Healthcare Information Research Articles

Tracing the complete journey of patient compliance in obstructive sleep apnea management: a 12-year retrospective study on diagnosis, device adherence, and treatment outcomes

BackgroundThe incidence of obstructive sleep apnea is rising globally, with significant health repercussions. Current research falls short in chronicling the complete trajectory of obstructive sleep apnea management, specifically, the intricacies of patient adherence to device therapy post-diagnosis.ObjectiveThis study aims to bridge the gap, providing a detailed analysis of the journey from diagnosis to consistent therapeutic device use, and identifying potential delays and patterns of adherence.MethodsA retrospective observational study was conducted at Rashid Hospital’s sleep study lab, Dubai, United Arab Emirates, spanning from 2010 to 2022 and encompassing 1,949 patients. The study population consisted of all patients referred for sleep testing on the basis of a high clinical suspicion of obstructive sleep apnea. Data were extracted from the hospital’s Healthcare Information System, focusing on demographics, sleep study results, and device usage patterns. Data were analyzed using Python’s Pandas library to evaluate compliance and treatment efficacy.Measurements and main resultsThe study revealed that 83.4% of patients visiting the sleep lab were diagnosed with obstructive sleep apnea. Of these, 39.6% purchased a therapeutic device, but only 19.7% of the total population adhered to the recommended device usage. Treatment reduced the Apnea-Hypopnea Index to below 5 in 26.5% of the total patient cohort. An increasing trend in OSA diagnoses was observed over the years, with patients experiencing an average delay of 1.3 years before initiating therapy.ConclusionThe study addresses a significant gap by detailing the patient journey from obstructive sleep apnea diagnosis to treatment, highlighting device acquisition delays and adherence challenges. It underscores the need for integrated care models considering socioeconomic factors and patient education to improve outcomes for obstructive sleep apnea.

Quality and reliability of short Chinese videos related to acute pancreatitis on TikTok and Bilibili

Background Acute pancreatitis (AP) is becoming a growing public health problem worldwide, with an increasing incidence year by year. Social media platforms such as TikTok and Bilibili are becoming increasingly popular, and they can be a source of information on AP. However, the quality of information in these videos remains unknown. Objective The objective of this study is to assess the information quality of Chinese AP short videos shared on TikTok and Bilibili short video platforms. Methods In April 2024, we conducted an assessment of the information quality and reliability of Chinese AP short videos (200 videos in total) from TikTok and Bilibili. This assessment was conducted using the JAMA, GQS, and DISCERN tools. Additionally, we explored the factors affecting video quality. Results Compared to Bilibili short videos, TikTok short videos are shorter in length but have more thumbs up, comments, favorites and shares, indicating that they are more popular. The quality of TikTok's and Bilibili's AP shorts is not as good as it could be, with Tiktok shorts being even worse, with median GQS scores of 1 and 2, median DISCERN scores of 34 and 42, and median JAMA scores of 2 and 1, respectively. Video duration is positively correlated with video quality, while thumbs up, comments, favorites and shares are negatively correlated with video quality. Conclusions The study demonstrated that short videos containing AP-related health information on Bilibili and TikTok were of poor quality, and that videos uploaded by healthcare professionals did not exhibit a significant advantage in terms of quality and reliability. Consequently, short videos providing healthcare information on TikTok and Bilibili must be meticulously evaluated for their scientific soundness before making healthcare management decisions. Overall, videos uploaded by healthcare professionals were of higher quality than those uploaded by others, but there was no significant difference in DISCERN scores.

But at What Cost? Healthcare Utilization of Canadian Carer-Employees

Caregiving plays a crucial role in aging societies by supporting individuals with chronic illnesses, disabilities, or aging-related needs. The unpaid labour provided by caregivers diverts healthcare resources from the formal healthcare system; however, this incurs costs to the caregivers themselves in terms of declines in personal wellbeing. This study explores the relationship between caregiving and healthcare spending for two groups of caregivers: eldercare only and sandwiched. We found that physician visits were the most common resource used by caregivers, at a mean of 3.69 (SD = 4.01) visits over a 6-month period, excluding non-users of this service. This was followed by mental health services (M = 5.86, SD = 7.02), emergency room visits (M = 1.77, SD = 1.38), and hospital admissions (M = 3.61, SD = 8.53). There were no significant differences in healthcare utilization between eldercare and sandwiched caregivers. There were mixed results regarding characteristics associated with greater resource use; however, the hours of weekly caregiving were most consistently associated with greater healthcare utilization, indicating that healthcare use may increase with care burden.

