodeficiency virus (HIV) are disproportionately impacted by socioeconomic deprivation and are at increased risk of developing other long-term conditions (LTCs). These illnesses require transformative action to tackle the adverse effects on their health. Data on lived experiences of LTCs among people living with HIV of Black African and Black Caribbean ethnicities are sparse, and how people with LTCs are impacted by social determinants of health (SDoH). Through a phenomenological study design this qualitative study, conducted in 2022, comprised four focus group discussions (FGDs) with 20 people of Black ethnicities living with HIV were purposively invited from a community organisation (CO) in London, including four semistructured interviews with CO staff. Following transcription, qualitative data were analysed thematically and measures to validate the findings were implemented. The findings are presented in terms of the following four levels of SDoH: (1) individual determinants (such as the impact of SDoH on lifestyle modification and self-management); (2) interpersonal determinants (such as positive experiences of accessing healthcare for LTCs); (3) clinical determinants (such as care pathway barriers)and (4) systemic determinants (such as systemic barriers related to race/ethnicity). It is necessary to provide ongoing and interactive education to community members who live with HIV, focusing on risks and management of LTCs. Additionally, individuals would benefit from support to navigate increasingly complex and fragmented health services. Health Service staff require cultural competence when caring for patients of Black African and Black Caribbean ethnicities with complex health and psychosocial needs. The research team collaborated with an HIVCOin South London from the very start of the project to agree the study design and learn about the realities of their daily lived experiences. Community collaborators helped to develop the semistructured interview and FGDtopic guides, and were directly involved in the data gathering, analysis and validation.

Qualitative ethical technology assessment of artificial intelligence (AI) and the internet of things (IoT) among filipino Gen Z members: implications for ethics education in higher learning institutions

ABSTRACT The primary aim of this paper is to identify the knowledge and perceptions of the Gen Z Filipino students about the forms and ethics of artificial intelligence (AI) and the internet of things (IoT). It likewise describes their experiences in the use of said technologies. The Gen Z population is considered the most exposed to AI and IoT. This paper is based on four focus group discussions (FGDs) with 28 university students. Results have revealed that the Gen Z participants consider the potential threats and challenges of AI and IoT to humanity which include privacy, confidentiality, and anonymity. In addition, the ethical challenges associated with AI and IoT pose the risks not only to data privacy but to security as well. Gen Z students suggest that people’s understanding of these technologies can be hastened through proper education and techno capacity-building. This implies that teaching ethics in HEIs needs to tackle ethical issues of technology and relate them to social, environmental, health, and economic issues.

Unlocking Potential: Exploring the Socio-Economic Landscape of High School STEM Girls in Khulna and Rajshahi Districts

The Board of Intermediate and Secondary Education in Bangladesh permits students to choose a specialization based on aptitude, passion, and academic excellence that equips them for the college degree of their choice. So, the students who prefer the science stream are recognized as capable in all aspects. This study aims to explore the socio-economic characteristics of the STEM girls in Khulna and Rajshahi Districts of Bangladesh who are studying in classes IX and X in the science stream at secondary school, which assesses their ability to pursue STEM education. For this, the researchers have chosen a survey design. The study utilized 410 STEM girl students for a questionnaire survey from eight girls' high schools in Bangladesh's Khulna and Rajshahi districts. The schools were selected purposefully, and the students were selected randomly from classes nine and ten. Besides this, four focus group discussions (FGD) were conducted in four selected schools, where 44 (forty-four) participants attended and gave their opinions, comments, and observations. Data and information have been collected between July 2021 and June 2023. Using descriptive statistics and qualitative methods, socio-economic strands of the STEM girls have been explored, which cover their religious affiliation, age, marital status, educational qualifications of respondents' parents, occupational status of their parents, household-based income and expenditure analysis of the respondents' parents or guardians, information about family and siblings of the STEM girls, monthly expense analysis, and residential status. It was found that most of them are ahead of the national index of Bangladesh in some indexes. So, it is logical to claim that even though some STEM girls face severe problems, they are capable of studying STEM education in Bangladesh's existing framework.

Information behavior and HIV/AIDS/STI awareness among Bangladeshi female sex workers: Do informational programs help?