Determinants of Self-Medication in Immigrants: A Systematic Review.

Immigrants intended to more rely on self-medication because of the difficulty of accessing formal healthcare in host countries. Negative consequences could occur when self-medication was inappropriate. This study aimed to systematically explore the prevalence, sources and determinants of immigrants' self-medication and the extent of their inappropriate self-medication episodes. PubMed, Scopus, SpringerLink, and ScienceDirect were used for data searching. The search date was 10th June 2023, with no beginning date to limit searching articles. Thirty-two studies were included. The prevalence of immigrants' self-medication presented from 18 studies ranged between 20.2% and 94.6%. Major sources of immigrants' self-medication were commonly obtained from their home countries, local markets or shops, and informal networks. The determinants of immigrants' self-medication were systematically collated into four themes: (1) illness and self-medication perception, (2) access to healthcare and medication, including 6 dimensions: accessibility, availability, affordability, acceptability, awareness and accommodation, (3) worry, and (4) predisposing factors of immigrants. About 46% of immigrant's self-medication episodes were inappropriate, especially antibiotic use. About 66% of the included studies described antibiotic self-medication. Prevalence rates of self-medication among different immigrantsvaried based on different time frames, context of diseases and migrated countries. Immigrants' cultural health belief, facing significant worry about job security, legal status, and cultural barriers influenced their self-medication. When immigrants have greater availability, accommodation, awareness, accessibility, acceptability, and affordability of health services in host countries, they are less likely to use self-medication. The predisposing factors like age, income, work status and immigrants' language also influenced their self-medication.

"Feeling Like You Matter:" LGBTQ + Young Adult Perspectives on Affirmative Mental Healthcare.

The purpose of this study was to explore the experiences of LGBTQ + young people in mental healthcare and to understand their perspectives on what affirmative mental healthcare practice should look like. Between June and September of 2023, interviews were conducted with LGBTQ + young people ages 18-26years in Los Angeles and Seattle. Interviews lasted 30 to 60min and were transcribed verbatim for thematic analysis (N = 28). Four themes were developed from analysis of the interviews: (1) disconnection from community and self as an impetus for seeking formal mental healthcare; (2) marginalization during mental health service encounters; (3) the therapeutic power of belonging and mattering in the mental healthcare system; and (4) mutual human connection as the foundation for affirming mental healthcare experiences. Affirmative mental healthcare was defined by LGBTQ + young adults as free of judgment with priority placed on the therapeutic power of genuine human connection. The need for trans-specific mental healthcare was also highlighted. Participants also expressed a preference for providers with shared identities and experiences to alleviate feelings of isolation and increase feelings of connectivity. Mental health providers should emphasize connectivity and empathy to offer affirming care with LGBTQ + clients, such asking about client preferences for care, developing knowledge about sexuality and gender identity, and acknowledging provider limitations or knowledge gaps. Improving access to affirmative mental healthcare for LGBTQ + young adults (e.g., workforce development, training requirements) is needed to address the disparities in mental healthcare.

The Use, Profile, Uptake, Characteristics and Attributes of Users of Homeopathy: Initial Findings from a Student Teaching Tele-Healthcare Clinic Based in North America

Research into the uptake profile and usage of Homeopathy has hitherto tended to be buried amongst complementary medicine research. Despite high levels of uptake of homeopathy, and robust numbers of over-the-counter sales of homeopathic products the current evidence evaluating the uptake of homeopathy remains limited on several fronts. The aim of this study is to explore the basic demographic features and characteristics of users of homeopathy services. The setting is a student teaching tele-health facility based in NA. Concurrent intake forms from 303 participants were analyzed. Intake forms were entered into a coding frame instrument designed and developed to explore health care information. A majority of participants (70%) who attend this clinic are female. The average age is 31 years old. Almost half of the participants in this clinic were using other additional complementary therapies in the management of their conditions. Almost the same number of participants (134) were only using homeopathy. The majority had some prior use of homeopathic products (91.6%), but 52.8% of participants had never worked with a professional homeopath. Twenty-four conditions are listed by participants as chief health complaints. Findings are in alignment with what is already known about the uptake in complementary medicine. Findings also reveal that the users of Homeopathy are seeking an ‘alternative’ to conventional medicine rather than only using Homeopathy as ‘complementary’ medicine. A proportion of participants in this clinical setting find homeopathy through over-the-counter sales and are, for a period, self-prescribing in chronic conditions. Further comparative research is needed to compare this to other complementary medicine avenues as well as conventional medicine settings. Conclusion: This in-depth empirical study of the users of homeopathy at one clinical facility represents initial, novel measured preliminary insights into the participants features and characteristics.

Social norms and maternal health information-seeking behavior among adolescent girls: A qualitative study in a slum of Bangladesh.

Adolescent girls of reproductive age who actively seek information on maternal health often tend to have better health-seeking behaviors and maternal health outcomes. Due to scant research on reproductive aged adolescent girls' maternal health information seeking behavior in slum, in connection with social norms, we aimed for this particular study. Adopting an explorative qualitative research approach, we collected data from purposively selected married and unmarried adolescent girls aged 15-19 of different occupation by implying 12 in-depth interviews (IDIs), 2 focus group discussions (FGDs) with the same categories employed for IDIs, and 2 key informant interviews (KIIs) with a traditional birth attendant and a drug seller. Furthermore, the data were subjected to thematic analysis. Care's Social Norms Analysis Plot (SNAP) framework was undertaken as an interpretative tool for data that was emerging rather than serving as the foundation for the study's conduct and design. Thematic analysis was followed to analyze primary data. Findings show that most girls rely on maternal health-related information from unverified sources, including family members, traditional birth attendants, and drug sellers, which increases health risks. The majority reported that adolescent girls need professional healthcare providers in their area who would work according to their work schedule as most of the girls are engaged in income-generating work for about 9-11 hours, and the scope of work (daily wagers) hardly supports 'leave with pay'. Therefore, there is a critical need for professional healthcare services tailored to the girls' work schedules. Social norms and stigma further restrict access to reliable health information, especially for unmarried girls. Socioeconomic disparities also shape health-seeking behaviors, with wealthier adolescents having greater access to formal healthcare services. Addressing these barriers is crucial for improving maternal health outcomes. The results might be useful for informed policy formulation and program design to ensure better health outcomes for marginalized adolescents.

Cancer incidence and stage at diagnosis in children and adolescents in the Community of Madrid, 2015-2018.

Cancer is the leading cause of death in children aged 1-14 and the second in 15-19-year-old adolescents in Spain. The Paediatric Population-Based Cancer Registry of the Community of Madrid was created to monitor its incidence and survival. This study presents the incidence of childhood and adolescent cancer (0-19 years) in Madrid at a population level by sex, age group, type of tumour and stage at diagnosis. This study was a retrospective analysis of the total number of cases registered in the Paediatric Population-Based Cancer Registry of the Community of Madrid. The registry employs passive and active case finding: by cross-referencing hospital discharge data, primary healthcare data, mortality data and administrative information; and by validation of all potential incident cases through a review of electronic medical charts. All new diagnoses of malignant neoplasms, non-malignant neoplasms of the Central Nervous System, and uncertain and insitu neoplasms of the bladder, identified in 2015-2018 in individuals under age 20 residing in Madrid, were included. Patient information was collected along with tumour characteristics, including stage at diagnosis according to the Toronto Childhood Cancer Stage Guidelines. Age-specific and age-standardised incidence rates were computed with 95% confidence intervals (CI). A total of 1002 tumours were registered in 5,269,524 person-years, yielding an age-standardised rate of 192.7 (95% CI 184.3, 201.4) cases per million person-years. Male/female rate ratio was 1.1. The most common cancers across all ages comprised CNS tumours, leukaemias and lymphomas (primarily Hodgkin): 45.5 (95% CI 39.9, 51.7), 41.1 (95% CI 35.7, 47.1) and 35.8 (95% CI 30.9, 41.3) cases per million person-years, respectively. The proportion of metastatic tumours at diagnosis was similar for ages 0-14 (18.6%) and 15-19 (18.7%). This study provides a comprehensive understanding of childhood and adolescent cancer incidence in Madrid. The registry provides high-quality data and consolidates epidemiological surveillance of cancer in the region.