Using de Certeau's concepts of “tactics” and “strategies,” this study explores the everyday information seeking behavior of female sex workers (FSWs) in Bangladesh. This study also examined the effectiveness of informational programs on HIV/AIDS and STI in empowering FSWs to negotiate condom use during sex. A mixed method research design was employed in this study, which included face-to-face surveys with 116 female sex workers (FSWs) and four focus group discussions (FGDs) with 23 street based FSWs. The study finds that Bangladeshi female sex workers use “tactics” in meeting their information needs. They reported rarely using formal information sources such as government agencies and indicated sometimes being harassed by law enforcement agencies because of their professional status, creating a distance between formal information agencies and their everyday life information seeking. Furthermore, FSWs reported having significant unmet information needs. The findings regarding the effectiveness of HIV/AIDS and STI informational programs indicated that simply providing ‘information’ may not be sufficient to empower FSWs to negotiate safer sexual practices with their clients.

"We have nice policies but…": implementation gaps in the Ghana adolescent health service policy and strategy (2016-2020).

Although policies for adolescent health exist in Ghana, their implementation is challenging. Availability of services for adolescent sexual and reproductive health and adolescent mental health remains less than desired, with adolescent mental health being particularly neglected despite being an important contributor to poor health outcomes. This study presents an analysis of gaps in the implementation of the Ghana Adolescent Health Service Policy and Strategy (2016-2020), including how and why the context influenced the observed implementation gaps. Data for this study is drawn from 17 in-depth interviews with purposefully identified key stakeholders in adolescent mental, sexual, and reproductive health across the national and subnational levels; four focus group discussions (FGDs) with district health management teams; and 11 FGDs with adolescents in and out of schools in four selected districts in the Greater Accra region. Data were analyzed using both inductive and deductive approaches. The deductive analysis drew on Leichter's conceptualization of context as structural, cultural, situational, and environmental factors. Of the 23 planned strategies and programs for implementing the policy, 13 (57%) were partially implemented, 6 (26%) were not implemented at all, and only 4 (17%) were fully implemented. Multiple contextual factors constrained the policy implementation and contributed to the majority of strategies not being implemented or partially implemented. These factors included a lack of financial resources for implementation at all levels of the health system and the related high dependence on external funding for policy implementation. Service delivery for adolescent mental health, and adolescent sexual and reproductive health, appeared to be disconnected from the delivery of other health services, which resulted in weak or low cohesion with other interventions within the health system. Bottom-up approaches that engage closely with adolescent perspectives and consider structural and cultural contexts are essential for effective policy implementation. It is also important to apply systemic and multi-sectoral approaches that avoid fragmentation and synergistically integrate policy interventions.

Perceptions of pregnant women on antenatal care visit during their first trimester at area 25 health center in Lilongwe, Malawi – a qualitative study

BackgroundInitiation of antenatal care during the first trimester is crucial for reducing maternal and neonatal morbidity and mortality. Unfortunately, only 24% of pregnant women in Malawi initiate antenatal care during this time with even lower rates of 15% at Area 25 Health Centre in Lilongwe. Despite such cases, there is little literature on obstacles that prevent women from accessing first-trimester antenatal care in Malawi.AimTo explore perceptions of pregnant women and how they influence antenatal care visits during the first trimester at Area 25 Health Centre in Lilongwe, Malawi.MethodsWe employed a qualitative exploratory study on 55 purposely identified participants. The participants were aged between 18 and 37 years with a gestational period of 36 weeks and below and attended antenatal care at Area 25 Health Centre in Lilongwe Urban, Malawi. Data were collected by MN and 2 data collectors from 19th March 2021 to 16th April 2021 through a total of 15 In-depth Interviews (IDIs) and four Focus Group Discussions (FGDs). Data were manually analysed using thematic analysis, which included categorization and deductive theme identification with reference to the study objectives and the Health Belief Model (HBM).ResultsPregnant women perceived that the first-trimester antenatal care visits were only for those experiencing ill health conditions like backache, headache, and HIV/AIDS during pregnancy. First-trimester pregnancy was perceived as too small and not worthy of seeking antenatal care; the women placed a low value on it. The majority of those who initiated antenatal care in the first trimester had previously experienced disorders and complications such as previous cesarean sections and abortions. In addition to limited knowledge about the required total number of ANC visits, challenges such as long-distance, preoccupation with business, multiple antenatal visits, scheduling of antenatal care visits, negative attitude of health workers, adherence to COVID-19 containment measures, and inadequate partner support, were identified as barriers to seeking antenatal care during the first trimester.ConclusionThe negative perceptions among pregnant women, coupled with various health systems, socio-economic and individual barriers, contributed to low attendance rates for first trimester antenatal care in Malawi. Addressing knowledge gaps and overcoming barriers related to economic, individual and health care delivery can improve women’s early antenatal care visits. Future research should consider the pregnant women from diverse socioeconomic backgrounds to gain a better understanding of these perceptions and barriers.