A Qualitative Study to Describe the Nature and Scope of Street Medicine Programs in the United States

Street medicine is a health delivery model designed to provide direct patient care to people experiencing unsheltered homelessness where they are physically located, whether that be on the streets or in encampments. The model has developed in response to the barriers people experiencing homelessness (PEH) encounter when accessing care through traditional points of access such as primary care clinics. Street medicine programs are rapidly emerging across the United States (U.S.) in response to the health needs and challenges associated with care access and coordination for unsheltered homeless individuals. Although street medicine is a rapidly growing field, existing street medicine programs have rarely been studied collectively, limiting our understanding of the nature, scope, and range of street medicine programs in the U.S. This study examined 13 programs from across the U.S. to develop a broad characterization of street medicine programs. Results from interviews with representatives from each of the 13 programs show that there is a high degree of variability among the structure, operations, and scope of care of street medicine programs. However, consistent among street medicine programs is the adoption of a patient-centered approach to care and the use of harm-reduction principles. Street medicine programs are also highly engaged with community partners and affiliate organizations that work in their local and regional areas. Because street medicine programs often serve as a bridge between formal healthcare entities and PEH, street medicine offers a strategy for reconnecting individuals to vital healthcare services.

Low sexually transmitted infection (STI) screening and presumptive treatment and high STI positivity among United States females visiting the emergency department after sexual assault.

The Centers for Disease Control and Prevention sexually transmitted infection (STI) treatment guidelines state that the decision to provide STI/human immunodeficiency virus (HIV) testing and presumptive treatment after sexual assault (SA) should be made on an individual basis to minimize retraumatization of the patient. However, little is known about STI screening, presumptive treatment, and positivity in the emergency department (ED) setting. The objective of this study was to evaluate STI testing rates and positivity, presumptive gonorrhea and chlamydia treatment, pregnancy testing, and emergency contraception offered to SA survivors in the ED in the United States. The Premier Healthcare Database, a national administrative data set containing health care information from inpatient and hospital-based outpatient encounters, was used. Approximately 30% of encounters have available laboratory test results. ED visits for SA (identified by ICD-10-CM codes) among female patients aged 15-44 years between 2019 and 2023 were included. For patients presenting multiple times to the ED, only the first ED visit after SA was included. Of 49,047 total visits where females ages 15-44 years presented to the ED for SA, chlamydia, gonorrhea, syphilis, and HIV tests were conducted in 18.6%, 18.6%, 13.4%, and 16.9%, respectively, and pregnancy tests in 33.1% of visits. Presumptive gonorrhea and chlamydia treatment was provided in 53.7% and 52.2%, respectively, and emergency contraception in 27.2% of visits. Approximately 40% of patients were neither tested nor treated for either chlamydia or gonorrhea. Of patients with available laboratory test results, chlamydia, gonorrhea, and syphilis positivity rates were 10.0%, 3.8%, and 1.0%, respectively. Low STI testing and treatment rates and high STI positivity identified in this study suggest that an important opportunity exists for improving STI screening and presumptive treatment for female patients presenting to the ED after SA.

Video Remote Sign Language Interpreting in Health Communication for Deaf People: Protocol for a Randomized Controlled Trial.

The current standard of interpretation provision is not efficacious or not acceptable to Deaf patients who communicate using sign language. In-person or video relay interpretation (VRI) sign language interpretation is largely unavailable. There are no clear data on the availability of VRI or in-person interpretation. Given the limited number of available sign language interpreters and the cost, VRI may be more available than in-person. Existing evidence tends to focus on assessing personal preferences of Deaf users regarding interpretation and interpreters' preferences. Although respecting preferences is essential, there is a vacuum of knowledge on how the format of access to interpretation impacts the quality of communication between Deaf persons and health personnel. This study aims to look at the effectiveness of the VRI system in improving communication outcomes between Deaf patients and doctors versus the available standard of care of the usual communication tools, including informal interpretation, lip- or note-reading, and using their mobile phones to contact a formal or informal interpreter, for Deaf patients aged 18 years and older in Bogota, Colombia. This is a randomized controlled trial with a total sample size of 216 participants, divided into 2 groups: an intervention group, which receives a medical appointment using VRI, and a control group, which receives a medical appointment using standard communication. Both the Deaf participants and the health care professionals will be blinded to the allocation, as they will not know whether the appointment will involve VRI or standard communication until they arrive at the office. The primary outcome measure will be an assessment of communication using a Doctor-Patient Communication Scale. This scale was translated into Colombian Sign Language following a rigorous cultural adaptation and translation procedure. Furthermore, the database contains key clinical variables and recommendations provided by the doctor during a general medicine appointment. We will compute associations. Recruitment opened on August 24, 2023. As of July 2024, 180 participants had been enrolled. The intervention and data collection were finalized in October 2024. The findings of this study are expected to be submitted for publication in early 2025. This study will provide rigorous evidence regarding information and communications technology intervention in health care, addressing empirical challenges in using inclusive research designs in public health. In addition, effective VRI models that address the challenges faced by Deaf people will be tested, implemented, and maintained in low- and middle-income countries. A disability-inclusive evaluative tool for quality communication mediated by VRI in health care is also tested. Ultimately, this will lead to evidence-based recommendations for implementing the Convention on the Rights of Persons with Disabilities (CRPD) in mobile health contexts. ClinicalTrials.gov NCT05966623; https://clinicaltrials.gov/study/NCT05966623. DERR1-10.2196/64590.

Obstetric healthcare experiences and information needs of Dutch women in relation to their vegan diet during pregnancy

ObjectivesThe prevalence of a vegan (strict plant-based) diet is increasing. Adequate access to nutritional information for pregnant women on a vegan diet is vital, as optimal maternal nutrition is important in order to prevent maternal and fetal complications. This study evaluated the obstetric healthcare experiences and information needs of pregnant women following a vegan diet in the Netherlands. MethodsAn online survey examined women’s experiences with obstetric healthcare in relation to their vegan diet during pregnancy. In total, 195 women, all of whom followed a vegan diet during their pregnancy and gave birth between January 2018 and April 2020, completed an online survey about their experiences. Descriptive statistics were used to present the data. ResultsIn total, 36.5% of participants reported that an obstetric healthcare provider had inquired about their diet in general during the first prenatal consultation, and an additional 43.1% of participants proactively informed their healthcare provider about their diet. Only 19.0% of all participants received specific information about their vegan diet during pregnancy, and 25.2% reported having had extra checks, mostly blood tests, during their pregnancy. Of all participants, 35.9% would have preferred to receive additional information regarding their diet. ConclusionsOur data shows that only a minority of pregnant women following a vegan diet received information and recommendations about their diet from their healthcare providers. It is our recommendation that healthcare providers inquire about pregnant women’s diets, and refer those following a vegan diet to reliable sources of dietary information or to a specialized dietitian.

Cultural Transformation of the International Statistical Classification of Diseases and Related Health Problems' Guidelines Needed to Effectively Measure Well-Being.

A cultural transformation is underway at the Veterans Health Administration and other health care systems to address the well-being of the whole person and not just their disease states. A part of this evolution is to develop a measurement paradigm because the existing ones are generally disease-specific; however, the International Statistical Classification of Diseases and Related Health Problems (ICD)-10th Revision-Clinical Modification does include codes for social determinants of health (SDOH). The ICD coding system is an internationally recognized system to identify and classify diseases, injuries, health encounters, and inpatient procedures. Medical and social service providers, researchers, health information managers, public health and health care system professionals, policymakers, and coders use these codes to conduct surveillance, such as on the existence of diseases and their outcomes, health care utilization, and health care-associated adverse events, and for billing and claims reimbursement. The ICD coding system has been the backbone of health care systems' clinical documentation and coding practices on an international level since 1909. Clinical documentation and coding have an immense influence on what can be measured in medical records. The current ICD guidance needs to undergo a cultural transformation to have parity between codes for medical and nonmedical conditions, such as supporting the standard use of SDOH as primary diagnoses for outpatient encounters, expanding its list of SDOH codes, and incorporating a wellness perspective. Developing a measurement paradigm that assesses the well-being of the whole person must involve in tandem revising the ICD coding system to include this same perspective.