Exploring the pharmacist role and challenges during COVID-19 pandemic in the public healthcare setting: A qualitative study

Background: Pharmacists working in the Public Health Center (PHC) setting are at the frontline response and often have to adapt to the COVID-19 crisis. However, there is a deficit of studies examining their roles and challenges regarding providing pharmaceutical care and how they adapt to the COVID-19 situation in Indonesia. Objective: This study aims to explore the views and experiences of pharmacists in the PHC during the COVID-19 pandemic. Methods: Four Focus Group Discussions (FGDs) involving 40 PHC pharmacists working in Surabaya were conducted in May 2021. The FGDs were audio recorded, transcribed verbatim and subsequently analysed for any emerging theme. Results: Most participants viewed that the restriction of face-to-face interaction hampered the provision of pharmaceutical care in the PHC. Protective equipment and partition screens during patient visits have challenged pharmacists to communicate effectively. Services such as direct one-on-one drug information and patient counselling were still provided, often facilitated with written aids, but for a limited time, providing opportunities for pharmacists to deliver messages through WhatsApp and telephone. Conclusion: The COVID-19 pandemic significantly impacted pharmaceutical service delivery in PHC. However, it has preserved the important role of pharmacists to ensure safe and quality services, particularly with the presence of the COVID-19 vaccination programme.

End-user acceptability of a prototype digital stethoscope to diagnose childhood pneumonia- a qualitative exploration from Sylhet, Bangladesh

BackgroundConsidering the high frequency of respiratory infections among children in low- and middle-income countries (LMICs), the World Health Organization (WHO) developed a pragmatic guideline for managing pneumonia in low-resource settings. The guideline’s low specificity leads to many false-positive pneumonia cases receiving antibiotic treatment. Integrating diagnostic technology to incorporate lung sounds into WHO guidelines could improve childhood pneumonia diagnosis and management. This qualitative study aimed to explore the acceptability of a prototype digital stethoscope device among potential end-users in Bangladesh.MethodsWe conducted four focus group discussions (FGDs) with beneficiaries and service providers who used a 2018 digital stethoscope prototype. The data collection was conducted in November 2020. The study was carried out at Zakiganj Upazila (sub-district) of Sylhet district of Bangladesh. A total of 34 respondents, including parents of under-5 children, Community Health Care Providers (CHCPs), and community leaders were enrolled. Two researchers (TJ and a research assistant (not a co-author of this manuscript) conducted the FGDs. Verbatim transcripts were prepared, and translations were completed. Coding was executed in Microsoft Excel, and relevant quotes were extracted to ascertain the emerging themes. To ensure validity, two researchers coded the dataset independently and inconsistencies were resolved through discussion.FindingsMothers were more aware of the digital stethoscope than fathers. Except for the female community leaders, male leaders were unaware of the stethoscopes. Most CHCPs had positive perceptions of the digital stethoscope. They appreciated stethoscope training as they learned about new technology and diagnostic approaches. The users mentioned several technical shortcomings of the prototype device. A few stakeholders expressed dissatisfaction with the level of community involvement and information sharing from the study. The use of the device plummeted during the COVID-19 pandemic for fear of infection, to counteract which the CHCPs cleaned the device with chlorhexidine after every application as a precaution.ConclusionOverall, device use was supported by stakeholders despite perceptions that the prototype had some technological limitations, community engagement was suboptimal, and the COVID-19 pandemic caused disruptions. Stronger community engagement, addressing technological issues, and further research on its health systems application would improve the acceptability and effective use of the digital stethoscope.