Psychosocial well-being and diabetes distress in the transition to motherhood among women with type 1 or type 2 diabetes

ObjectiveTo investigate the associations between psychological well-being, measured with the Postnatal Well-being in Transition (PostTrans) Questionnaire, and diabetes distress among mothers with type 1 or type 2 diabetes. MethodEighty-two postnatal women completed a cross-sectional survey. The survey included the Diabetes Distress Scale, and the PostTrans Questionnaire to assess the psychosocial well-being of women transitioning to motherhood. Linear and logistic regressions were used to assess associations. ResultsUsing the Diabetes Distress Scale (cut-off score ≥ 2), the overall prevalence of diabetes distress was 64 %. Psychosocial well-being was negatively associated with diabetes distress (B=─1.65; 95 % CI, ─2.02, ─1.29; P < 0.001), and more strongly with regimen-related distress (B= ─1.90; 95 % CI, ─2.44, ─1.35; P < 0.001). Four sub-scales of the PostTrans Questionnaire (coping with diabetes and managing an infant, anxiety and guilt about diabetes, sensitivity to opinions, healthcare professional support and information) were negatively associated with diabetes distress score (B between ─0.42 and ─0.68), while receiving family support and prioritising self-care did not show a statistically significant association with diabetes distress. ConclusionPsychological factors unique to postnatal women and a lack of healthcare professional support are significantly associated with diabetes distress. However, it is unclear whether lack of family support and self-care behaviours could contribute to increased diabetes distress. Interventions that target psychological factors and that involve healthcare professionals, may optimise diabetes self-management and infant care.

ACOG Committee Statement No. 13: Self-Managed Abortion.

Self-managed abortion (SMA) refers to actions people take to end a pregnancy outside the formal health care system. There are a variety of reasons people choose to self-manage their abortions, and these reasons may vary based on regional contexts. For some people, medically delivered abortion care is no longer, or has never been, available in their community. Available options might be inaccessible or unacceptable, or the person might have a preference for self-managed care as a primary choice. The majority of SMAs are completed safely with misoprostol, either alone or with mifepristone. Rare medical complications should be managed as they would be in any case of spontaneous pregnancy loss. For many people, the greatest risk of harm related to SMA comes from the threat of criminalization. Many U.S. states have at least one law in place that could be misused to prosecute people attempting or assisting with SMA. Criminalization makes people less safe and harms the confidential patient-practitioner relationship. Obstetrician-gynecologists and other health care professionals should provide all people with compassionate, nonjudgmental medical care, including those presenting before, during, or after self-managing an abortion.

"Does My Kid Have an Ear Infection?" An Analysis of Pediatric Acute Otitis Media Videos on TikTok.

With the rise of social media, online platforms have become a common way to access healthcare information. This study examines the quality of pediatric acute otitis media (AOM) videos on TikTok, a popular short-form video social media platform. A TikTok search was conducted between 8/18 and 8/19/2023 using pediatric AOM hashtags: #pediatric acute otitis media management, #kid ear infections remedy, #child ear infections treatment, and #kid ear infection. Data collected include number of views/shares per day, uploader type (nonmedical influencer, lay individual, and medical professional), and content categories. The Patient Education Materials Assessment Tool for Audiovisual Material (PEMAT-AV) and DISCERN questionnaire measured understandability, actionability, and quality of videos. Multivariable linear regression models were used (significance set at ≤0.05). Of 166 videos, 38.6% (64) of uploaders were medical professionals, and 32.5% (54) were nonmedical influencers. Nonmedical influencer videos were viewed and shared significantly more than those by medical professionals (p < 0.05). Controlling for covariates, physicians were more likely to produce more beneficial and higher quality videos as compared with nonmedical influencers (β = 2.4 and 1.3, p < 0.01, respectively). However, physicians did not have significantly different ratings for understandability compared with nonmedical influencers (β = 0.45, p > 0.05). AOM content on TikTok is often geared toward caretakers of symptomatic children. Although physician-created AOM content was significantly higher quality, these videos reached a statistically smaller audience than those from nonmedical influencers. Addressing misinformation on social media platforms requires physicians to reach larger audiences by producing more actionable and understandable content. NA Laryngoscope, 134:5184-5192, 2024.

Paradox within the Healthcare System: An Intersectional Analysis of Health Seeking Experiences of Migrants in the U.S.

ABSTRACT This study examined the complexities surrounding migrants’ health-seeking behaviors in the United States. Using intersectionality as a guiding analytic, we conducted in-depth interviews with 15 visa-holding migrants from West African, East, and Southeast Asian countries to understand their experiences navigating healthcare in another country. Participants mentioned the convergence of three power systems: nativity/language of origin status, education status, and migration (legal) status. Based on participants’ experiences navigating these converging systems, we identified two paradoxes migrants’ experience when seeking health information: (1) the empowerment and disempowerment in the pursuit of health information and (2) the scarcity and sufficiency in the accessibility of health information. Our findings offer a more nuanced understanding of migrant health processes. In particular, we propose that more theorizing and practical interventions should consider intersectional tensions and paradoxes that emerge from individuals whose identities grant them both access and limitations when it comes to seeking healthcare information.

Navigating the Lay Referral System for Treatment-Seeking Decisions During Illness in the Digital Age: A Qualitative Study of Adults Living in Slums in Nigeria.

Interaction with a lay referral system (informal networks that provide health advice during illness) influences the treatment-seeking decisions of individuals with perceived healthcare needs. We examined how this occurred in urban slums in Nigeria with scarce formal healthcare and unstable social networks. Using existing theories of social networks and lay referral, we examined the use of these systems for treatment-seeking decisions in slums, including the use of digital technologies. We interviewed 30 adults (aged 18-64) of diverse age, gender, network size and use of digital technologies for health advice in two Nigerian slums. We analysed the data using a thematic inductive-deductive approach. Lay referral was multidimensional: discussion of illness during daily bonding, social demonstration of self and purposeful exchange of support. People limited lay referrals to a few family members and friends, avoiding wider interactions due to mistrust. Use of online sources was scarce due to limited access to smart devices and low digital health literacy. Lay referral motivated timely care seeking but also facilitated unhelpful advice. Slum residents were agentic in their use of their lay referral system. The effectiveness of their agency may be improved if trusted and reliable health advice sources are available in addition to their social network.

Conceptualising maternal mental health in rural Ghana: A realist qualitative analysis.

In low-and-middle income countries, maternal mental health needs remain neglected, and common mental disorders during pregnancy and after birth are routinely associated with hormonal changes. The psycho-social, and spiritual components of childbirth are often downplayed. A qualitative study was conducted as part of a wider realist evaluation on health systems responsiveness to examine the interrelationships between pregnant and postnatal women, their families, and their environment, and how these influence women's interactions with healthcare providers in Ghana. Data collection methods combined six qualitative interviews (n= 6) and 18 focus group discussions (n= 121) with pregnant and postnatal women, their relatives and health care providers (midwives, community mental health nurses) at the primary healthcare level. Data analysis was based on the Context-Mechanism-Outcome heuristic of realist evaluation methodology. A programme theory was developed and iteratively refined, drawing on Crowther's ecology of birth theory to unpack how context shapes women's interactions with public and alternative health care providers. We found that context interacts dynamically with embodiment, relationality, temporality, spatiality, and mystery of childbirth experiences, which in turn influence women's wellbeing in three primary areas. There is an intricate intersection of pregnancy with mental health impacting women's expectations of temporality, which does not always coincide with the timings provided by formal healthcare services. Societal deficiencies in social support structures for women facing economic challenges become particularly evident during the pregnancy and postnatal period, where women need heightened assistance. Socio-cultural beliefs associated with the mystery of childbirth, support the role of private providers in offering women a feeling of protection from uncertainty. Co-production of context specific interventions, including the integration of maternal and mental health policies, with relevant stakeholders can help formal healthcare providers accommodate women's perspectives on spirituality and mental health, which can subsequently help to make health system responsive to maternal mental health conditions.

Promoting the Resilience of Health Care Information Systems—The Day Hospitals Stood Still

This Viewpoint describes health care disruption owing to a global computer system outage and advocates for preventive methods to avoid future IT events disrupting the health care sector.