Weighing the necessities and concerns of deprescribing among older ambulatory patients and primary care trainees: a qualitative study

BackgroundDeprescribing can be a challenging and complex process, particularly for early career doctors such as primary care trainees. To date, there is limited data from patients’ and doctors’ perspectives regarding the deprescribing of medications in older persons, particularly from developing countries. This study aimed to explore the necessities and concerns of deprescribing in older persons among older ambulatory patients and primary care trainees.MethodsA qualitative study was conducted among patients and primary care trainees (known henceforth as doctors). Patients aged ≥ 60 years, having ≥ 1 chronic disease and prescribed ≥ 5 medications and could communicate in either English or Malay were recruited. Doctors and patients were purposively sampled based on their stage of training as family medicine specialists and ethnicity, respectively. All interviews were audio-recorded and transcribed verbatim. A thematic approach was used to analyse data.ResultsTwenty-four in-depth interviews (IDIs) with patients and four focus group discussions (FGDs) with 23 doctors were conducted. Four themes emerged: understanding the concept of deprescribing, the necessity to perform deprescribing, concerns regarding deprescribing and factors influencing deprescribing. Patients were receptive to the idea of deprescribing when the term was explained to them, whilst doctors had a good understanding of deprescribing. Both patients and doctors would deprescribe when the necessity outweighed their concerns. Factors that influenced deprescribing were doctor-patient rapport, health literacy among patients, external influences from carers and social media, and system challenges.ConclusionDeprescribing was deemed necessary by both patients and doctors when there was a reason to do so. However, both doctors and patients were afraid to deprescribe as they ‘didn’t want to rock the boat’. Early-career doctors were reluctant to deprescribe as they felt compelled to continue medications that were initiated by another specialist. Doctors requested more training on how to deprescribe medications.

What has state weakness got to do with it? Oil theft and implications on human and environmental security in Nigeria’s Niger Delta region

ABSTRACT This paper draws on qualitative approach comprising interviews and relevant archival materials to examine how oil theft in Nigeria’s Niger Delta has degraded the environment with dire consequences on environmental and socio-economic sustainability as well as human security. The purpose of this paper is to interrogate the unexplored dimensions of the linkage between oil theft, environmental degradation and human insecurity in the face of apparent state nonchalance and weakness. Specifically, the primary data were generated from the interview of twenty-six key informants, who were purposively selected as well as four focus group discussions (FGDs). The complementary secondary data were extracted from journals, books, government documents and web-based materials. The paper finds that the operations of oil thieves and artisanal refiners have worsened environmental challenges and aggravated human insecurity in the region. The implications include among others, the emasculation of the local economy due to the destruction of traditional means of livelihoods, deepening impoverishment, and heightened prospects of restiveness with negative impacts on Nigerian economy. This paper recommends strengthening the surveillance and response capacity of relevant state institutions, legitimising artisanal refining, and developing sustainable welfare packages to cushion socio-economic deprivations being suffered by oil-bearing communities.

English

This study examined how the use of social media among youth influences their offline civic participation outside the election period in Tanzania. Unlike previous studies, this study used multidimensional aspects of civic participation.  Civic participation was studied using the concurrent qualitative dominant mixed-methods approach. The study conducted four focus group discussions (FGD) with the aid of an FGD guide and surveyed 372 young people with the help of a questionnaire. Narrative responses were analyzed thematically with the aid of NVivo-12, whereas statistical data were analyzed with the aid of SPSS 26 software. The participants in this study agreed that they comment and share messages, photos, voice messages and videos related to civic activities using social media, and that they actively participate in their own community offline. The research findings confirmed the connection between the social media interactivity of youth and their active offline civic participation. This study lays the foundation for further research and theory development.   Key words: Social media, engagement, civic participation, youth, Tanzania.

University students' awareness of e-waste and its disposal practices in Pakistan: a construction of the conceptual framework.

Pakistan is among the few countries generating and receiving enormous e-waste, which posits a threat to itsfuture generations. A systematic literature review also suggests exploring e-waste awareness in Asia to understand awareness and behavior. Therefore, the present study explored university students' awareness of e-waste and the factors hindering the disposal of laptops, personal computers, and cellphones and suggested a conceptual framework. The study used the qualitative research approach and non-probability sampling. We collected data through four focus group discussions (FGDs) with students at a Pakistani university. After data saturation, we developed themes from FGDs and found computer sciences and engineering students with better awareness than others. The factors hindering e-waste disposal were lower monetary benefits for disposal, breach of sensitive information, nostalgic association with devices, and non-availability of disposal facilities. Other variables like lower resale value and high family sharing increased the storage of e-devices and reduced e-waste disposal. The research is among a few initial attempts to explore e-waste awareness and factors hindering disposal behavior in e-waste-receiving countries (e.g., Pakistan) and provides evidence from students who are the primary users. Our findings are crucial for policymakers to take corrective actions, introduce monetary benefits, and secure disposal to reduce e-waste.